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1 Outline 提纲 Overview of dizziness 头晕的概述 Pre-test preparations 测试前准备 ENG/VNG test battery ENG/VNG 测试组 Best practices in administering each test 最佳测试方法 Recognizing and avoiding common errors and artifacts 常见错误与伪迹的识别和避免 General interpretation guidelines for each test 每种测试结果一般解释指南 Correlations among different tests 各测试间的联系 Head impulse testing and VEMP 甩头试验 (HIT) 和前庭诱发肌源性电位 (VEMP) 1

常见错误与伪迹的识别和避免 General interpretation guidelines for each test 每种测试结果一般解释指南

2 OVERVIEW OF DIZZINESS 头晕的概述

3 Prevalence and Incidence of Dizziness 头晕的流行病学和发生率 Dizziness is a common complaint (Neuhauser and Lempert, 2009) 很多人抱怨有头晕 Incidence (1 yr) ~ 4% 发生率 (1 年 ) ~ 4% Prevalence (1 yr) ~24% 流行率 (1 年 ) ~24% Prevalence (lifetime) ~ 30% 流行率 ( 终生 ) ~24% Prevalence by age increases threefold from 18 to 70+ 从 18 岁至 70 岁以上, 随年龄增长流行率增长 3 倍 Male to female ratio ~ 1 to 2.5 男性 : 女性为 1:2.5 Dizziness encompasses many symptoms: 头晕包括很多症状 Vertigo 眩晕 Syncope or pre-syncope 晕厥或先兆晕厥 Unsteadiness 姿势不稳 Lightheadedness and other vague sensations of disorientation 头晕以及其他难以表述的方向感失调 3

70+ 从 18 岁至 70 岁以上, 随年龄增长流行率增长 3 倍 Male to female ratio ~ 1 to 2.5 男性 : 女性为 1:2.

4 Anatomical Sites and Causes of Dizziness 解剖部位和头晕的病因 ICD-9 codes with primary complaint of dizziness ~63 Source: A Guide to Evaluation and Management of Dizziness (2001), ICS Medical Anatomical sites-ear, brain, eyes, muscles/joints, other 解剖部位耳朵, 大脑, 眼睛, 肌肉 / 关节, 其他 Underlying causes-infection, vascular, psychogenic, trauma, metabolic,tumors, neoplasms, toxic, congenital 可能病因感染, 血管性的, 心理性的, 外伤, 新陈代谢, 肿瘤, 神经瘤, 4 中毒, 先天性的

muscles/joints, other 解剖部位耳朵, 大脑, 眼睛, 肌肉 / 关节, 其他 Underlying causes-infection, vascular, psychogenic,

5 Causes of Dizziness 头晕的病因 Otologic 耳科学的 (vertigo is very common 眩晕极其常见 ) Neurologic 神经病理学的 (vertigo is common 眩晕多见 ) Prevalence 流行率 ~50% ~20% Common Etiologies 病因学 BPPV 良性阵发性位置性眩晕 Meniere s disease 梅尼埃病 Labyrinthitis/vestibular neuritis 内耳迷路炎 / 前庭神经炎 Superior canal dehiscence (SCD) 上半规管裂 Perilymph fistula 外淋巴瘘管 Eighth nerve/other tumors 听神经瘤 / 其他肿瘤 Ototoxicity/bilateral vestibular loss 耳毒性 / 双侧前庭损伤 Autoimmune 自身免疫疾病 Migraine 偏头痛 Stroke and TIA 中风和短暂性脑缺血 Seizures 癫痫 Neurodegenerative diseases 神经变性疾病 Vascular insufficiencies/vbi 血管供血不足 / 椎基底动脉供血不足 Neoplasms/infections 肿瘤 / 感染 5

Perilymph fistula 外淋巴瘘管 Eighth nerve/other tumors 听神经瘤 / 其他肿瘤 Ototoxicity/bilateral vestibular loss 耳毒性 / 双侧前庭损伤 Autoimmune 自身免疫疾病 Migraine 偏头痛

