Eye movements in patients with superior canal dehiscence syndrome align with the abnormal canal
Eye movements in patients with superior canal dehiscence syndrome align with the abnormal canal
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DOI：
10.1212/wnl.55.12.1833
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发表时间：
2000-12-26
期刊：
影响因子：
9.9
通讯作者：
Della Santina, CC
中科院分区：
文献类型：
--
作者：
Cremer, PD;Minor, LB;Della Santina, CC
背景资料：上级半规管裂开（SCD）综合征包括声音或压力引起的眼球震颤和由覆盖上级半规管的骨缺损引起的眩晕。SCD综合征的诊断基于特征性症状、体征和颞骨CT成像结果。然而，SCD综合征经常被误诊为外淋巴瘘（PLF），并且声音和压力引起的眩晕症状更常见于前庭椭圆囊，而不是上级半规管。本研究探讨了上级管和椭圆囊在SCD综合征的病理生理学中的作用。方法：对11例SCD综合征患者采用三维巩膜探测线圈记录眼球运动。结果如下：当受影响的耳朵听到响亮的声音或当患者进行瓦尔萨尔瓦动作时，10名患者出现上半规管激动特征的向上扭转慢相眼球震颤。上级激活。视觉固定导致眼球震颤抑制和眼睛持续扭转偏斜的出现。两名患者也有声音诱发的头部运动在同一方向的眼慢相。受影响的上级管的快速头部旋转的反应进行了测试，在9名患者。对于那些覆盖上级髓腔的骨缺损较大（大于或等于5 mm）的患者，反应减弱。结论：SCD综合征患者的诱发性眼球运动起源于上级管，而不是椭圆囊。该综合征通过改变中耳或颅内压的音调或动作引起的特征性眼球震颤来识别。这种眼球震颤的检查应在防止视觉注视的条件下进行。
Background: The superior canal dehiscence (SCD) syndrome consists of sound- or pressure-induced nystagmus and vertigo caused by a defect in bone overlying the superior semicircular canal. The SCD syndrome is diagnosed based upon characteristic symptoms, signs, and findings on CT imaging of the temoral bones. However, SCD syndrome is often misdiagnosed as perilymphatic fistula (PLF), and the symptoms of sound- and pressure-induced vertigo are more commonly attributed to the vestibular utricle, rather than to the superior semicircular canal. This study explored the role of the superior canal and the utricle in the pathophysiology of SCD syndrome. Methods: Three-dimensional scleral search coils were used to record eye movements in 11 patients with SCD syndrome. Results: Ten patients developed nystagmus with upward torsional slow phases characteristic of superior canal activation when loud tones were presented to the affected ear or when the patients performed a Valsalva maneuver. Visual fixation led to a suppression of the nystagmus and the appearance of a sustained torsional deviation of the eyes. Two patients also had sound-evoked head movements in the same direction as the ocular slow phases. The response of the affected superior canal to rapid head rotations was tested in nine patients. The response was diminished in those with large (greater than or equal to5 mm) defects in the bone overlying the superior canal. Conclusions: The evoked eye movements in patients with SCD syndrome arise from the superior canal, not the utricle. The syndrome is recognized by the characteristic nystagmus evoked by tones or maneuvers that change middle ear or intracranial pressure. Examination for this nystagmus should be performed under conditions that prevent visual fixation.