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首页> 外文期刊>Journal of neurology >Head-shaking tilt suppression: a clinical test to discern central from peripheral causes of vertigo
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Head-shaking tilt suppression: a clinical test to discern central from peripheral causes of vertigo

机译：头部摇摆倾斜抑制：从眩晕外围原因辨别中央的临床试验

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摘要

Tilt suppression refers to both tilting the head away from an Earth vertical axis and a reduction of an induced horizontal nystagmus. This phenomenon of reducing an induced horizontal nystagmus involves a circuitry of neurons within the vestibular nuclei and the cerebellum (collectively referred to as velocity storage) and signals from the otolith end organs. Lesions involving this circuitry can disrupt tilt suppression of induced horizontal nystagmus. We investigated the clinical value of combining the horizontal head-shaking nystagmus test with tilt suppression in 28 patients with unilateral peripheral vestibular hypofunction and 11 patients with lesions affecting the central nervous system. Each of the subjects with peripheral vestibular lesions generated an appropriately directed horizontal nystagmus after head shaking that then suppressed the induced angular slow phase velocity on average 52 +/- 17.6% following tilt down of the head. In contrast, patients with central lesions had very little ability to suppress post-head-shaking nystagmus (mean 3.4 +/- 56%). We recommend tilting the head after head shaking as a useful clinical test to assist in the differential diagnosis of vertiginous patients. In the case of unilateral peripheral vestibular hypofunction, head tilt suppresses the induced nystagmus via influence of the otolith organ. In the case of central pathology, the inability to suppress the nystagmus is from lesions impairing the otolith mediation on the velocity storage circuitry.
机译：倾斜抑制指的是头部远离地球垂直轴的倾斜，以及诱发的水平眼球震颤的减少。这种减少诱发水平眼震的现象涉及前庭核团和小脑内的神经元回路（统称为速度存储）以及来自耳石末端器官的信号。涉及该回路的病变可破坏诱发水平眼震的倾斜抑制。我们研究了28例单侧外周前庭功能减退患者和11例中枢神经系统病变患者的水平摇头眼震试验与倾斜抑制相结合的临床价值。每个前庭周围病变的受试者在摇头后产生了一个适当定向的水平眼球震颤，然后在头部向下倾斜后抑制了诱导的角慢相速度，平均为52+/-17.6%。相比之下，中心性病变患者抑制摇头后眼球震颤的能力非常低（平均3.4+/-56%）。我们建议在摇头后倾斜头部作为一种有用的临床试验，以帮助眩晕患者的鉴别诊断。在单侧外周前庭功能减退的情况下，头部倾斜通过耳石器官的影响抑制诱发的眼球震颤。在中枢病理学的情况下，抑制眼球震颤的能力是由于损害了速度存储电路上的耳石中介。

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