Multiple sclerosis as a cause of the acute vestibular syndrome
Multiple sclerosis as a cause of the acute vestibular syndrome
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多发性硬化症是急性前庭综合征的一个原因
DOI：
10.1007/s00415-013-6850-1
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发表时间：
2013
影响因子：
6
通讯作者：
J. Kattah
中科院分区：
文献类型：
--
作者：
J. Pula;D. Newman;J. Kattah
多发性硬化症（MS）会导致头晕和眩晕。报告表明，责任病变往往是在脑桥内第8神经束。我们试图确定脱髓鞘急性前庭综合征（AVS）的频率和临床特征。这是一项前瞻性观察性研究（1999-2011）。连续患有中枢定位风险的动静脉畸形患者（眩晕、眼球震颤、恶心/呕吐、头部运动不耐受、步态不稳）接受了结构化床旁检查和神经影像学检查。适用时，我们根据临床、影像学和实验室特征识别MS。在170例AVS表现中，4%（n = 7）是由于脱髓鞘疾病。5例患者有可能导致临床综合征的急性MS斑块。病变位置不同-1例位于髓质; 1例位于小脑下脚; 1例位于小脑中脚; 1例位于脑桥后被盖; 1例位于脑桥内第8神经束; 1例位于上级小脑脚; 1例位于中脑。只有两个有一个病变或附近的脑桥内第8神经束。三个是第一次介绍（即，临床上孤立的脱髓鞘综合征），而其他人是已知的MS。在两名患者中，唯一的中枢体征是前庭功能的水平头脉冲试验（h-HIT）正常。所有患者均在类固醇治疗后好转。脱髓鞘疾病在我们的研究中是一种罕见的引起AVS的原因。症状性病变不限于第8神经束。5例患者有较明显的眼部体征，与前庭神经炎的鉴别比较简单。2例患者出现单向、水平眼球震颤，遵循亚历山大定律，并通过固定抑制（真性假神经炎）。正常的h-HIT在这些建议的中央定位的存在。
Multiple sclerosis (MS) causes dizziness and vertigo. Reports suggest responsible lesions are often in the intra-pontine 8th nerve fascicle. We sought to determine frequency and clinical features of demyelinating acute vestibular syndrome (AVS). This is a prospective observational study (1999–2011). Consecutive AVS patients (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with a risk for central localization underwent structured bedside examination and neuroimaging. When applicable, we identified MS based on clinical, imaging, and laboratory features. Of 170 AVS presentations, 4 % (n = 7) were due to demyelinating disease. Five had an acute MS plaque likely responsible for the clinical syndrome. Lesion location varied—1 medulla; 1 inferior cerebellar peduncle; 1 middle cerebellar peduncle; 1 posterior pontine tegmentum; 1 in the intrapontine 8th nerve fascicle; 1 superior cerebellar peduncle; 1 midbrain. Only two had a lesion in or near the intra-pontine 8th nerve fascicle. Three were first presentations (i.e., clinically isolated demyelinating syndrome), while the others were known MS. All had central oculomotor signs. In two patients, the only central sign was a normal horizontal head impulse test (h-HIT) of vestibular function. All patients improved with steroid therapy. Demyelinating disease was an uncommon cause of AVS in our series. Symptomatic lesions were not restricted to the 8th nerve fascicle. Five patients had relatively obvious oculomotor signs, making differentiation from vestibular neuritis straightforward. Two patients had unidirectional, horizontal nystagmus that followed Alexander’s law and was suppressed with fixation (true pseudoneuritis). The presence of a normal h-HIT in these suggested central localization.