6 Causes of Dizziness (continued) 头晕的病因 ( 续 ) Medical 医学的 (vertigo is rare 眩晕少见 ) Prevalence 流行率 Common Etiologies 病因学 ~5% Cardiac arrhythmia/low blood pressure 心率失常 / 低血压 Hypoglycemia/diabetes/hypothyroidism 低血糖 / 糖尿病 / 甲状腺功能低下 Vitamin deficiency 维生素缺乏症 Blood disorders/anemia 血液循环障碍 / 贫血 Psychogenic 精神性的 (vertigo is rare 眩晕少见 ) Other or Undiagnosed 其他或未确诊的 (vertigo is rare 眩晕少见 ) ~10% Chronic subjective dizziness 慢性主观性头晕 Anxiety/panic disorder 焦虑恐慌 Somatization disorder 躯体化失调 ~15% Trauma with or without other findings 伴随或为伴随其他发现的外伤 Cervical 颈部的 Multisensory associated with aging 与年龄相关的多感觉的 Congenital/other 先天性的 / 其他 Malingering 装病 Drug effect 药物作用 6 Modified from Hain (2002) Approach to the Vertigo Patient, in J. Biller (ed.) Practical Neurology

Undiagnosed 其他或未确诊的 (vertigo is rare 眩晕少见 ) ~10% Chronic subjective dizziness 慢性主观性头晕 Anxiety/panic disorder 焦虑恐慌 Somatization disorder 躯体化失调 ~15% Trauma with or without other

7 Patient Instructions 病人须知 To be given to the patient several days before the test: 测试前提前数天告知病人 Medications 药物 Continue life-supporting medications heart, blood pressure, seizure, diabetes, etc. 继续服用维持生命的药物心脏, 血压, 癫痫, 糖尿病等 Stop tranquilizers, sedatives, vestibular suppressants, and other CNS-acting medications for at least 48 hours before the test. 测试停用镇静剂前庭抑制剂或者其它有中枢神经系统抑制药物至少 48 小时 Check with your physician before stopping medications 停药前咨询医生 No alcohol for 48 hours before testing 测试前 48 小时戒酒 No facial make-up around the eyes 眼部周围不要化妆 Do not eat about two hours before testing 测试前两小时内禁食 Wear comfortable clothing 穿着舒适 7

继续服用维持生命的药物心脏, 血压, 癫痫, 糖尿病等 Stop tranquilizers, sedatives, vestibular suppressants, and other CNS-acting medications for at least 48 hours before the test.

8 CALIBRATION 校准

9 Calibration Purpose 校准目的 Calibration 校准 Calculates a conversion factor between measured parameters and eye movements 计算获得的参量与眼动之间的转换因子 ENG 眼震电图 Corneoretinal potential (CRP) 角膜视网膜电位 (CRP) VNG 眼震视图 Center of pupil 瞳孔中心 Faulty calibration 错误校准 Inaccurate eye movement amplitude for all subsequent subtests 在后面各项测试时出现错误的眼动振幅 9

potential (CRP) 角膜视网膜电位 (CRP) VNG 眼震视图 Center of pupil 瞳孔中心 Faulty calibration 错误

10 Calibrations 校准 ENG vs. VNG ENG 眼震电图 CRP is different from person to person 每个人的 CRP 不同 CRP changes with changes in lighting conditions 光照条件不同 CRP 不同 CRP changes after vigorous patient movement 病人剧烈移动身体 CRP 改变 CRP changes over time even without changes in the lighting condition or patient movement (maximum change occurs after about 10 minutes) 即使光照条件不变, 病人身体不移动,CRP 也会随着时间延长发生改变 (10 分钟后达到最大 ) VNG 眼震视图 Converts units from the camera to the eye coordinate system 从摄像机转换到眼睛定标系统 Depends on the distance of the camera from the eye 取决于摄像头和眼睛的距离 10

after vigorous patient movement 病人剧烈移动身体 CRP 改变 CRP changes over time even without changes in the lighting condition or patient movement (maximum

