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ENGLISH ABSTRACT
中枢性阵发性位置性眩晕的初步分析
吴海燕
王素菊
高志强
姜鸿
作者及单位信息
·
DOI： 10.3760/cma.j.cn115330-20200616-00504
Preliminary analysis of central paroxysmal positional vertigo
Wu Haiyan
Wang Suju
Gao Zhiqiang
Jiang Hong
Authors Info & Affiliations
Wu Haiyan
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Wang Suju
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Gao Zhiqiang
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Jiang Hong
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn115330-20200616-00504
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摘要

目的通过分析中枢性阵发性位置性眩晕（central paroxysmal positional vertigo，CPPV）的临床表现和特点探讨CPPV可能的发病机制。

方法收集2014年6月至2018年6月中国医学科学院北京协和医院收治的3例CPPV患者的临床资料，其中男性1例，女性2例，年龄分别为36、14、70岁。回顾性分析患者的临床症状、眼震特征、伴随的其他中枢眼动异常、MRI、正电子发射型计算机断层显像（PET-CT）及实验室检查结果。

结果所有患者在头部相对于重力变化时均表现出短暂的眩晕和诱发的眼震，但眼震的特点不符合良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）眼震的典型特征。3例患者行复位治疗均无效，并且都伴有视眼动系统异常的体征或其他中枢系统症状。MRI、PET-CT、血生化结果证实了病因分别为慢性出血、炎症和副肿瘤小脑变性。3例患者虽病因不同但病变部位均涉及中枢速度存储机制（velocity storage mechanism，VSM）。

结论VSM破坏，导致反馈性旋转信号修正通路受损，头位相对于重力发生变化时呈现CPPV的临床表现。

良性阵发性位置性眩晕;眼震电图描记术;中枢性阵发性位置性眩晕
ABSTRACT

ObjectiveTo explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics.

MethodsThe clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively.

ResultsAll patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism.

ConclusionThe damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.

Benign paroxysmal positional vertigo;Electronystagmography;Central paroxysmal positional vertigo
Jiang Hong, Email: mocdef.3ab61hcmup_gnaij
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引用本文

吴海燕,王素菊,高志强,等. 中枢性阵发性位置性眩晕的初步分析[J]. 中华耳鼻咽喉头颈外科杂志,2020,55(08)：754-759.

DOI:10.3760/cma.j.cn115330-20200616-00504

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阵发性位置性眩晕是指头位相对于重力变化出现的短暂眩晕伴发短暂的诱发眼震，时间通常小于1 min。根据病因不同阵发性位置性眩晕可分为外周源性和中枢源性。外周源性最常见的为良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV），是最常见的前庭病变，人群累计发病率为10% [ 1 ]，约占门诊头晕、眩晕患者的20%~30% [ 2 ]。中枢性阵发性位置性眩晕（central paroxysmal positional vertigo，CPPV）又称恶性阵发性位置性眩晕 [ 3 , 4 ]，临床罕见。病变部位以脑干、小脑为主，如第四脑室背外侧、脑桥、延髓、小脑蚓部、绒球和小结病变 [ 5 , 6 , 7 , 8 ]。CPPV虽源于中枢系统病变，但发病时可能仅有阵发性位置性眩晕的表现，即仅表现为孤立性眩晕 [ 8 ]，并无明显的神经功能损害的提示，临床表现与BPPV有很多相似之处，易于混淆。CPPV是多种病因导致的共同结果，已知的文献报道的病因包括血管源性疾病如出血、梗死 [ 3 , 6 , 8 , 9 , 10 , 11 , 12 ]，占位性病变如肿瘤 [ 4 , 5 , 6 , 8 , 13 , 14 , 15 , 16 ]，阻塞性病变如脑积水 [ 15 ]，退行性病变如小脑共济失调和多系统萎缩 [ 10 ]。关于慢性出血性疾病、炎症性疾病和副肿瘤小脑变性引起的CPPV报告较少，本文探讨这3种情况引发的CPPV，结合病例分析CPPV的临床特点、可能的病理机制及其与BPPV的鉴别要点。
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备注信息
A
姜鸿，Email： mocdef.3ab61hcmup_gnaij
B
所有作者均声明不存在利益冲突
C
国家卫生和计划生育委员会保健局保健重点科研项目 (W2016ZD03)
国家自然科学基金面上项目 (81870729)
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