Inferior vestibular neuritis
Inferior vestibular neuritis
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DOI：
10.1007/s00415-011-6375-4
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发表时间：
2012-08-01
影响因子：
6
通讯作者：
Kim, Hyo Jung
中科院分区：
文献类型：
--
作者：
Kim, Ji-Soo;Kim, Hyo Jung
前庭神经炎（VN）主要累及前庭神经的上级部分和迷路。本研究旨在描述仅累及前庭下迷路及其传入神经的VN的临床特征。在2004年至2010年首尔国立大学盆唐医院诊断为VN或尿道炎的703例患者中，我们回顾性招募了9例诊断为孤立性下VN的患者（6例女性，年龄范围15 - 75岁）。孤立性下VN的诊断是基于扭转下跳自发性眼球震颤、后半规管（PC）的异常头脉冲试验（HIT）和正常HIT和双温冷热试验确定的正常水平和前半规管存在下的异常颈前庭诱发肌源性电位（VEMP）。所有患者均表现为急性眩晕伴恶心、呕吐和失衡。3例患者患侧还出现耳鸣和听力损失。扭转下跳性自发性眼震的旋转轴最好与受累PC的旋转轴对齐。HIT也仅对所涉及的PC呈阳性。7例患者的颈部VEMP异常，4例患者的眼部VEMP均正常。眼球扭转和主观视觉垂直测试大多在正常范围内。由于孤立的下VN缺乏更普遍的上级VN的典型表现，它可能被误认为是中枢性前庭障碍。认识到这种罕见的疾病可能有助于避免急性前庭病变患者不必要的检查。
Vestibular neuritis (VN) mostly involves the superior portion of the vestibular nerve and labyrinth. This study aimed to describe the clinical features of VN involving the inferior vestibular labyrinth and its afferents only. Of the 703 patients with a diagnosis of VN or labyrinthitis at Seoul National University Bundang Hospital from 2004 to 2010, we retrospectively recruited 9 patients (6 women, age range 15-75) with a diagnosis of isolated inferior VN. Diagnosis of isolated inferior VN was based on torsional downbeating spontaneous nystagmus, abnormal head-impulse test (HIT) for the posterior semicircular canal (PC), and abnormal cervical vestibular-evoked myogenic potentials (VEMP) in the presence of normally functioning horizontal and anterior semicircular canals, as determined by normal HIT and bithermal caloric tests. All patients presented with acute vertigo with nausea, vomiting, and imbalance. Three patients also had tinnitus and hearing loss in the involved side. The rotation axis of torsional downbeating spontaneous nystagmus was best aligned with that of the involved PC. HIT was also positive only for the involved PC. Cervical VEMP was abnormal in seven patients, and ocular VEMP was normal in all four patients tested. Ocular torsion and subjective visual vertical tests were mostly within the normal range. Since isolated inferior VN lacks the typical findings of much more prevalent superior VN, it may be mistaken for a central vestibular disorder. Recognition of this rare disorder may help avoid unnecessary workups in patients with acute vestibulopathy.