11 Calibrations Procedure 校准步骤 Manual Auto (Sonar) Place the patient at the prescribed distance from the targets 病人与靶点在规定距离内 Adjust the recording system as the computer moves the target at the prescribed amplitude (usually ±10-15º) and ask the patient to follow it until eye movements match target movements 调节记录系统, 靶点将在规定的幅度 ( 通常 ±10-15º) 内移动, 要求病人跟踪靶点直到眼动与靶点轨迹相符 11

prescribed amplitude (usually ±10-15º) and ask the patient to follow it until eye movements match

12 Calibration Tracings 校准跟踪 12

13 Calibrations Errors 校准 - 错误 Errors in determining eye movements 判断眼动时出错 Contamination by noise or other artifacts 受噪声或其他伪迹干扰 Uncooperative patient 病人不合作 Can be recognized in saccade and tracking tests 可以在扫视和跟踪试验被识别 13

artifacts 受噪声或其他伪迹干扰 Uncooperative patient 病人不合作

14 Calibrations Errors 校准 - 错误 14

15 Calibrations Errors in Saccade Test 校准 - 扫视试验时出错 Saccades begin and end on the target. Check calibration/adjust gain. 扫视试验开始和结束时都落在靶点轨迹上检查校准 / 调节增益 15

16 Calibrations Errors in Tracking Test 校准 - 跟踪试验时出错 Peaks must match at least for low freq. Check calibration/adjust gain. 波峰至少在低频时应符合检查校准 / 调节增益 16

17 Calibrations Errors 校准 - 错误 Errors in determining target movements 判断靶点运动时出错 Inaccuracy in measuring the distance between the patient and the fixation targets (light bar) 测量病人和靶点 ( 视靶 ) 距离时不准确 Cannot be easily recognized 不易识别 Can lead to misinterpretation of abnormal positional nystagmus or hyperactive/hypoactive caloric responses 可导致被误解为位置性眼震异常或冷热试验反应过度强烈 17

距离时不准确 Cannot be easily recognized 不易识别 Can lead to misinterpretation of abnormal positional

18 Calibrations Effect of Distance 校准 - 距离的影响 18

19 Calibrations Effect of Distance 校准 - 距离的影响 19

20 Recalibrations How often? 重新校准 - 多久一次? In VNG: 眼震视图 Recalibration not necessary unless cameras or goggles are moved 只有在摄像头或眼罩位置移动时才重新校准 In ENG: 眼震电图 Recalibrate when lighting condition changes or patient moves rapidly 光照条件改变或病人快速移动时需重新校准 Recalibrate in regular intervals (at the beginning, after oculomotor tests, and after the position test) 定期校准 ( 测试开始时, 眼动测试后, 位置测试后 ) What about recalibration between caloric irrigations? 冷热试验灌注是否需要重新校准? 20

电图 Recalibrate when lighting condition changes or patient moves rapidly 光照条件改变或病人快速移动时需重新校准 Recalibrate in

21 Overview of VNG/ENG Subtests VNG/ENG 测试项概述 Tests of oculomotor function (with fixation) 测试眼动系统功能 ( 固视 ) Saccade, tracking, optokinetic ( central) 扫视, 视跟踪, 视动 ( 中枢 ) 21

22 Overview of VNG/ENG Subtests VNG/ENG 测试项概述 Tests of gaze stabilization (with fixation and without with alerting) 凝视试验 ( 固视和非固视交替 ) Gaze/spontaneous nystagmus, static position (w/ fix. only central) 凝视 / 自发性眼震, 静态位置 ( 固视中枢 ) 22

23 Overview of VNG/ENG Subtests VNG/ENG 测试项概述 Tests of gaze stabilization (with fixation and without with alerting) 凝视试验 ( 固视和非固视交替 ) Gaze/spontaneous nystagmus, static position (w/o fix. non-localizing) 凝视 / 自发性眼震, 静态位置 ( 非固视无法定位 ) 23

