頂帽沉石型水平半規管良性陣發性位置性眩暈－二例報告

Cupulolith Type of Horizontal Canal Benign Paroxysmal Positional Vertigo - Report of Two Cases

蔡世哲(Shih-Che Tsai) ； 李信賢(Xin Xian Lee) ； 邱文耀(Wen-Yaw Chiou)

《中華民國耳鼻喉科醫學雜誌》 37卷4期 (2002/06) Pp. 302-306

https://doi.org/10.6286/2002.37.4.302

摘要

持續且方向變換性之眼振在過去常被懷疑為中樞病灶之徵候，然而週邊性病灶亦可能造成同樣的狀況。本科經驗兩例持續性位置性眩暈之病例，在各項相關檢查後排除中樞病灶的可能。兩病例除了都曾發生良性陣發性位置性眩暈（benign paroxysmal positional vertigo, BPPV）之外，並無其他特殊病史，依據前庭功能檢查結果，推測該眼振及眩暈是耳石（otolith）附著於水平半規管壺腹之頂帽（cupula）造成。在施以持續姿勢法（forced prolonged position maneuver, FPP）治療12小時後，其中一例眼振立即減弱，且眩暈獲得改善，另一例轉變成為管耳石型水平半規管BPPV（canalith, hc-BPPV），該例繼續以FPP法反向治療12小時後，眼振及眩暈感亦隨之消失。兩病例之眼振形態和臨床病程顯示水平半規管頂帽沉石（cupulolith）的存在，且可有囊側（utricle-sided）及管側（canal-sided）兩種不同位置。

關鍵字

眩暈 ； 眼振 ； 良性陣發性位置性眩暈 ； 持續姿勢法

並列摘要

Persistent direction-changing nystagmus used to be considered as a sign of central lesion. However, it also can be caused by peripheral vestibular lesion. We reported two cases of persistent positioning vertigo and nystagmus, which were obviated the possibility of central lesion. We inferred that the nystagmus and vertigo were caused by otolith which adherent to cupula in the horizontal semicircular canal. After forced prolonged position maneuver, the nystagmus and vertigo were subsided in a patient and were transformed to canalith type horizontal canal BPPV (hc-BPPV) in the other. The nystagmus of hc-BPPV was ceased after another FPP was done to the opposite side. According to the clinical course, we deduced the existence of cupulolith in horizontal canal with two different types, utricle-sided and canal-sided.

並列關鍵字

vertigo ； nystagmus ； benign paroxysmal positional vertigo ； forced prolonged position maneu-ver