Head Roll-Tilt Subjective Visual Vertical Test in the Diagnosis of Persistent Postural-Perceptual Dizziness.
Head Roll-Tilt Subjective Visual Vertical Test in the Diagnosis of Persistent Postural-Perceptual Dizziness.
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DOI：
10.1097/mao.0000000000003340
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发表时间：
2021-12-01
期刊：
影响因子：
--
通讯作者：
Horii A
中科院分区：
文献类型：
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作者：
Yagi C;Morita Y;Kitazawa M;Nonomura Y;Yamagishi T;Ohshima S;Izumi S;Takahashi K;Wada Y;Kitahara T;Horii A
目的探讨头部滚动倾斜主观视觉垂直（HT-SVV）在诊断持续性体位知觉头晕（PPPD）中的有效性。回顾性研究。三级转诊中心。PPPD患者61例，单侧前庭功能减退（UVH）患者10例，心因性头晕（PD）患者11例，均出现慢性前庭症状，持续时间为30 ~ 3个月。测量头部左右倾斜约30°（HT-SVV）和常规头部直立SVV （UP-SVV）时的头部倾斜感知增益（HTPG，即平均感知增益[感知/实际倾斜角]）。进行了双热热测试、颈椎和眼前庭诱发肌生成电位（cemp和oVEMP）和体位照相。在疾病组中对HT-SVV和其他前庭测试进行了多次比较。建立了患者工作特征曲线，利用HTPG预测PPPD。PPPD组HTPG明显高于UVH和PD组。各疾病组间UP-SVV、cVEMP、oVEMP和体位照相（泡沫比和泡沫上的Romberg比）无显著差异，而UVH组与其他两组相比，管瘫程度最高。预测PPPD的受试者工作特征曲线曲线下面积为0.764，HTPG值为1.202诊断PPPD的特异性为95.2%。虽然传统的前庭测试包括UP-SVV、VEMPs和体位摄影未显示PPPD异常，但HT-SVV测试中的高HTPG，头部过度倾斜的感觉，可以作为区分PPPD与其他慢性前庭疾病的特异性标志物。
To examine the validity of head roll-tilt subjective visual vertical (HT-SVV) in diagnosing persistent postural-perceptual dizziness (PPPD). Retrospective review. Tertiary referral center. Sixty-one patients with PPPD, 10 with unilateral vestibular hypofunction (UVH), and 11 with psychogenic dizziness (PD), showing chronic vestibular symptoms for >3 months. Head-tilt perception gain (HTPG, i.e., mean perceptual gain [perceived/actual tilt angle]) during right or left head tilt of approximately 30° (HT-SVV) and conventional head-upright SVV (UP-SVV) were measured. Bithermal caloric testing, cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), and posturography were conducted. Multiple comparisons were performed for the HT-SVV and other vestibular tests among the disease groups. A receiver operating characteristic curve was created to predict PPPD using HTPG. HTPG was significantly greater in the PPPD group than in the UVH and PD groups. There were no significant differences in UP-SVV, cVEMP, oVEMP, and posturography (foam ratio and Romberg ratio on foam) among the disease groups, while the UVH group had the highest canal paresis compared to the other two groups. The area under the curve of the receiver operating characteristic curve for predicting PPPD was 0.764, and the HTPG value of 1.202 had a specificity of 95.2% for diagnosing PPPD. While conventional vestibular tests including UP-SVV, VEMPs, and posturography did not show abnormalities in PPPD, high HTPG in the HT-SVV test, an excessive perception of head tilt, can be a specific marker for discriminating PPPD from other chronic vestibular diseases.