24 Overview of VNG/ENG Subtests VNG/ENG 测试项概述 Tests of vestibular function 前庭功能测试 Caloric ( lat SCC/superior vest. n.) Does not rule out vestibular lesions! 冷热试验 ( 外侧半规管 / 上前庭神经 ) 不排除前庭损伤! 24

25 Overview of VNG/ENG Subtests VNG/ENG 测试项概述 Tests for specific etiologies 特殊的病因学测试 Dynamic positioning/dix-hallpike ( BPPV post SCC/inf. vest. nerve) 动态位置 /Dix-Hallpike( 后半规管 BPPV / 下前庭神经 ) 25

26 Abnormal Saccades Internuclear Ophthalmoplegia 异常扫视核间性眼肌麻痹 INO denotes a central lesion in the medial longitudinal fasciculus on the side of sluggish adduction (can be caused by MS, infarcts or tumors) 提示中枢病变, 病变位于迟缓侧内侧纵束 ( 可由 MS, 梗塞或肿瘤引起 ) 26

27 Correlations in Oculomotor Tests Tracking & OPK 动眼测试间的关联平稳跟踪试验 & 视动试验 Can instructions to the patient affect OPK responses? 对病人的指示说明会影响 OPK 反应吗? Neither set of instructions produces true OPK responses because foveal tracking is present in both cases 没有任何一套指令说明可以产生真实的 OPK 反应, 因为都会出现中央窝跟踪 OPK testing can be used to verify the results of the tracking test OPK 试验可以用于验证跟踪试验的结果 Look OPK nystagmus Stare OPK nystagmus 27

28 Correlations in Oculomotor Tests Tracking & OPK 动眼试验的校准平稳跟踪试验 & 视动性试验 OPK and tracking test results should be identical when equivalent test parameters are used and if age effects are considered 如果测试参数相同, 并且考虑年龄因素,OPK 和跟踪试验的结果应该是一样的 In case of conflict, investigate more 如果不同则应进一步检查 Reduced OPK nystagmus intensity for high-velocity leftward target movements 靶点向左快速移动, OPK 眼震强度降低 28

29 Abnormal Gaze Spontaneous (Vestibular) Nystagmus 异常凝视 - 自发性 ( 前庭 ) 眼震 Horizontal or horizontal with torsional component 水平或水平伴旋转性眼震 Can be vertical with torsional component for focal lesions involving anterior or posterior semicircular canals 有垂直并伴旋转性眼震, 损伤部位在前或后半规管 Caused by an asymmetry in peripheral or central vestibular pathways 由外周和中枢前庭通路不对称引起 Can be physiologic or pathologic (during the acute phase) 可能是生理的或病理的 ( 急性期时 ) Conjugate 共轭 Linear slow component 线性慢相成分 Suppressed with fixation 固视抑制 Unidirectional (intensity varies with gaze position) 单向 ( 强度随凝视位置改变 ) Stronger when gaze directed toward fast phases (Alexander s law) 凝视朝向快相侧时 29 变强 (Alexander 定律 )

30 Correlations in Gaze Stabilization and Tracking Tests 凝视与跟踪试验之间的关联 Borderline unilateral defective tracking can be caused by strong spontaneous nystagmus (in the direction of fast phases) 跟踪试验单侧跟踪不良, 可能是因为有较强的自发性眼震 ( 朝向快相 ) 30

31 Abnormal Gaze Stabilization Vertical Nystagmus 异常凝视稳定 - 垂直眼震 Downbeat nystagmus Upbeat nystagmus Downbeat or upbeat gaze nystagmus with fixation denotes a central lesion in the cerebellum or underlying medulla 凝视试验固视时有下跳或上跳性眼震, 说明在小脑或下髓质有中枢病变 Upbeat nystagmus is more commonly associated with side effects of medications, nicotine, or alcohol 受药物尼古丁或酒精的副作用影响, 上跳性眼震更常见 31

32 Abnormal Gaze Stabilization Vertical Nystagmus 异常凝视稳定 - 垂直眼震 No nystagmus with fixation 固视无眼震 Vertical nystagmus without fixation that exceeds the normal limit (7 /sec) denotes a finding of unknown clinical significance 非固视垂直眼震超过正常范围 ( 7 /sec ) 具有临床意义 32

