Causative factors and epidemiology of bilateral vestibulopathy in 255 patients
Causative factors and epidemiology of bilateral vestibulopathy in 255 patients
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DOI：
10.1002/ana.21105
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发表时间：
2007-06-01
影响因子：
11.2
通讯作者：
Strupp, Michael
中科院分区：
文献类型：
--
作者：
Zingler, Vera C.;Cnyrim, Christian;Strupp, Michael
目的：探讨双侧前庭病变(BV)的发病因素及流行病学。方法：对1988-2005年间在我们头晕科确诊的255例BV患者(平均年龄62岁+/-16岁)进行回顾性分析。所有患者都接受了标准化的神经眼科检查。神经耳科检查、眼震图热疗、头颅磁共振或计算机断层扫描(n=214)和实验室检查。以前的眩晕发作有36%，表明是一种序贯表现。确定BV的确切原因为24%，确定可能原因为25%：最常见的原因是耳毒性氨基糖苷类(13%)、梅尼尔氏病(7%)和脑膜炎(5%)。令人惊讶的是，25%的人出现了小脑体征。小脑功能障碍与周围多神经病相关的比例为32%，而在没有小脑体征的BV患者中，这一比例为18%。所有患者中，双侧听力减退的比例为25%，单侧听力减退的比例为6%。它最常出现在由Cogan综合征、脑膜炎或梅尼埃病引起的BV患者中。解释：尽管进行了深入的检查，但仍有大约一半的患者BV的原因尚不清楚。这些患者中有很大一部分有相关的小脑功能障碍和外周多发性神经病。这意味着一种新的综合症，可能是由神经退行性或自身免疫过程引起的。
Objective: To determine the causative factors and epidemiology of bilateral vestibulopathy (BV). Methods: This is a retrospective review of 255 patients (mean age, 62 +/- 16 years) with BV diagnosed in our dizziness unit between 1988 and 2005. All patients had undergone a standardized neurophthalmological. and neurootological examination, electronystagmography with caloric irrigation, cranial magnetic resonance imaging or computed tomography (n = 214), and laboratory tests.Results: Sixty-two percent of the study population were male subjects. Previous vertigo attacks had occurred in 36%, indicating a sequential manifestation. The definite cause of BV was determined in 24% and the probable cause in 25%: The most common causes were ototoxic aminoglycosides (13%), Meni re's disease (7%), and meningitis (5%). Strikingly, 25% exhibited cerebellar signs. Cerebellar dysfunction was associated with peripheral polyneuropathy in 32% compared with 18% in BV patients without cerebellar signs. Hypoacusis occurred bilaterally in 25% and unilaterally in 6% of all patients. It appeared most often in patients with BV caused by Cogan's syndrome, meningitis, or Meniere's disease.Interpretation: The cause of BV remains unclear in about half of all patients despite intensive examinations. A large subgroup of these patients have associated cerebellar dysfunction and peripheral polyneuropathy. This suggests a new syndrome that may be caused by neurodegenerative or autoimmune processes.