Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis
Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis
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DOI：
10.1007/s00405-016-3947-z
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发表时间：
2016-10-01
影响因子：
2.6
通讯作者：
Ricci, Giampietro
中科院分区：
文献类型：
--
作者：
Faralli, Mario;Lapenna, Ruggero;Ricci, Giampietro
良性阵发性位置性眩晕（BBPV）发作消退后残留头晕（RD）是患者常见的报告。可能的原因在文献中仍有争议。本研究讨论了耳石功能和从症状发作到诊断的RD发生的时间的可能作用。总共有116例年龄小于65岁的BPPV首次发作且无任何其他合并症的患者入组本研究。在床旁检查之前，如果病史提示BPPV，则确定主观视觉垂直（SVV）。对后半规管BPPV的患者，1周后进行SVV测试，其中定位操作显示BPPV消退。在1周的控制，报告的RD和头晕障碍量表（DHI）进行了记录。43例BPPV患者在4天内（A组）诊断和治疗，38例BPPV患者在5 - 8天（B组），35例BPPV患者在9天以上（C组）。C组记录的RD和DHI值较高，而A组记录的SVV偏差值较高，SVV和DHI之间呈反比关系。由于BPPV引起的初始外周前庭功能不对称可诱导新的中枢适应。耳石在内淋巴中漂浮的时间越长，这种适应就越好。由于这些变化，大脑无法在解决后快速重新适应旧模式，导致更持久的RD。
Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.