33 Correlations in Gaze Stabilization and Tracking Tests 凝视稳定和跟踪试验之间的关联 Defective tracking can be caused by superimposed gaze nystagmus 强烈的凝视性眼震可能导致跟踪不良 33

34 Dix-Hallpike Maneuver (Right) Procedure Dix-Hallpike 试验演示 ( 右 )- 步骤 Instruct the patient about the procedure 告知病人测试步骤 Begin from sitting position with head turned 45 right or left, move rapidly to supine head hanging 从坐位开始, 头向右或左转 45, 快速倒下至仰卧位, 呈头悬垂位 Observe eye movements (IR or Frenzel goggles are recommended) 观察眼动 ( 推荐使用 IR 或 Frenzel 眼罩 ) After nystagmus subsides, proceed to treatment or bring the patient back to sitting position and repeat to determine fatigability 眼震减弱后, 继续治疗或使病人恢复坐位, 重复测试以判断是否有疲劳性 34

35 Dix-Hallpike Maneuver Practical Issues Dix-Hallpike 演示 - 实际操作问题 When to do the test in the VNG/ENG battery VNG/ENG 测试时何时进行 Dix-Hallpike 试验? First If you do not plan on doing a full VNG/ENG 第一个 - 不打算做全套 VNG/ENG 测试时 Middle If you are concerned about fatiguing the response (usually, not a major concern) 中间 - 病人可能产生疲劳性 ( 通常不是主要考虑因素 ) Last If you are concerned about not being able to complete the caloric test 最后 - 不能做冷热试验时 Recording eye movements 记录眼动 In VNG, record eye movements (enable video recording) 在 VNG, 记录眼动 ( 开启视频记录 ) In ENG, do not record with electrodes, use Frenzel glasses or infrared goggles with video recording capability 在 ENG, 不需要用电极记录, 使用 Fenzel 眼罩或有视频记录功能的红外眼罩 With or without fixation? 固视或非固视? Torsional nystagmus not likely to be suppressed by fixation 旋转性眼震, 固视抑制无效 35

36 Dix-Hallpike Maneuver Practical Issues Dix-Hallpike 演示 - 实际操作问题 Head turn 转头 Turn the head 45 degrees to right or left first before moving the patient to avoid false-positive bilateral BPPV finding 在移动病人前头向右或左转 45, 避免出现假阳性双侧 BPPV Does not matter which side is done first 先做哪一侧都可以 How fast to move from the sitting to supine position? 从坐位到仰卧位以多快的速度移动? Particles are moved primarily by gravity 病人自由倒下 How far to hang the head in the supine position? 仰卧位时头部悬空程度? Excessive head hanging not recommended 不建议过度悬空 The best position for the examiner to perform the test 检查者最好的位置 Standing behind the patient reduces weight-bearing on the examiner 站在病人后方以减少测试时病人的受重 36

37 Dix-Hallpike Maneuver Practical Issues Dix-Hallpike 演示 - 实际操作问题 How long to wait before sitting the patient back up? 病人恢复坐位前需等待多久? Listen to the patient! 听病人的! Is it necessary to establish fatigability? 是否必须建立疲劳性? Not if you plan to proceed to treatment immediately 如果打算马上继续治疗的则不需要 Possible contraindications Check with the referring physician 禁忌症 - 询问转诊医师 Severe neck or back problems 严重的颈背问题 Arterial blood supply anomalies 动脉血供应异常 Vertebral Artery Screening Test is possible but remains controversial 有学者建议椎动脉筛查, 但仍然存在争议 Active heart disease 心脏病 Orthopedic and mobility restrictions for some maneuvers 整形外科或移动受限 37

38 Canalithiasis of Posterior SCC 后半规管结石 Dix-Hallpike toward the affected side causes excitation of the posterior canal and generates up beating and torsional nystagmus beating toward the undermost ear Dix-Hallpike 试验朝向患侧时, 引起后半规管兴奋, 产生上跳性和旋转性眼震, 方向偏向低位耳 38

