前庭性偏頭痛 前庭性偏頭痛的神經(jīng)-耳科癥狀 Michael VON BREVERN 德國(guó)，Park-klinik Weissensee，神經(jīng)內(nèi)科 無(wú)論在疾病急性發(fā)作期還是在發(fā)作間期，前庭性偏頭痛未發(fā)現(xiàn)任何特異性的異常檢查結(jié)果。然而，通過(guò)實(shí)驗(yàn)室檢查可以排除其他疾病和安撫病人。我們須記住，在前庭性偏頭痛間歇期，外周性和中樞性前庭功能障礙表現(xiàn)出的輕微體征并不少見(jiàn)。在前庭性偏頭痛急性發(fā)作期，相當(dāng)大部分病人出現(xiàn)自發(fā)性或位置性眼震，這提示前庭中樞功能受損。在間歇期，10-20%病人可出現(xiàn)中樞性位置性眼震。前庭性偏頭痛中最一致性的實(shí)驗(yàn)室檢查是單側(cè)冷熱試驗(yàn)反應(yīng)減弱，占病人的10-20%。約10%的前庭性偏頭痛患者可出現(xiàn)視頻頭脈沖試驗(yàn)單側(cè)增益輕度下降。前庭性偏頭痛患者的頸肌和眼肌前庭誘發(fā)肌源性電位結(jié)果有一些沖突。前庭性偏頭痛與梅尼埃病在前庭誘發(fā)肌源性電位上表現(xiàn)相似，因此并不能用于鑒別上述疾病。需要注意的是前庭性偏頭痛病人表現(xiàn)出的前庭功能減退的臨床及實(shí)驗(yàn)室檢查結(jié)果并不具備特異性，無(wú)前庭癥狀的偏頭痛患者也可以表現(xiàn)出相似結(jié)果。前庭性偏頭痛患者可能有感音神經(jīng)性聽(tīng)力下降表現(xiàn)，但極少表現(xiàn)出像梅尼埃病所表現(xiàn)出的典型的低頻、進(jìn)行性、波動(dòng)性的聽(tīng)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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