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前庭性偏头痛
前庭性偏头痛的神经-耳科症状 Michael VON BREVERN 德国，Park-klinik Weissensee，神经内科 无论在疾病急性发作期还是在发作间期，前庭性偏头痛未发现任何特异性的异常检查结果。然而，通过实验室检查可以排除其他疾病和安抚病人。我们须记住，在前庭性偏头痛间歇期，外周性和中枢性前庭功能障碍表现出的轻微体征并不少见。在前庭性偏头痛急性发作期，相当大部分病人出现自发性或位置性眼震，这提示前庭中枢功能受损。在间歇期，10-20%病人可出现中枢性位置性眼震。前庭性偏头痛中最一致性的实验室检查是单侧冷热试验反应减弱，占病人的10-20%。约10%的前庭性偏头痛患者可出现视频头脉冲试验单侧增益轻度下降。前庭性偏头痛患者的颈肌和眼肌前庭诱发肌源性电位结果有一些冲突。前庭性偏头痛与梅尼埃病在前庭诱发肌源性电位上表现相似，因此并不能用于鉴别上述疾病。需要注意的是前庭性偏头痛病人表现出的前庭功能减退的临床及实验室检查结果并不具备特异性，无前庭症状的偏头痛患者也可以表现出相似结果。前庭性偏头痛患者可能有感音神经性听力下降表现，但极少表现出像梅尼埃病所表现出的典型的低频、进行性、波动性的听力下降。 Vestibular Migraine NEURO-OTOLOGICAL FEATURES IN VESTIBULAR MIGRAINE Michael VON BREVERN Department of Neurology, Park-klinik Weissensee, Germany There is no specific testing abnormality in vestibular migraine (VM), neither in the acute episode nor in the interval. However, laboratory testing can be useful to exclude other diseases and to reassure the patient. It is important to bear in mind that minor signs of peripheral and central vestibular dysfunction are not uncommon in patients with VM in the symptom-free interval. Examination during an episode of VM usually yields spontaneous or positional nystagmus, indicating central vestibular dysfunction in most patients. In the interval, positional nystagmus of a central type is not uncommon and has been described in about 10–20% of patients. The most consistent laboratory finding in VMis a unilaterally reduced caloric response, occurring in about 10–20% of patients. Video-head impulse testing shows a mildly reduced unilateral gain in about 10% of patients with VM. Assessment of cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVOMPs) in patients with VM has yielded conflicting results. VEMPs do not seem to be helpful for the differentiation of VM from Menière’s disease, where similar results can be found. It is important to notice that clinical and laboratory findings of vestibular dysfunction are not specific to patients with VM but can also be found in migraine patients without a history of vestibular symptoms. Audiometry may reveal sensorineural hearing loss but low-frequency, progressive or fluctuating hearing loss, typical for Menière’s disease, is a rare finding in VM.
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