39 Abnormal Dix-Hallpike - Canal Involvement Dix-Hallpike 试验异常 - 与半规管关系 Right Dix-Hallpike 右侧 Dix-Hallpike 试验 Involved Canal 半规管 Right Posterior Canal 右后半规管 Left Anterior Canal 左前半规管 Sitting to Supine 坐位至仰卧位 Upbeat & Right Torsion 上跳性 & 向右旋转性 Downbeat & Left Torsion 下跳性 & 向左旋转性 Supine to Sitting 仰卧位至坐位 Downbeat & Left Torsion 下跳性 & 向左旋转性 Upbeat & Right Torsion 上跳性 & 向右旋转性 Left Dix-Hallpike 左侧 Dix-Hallpike 试验 Involved Canal 半规管 Left Posterior Canal 左后半规管 Right Anterior Canal 右前半规管 Sitting to Supine 坐位至仰卧位 Upbeat & Left Torsion 上跳性 & 向左旋转性 Downbeat & Right Torsion 下跳性 & 向右旋转性 Supine to Sitting 仰卧位至坐位 Downbeat & Right Torsion 下跳性 & 向右旋转性 Upbeat & Left Torsion 上跳性 & 向左旋转性 39

40 Caloric Test Artifacts 冷热试验伪迹 One irrigation produces significantly different response (dominates the test result). Repeat? 一次灌注产生不同的反应 ( 控制测试结果 ) 重复测试? 40

41 Caloric Test - Severe Unilateral Weakness 冷热试验 - 单侧半规管轻瘫严重 No caloric responses from the right ear (ice water?) 右耳冷热试验无反应 ( 是否冰水试验?) Do not accept computer-selected peaks 去除电脑自动选择的峰值 41

42 CORRELATIONS WITH VEMP AND HEAD IMPULSE TESTING 与前庭诱发肌源性电位 (VEMP) 和甩头试验 (HIT) 的关联

43 Correlation of VNG/ENG with VEMP and HIT VNG/ENG 与 VEMP 和 HIT 的关联 Can new tests of vestibular function enhance VNG/ENG s ability in identifying site of lesion in dizzy patients? 这些前庭功能的新测试能否提高 VNG/ENG 鉴别头晕病人损伤部位的能力? Vestibular evoked myogenic potentials (VEMP) 前庭诱发肌源性电位 (VEMP) Cervical (cvemp) 颈部 ( 颈部前庭诱发肌源性电位 ) Ocular (ovemp) 眼部 ( 眼动前庭诱发肌源性电位 ) Head impulset Test (HIT) 甩头试验 (HIT) Plane of right-left lateral canals 右外侧 - 左外侧半规管平面 Plane of right anterior-left posterior canals 右前 - 左后半规管平面 Plane of right posterior-right anterior canals 右后 - 右前半规管平面 43

44 Cervical Vestibular-Evoked Myogenic Potentials (cvemp) 颈部前庭诱发肌源性电位 (cvemp) Short-latency EMG potentials recorded from the ipsilateral sternocleidomastoid (SCM) muscle in response to high-level acoustic stimuli (vestibulocolic/vestibulospinal pathways) 高强度声刺激时来自同侧胸锁乳突肌 (SCM) 的短潜伏期肌源性电位 cvemp is presumed to test the saccule and the inferior vestibular nerve cvemp 用于测试球囊和下前庭神经 Bone-conducted cvemp most likely also involves utricle and its pathways 骨导 cvemp 很可能还包括椭圆囊及其通路 44

45 Ocular Vestibular-Evoked Myogenic Potentials (ovemp) 眼动前庭诱发肌源性电位 (ovemp) Short-latency EMG potentials recorded from the contralateral extraocular muscles in response to high-level acoustic stimuli 高强度声刺激时来自对侧眼外肌的短潜伏期肌源性电位 ovemp is presumed to test the utricle and the superior vestibular nerve ovemp 用于测试椭圆囊和上前庭神经 45

46 Caloric Test, cvemp and ovemp Pathways 冷热试验 cvemp 和 ovemp 通路 ovemp Caloric test cvemp 46

47 Interpretation of cvemp and ovemp Responses cvemp 和 ovemp 反应通路 From Curthoys, et al, ACTA Otorhinolaryngologica Italica

48 Head Impulse Test (HIT) 甩头试验 (HIT) Record eye movements as the head is moved briskly to right or left in the plane of horizontal semicircular canals 当头快速转向右侧或左侧时, 记录水平半规管平面的眼球运动 HIT is a test of lateral canals and superior vestibular nerve. HIT 测试外侧半规管和上前庭神经 Can be performed in the plane of right anterior-left posterior or right posterior-left anterior canals. 可在右前 - 左后或右后 - 左前半规管平面进行测试 Patients with peripheral vestibular deficits exhibit refixation (catch-up) saccades when the head is thrust toward the side of lesion. 外周前庭障碍的病人, 头部向患侧快速旋转后, 会即刻出现朝向健侧的快速眼运动补偿性眼跳 48

49 Head Impulse Test 甩头试验 Normal 正常 Abnormal 异常 49

50 Head Impulse Test Basis 甩头试验基础 Patients can generate covert saccades that may be missed during visual inspection 病人会产生隐藏的补偿性眼跳, 肉眼可能无法观察到 Video or search coil recordings will allow identification of both overt and covert saccades 视频或测量线圈记录系统可以识别任何明显的和隐藏的补偿性眼跳 50

51 Head Impulse Test Covert vs Overt Saccades 甩头试验 - 明显的和隐藏的补偿性眼跳 From Curthoys et al. (2010) 51

52 Head Impulse Test 甩头试验 Normal 正常 Left unilateral lesion 左侧损伤 From Curthoys et al. (2010) 52

53 Identifying Site of Lesion 鉴别损伤部位 SITE 部位 LAT 水平 HIT VERT 垂直 HIT CVEMP OVEMP Healthy Subject 健康个体 Lateral Canal 外侧半规管 Anterior Canal 前半规管 Posterior Canal 后半规管 Normal 正常 Normal 正常 Normal 正常 Normal 正常 Abnormal for ipsilesional thrust 转向患侧时异常 Normal 正常 Normal 正常 Normal 正常 Normal 正常 Normal 正常 Abnormal to contralesional downward thrust 转向健侧下方时异常 Abnormal to ipsilesional upward thrust 转向患侧上方时异常 Normal 正常 Normal 正常 Utricle 椭圆囊 Normal 正常 Normal 正常 Normal 正常 Saccule 球囊 Normal 正常 Normal 正常 Superior Vestibular Nerve 上前庭神经 Inferior Vestibular Nerve 下前庭神经 Total Unilateral Vestibular Loss 整个单侧前庭损伤 Abnormal for ipsilesional thrust 转向患侧时异常 Normal 正常 Abnormal for ipsilesional thrust 转向患侧时异常 Abnormal to contralesional downward thrust 转向健侧下方时异常 Abnormal to ipsilesional upward thrust 转向患侧上方时异常 Abnormal to contralesional downward and ipsilesional upward thrusts 转向健侧下方和患侧上方时异常 Abnormal for ipsilesional SCM muscle 患侧 SCM 肌异常 Normal 正常 Abnormal for ipsilesional SCM muscle 患侧 SCM 肌异常 Abnormal for ipsilesional SCM muscle 患侧 SCM 肌异常 Normal 正常 Normal 正常 Abnormal for contralesional eye muscle 健侧眼肌异常 Normal 正常 Abnormal for contralesional eye muscle 健侧眼肌异常 Normal 正常 Abnormal for contralesional eye muscle 健侧眼肌异常 53

54 Summary 总结 New vestibular tests have the potential to provide more specific information about different structures within the vestibular system 新的前庭功能测试可以提供更多有关前庭系统内不同结构的具体信息 More widespread clinical studies are needed to verify and validate the new methods 需要更多的临床研究去证明和验证这些新测试 54

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