[스크랩] BENIGN PAROXISMAL POSITIONAL VERTIGO (BPPV), 양성 체위성 현훈

 

양성 발작성 체위성 현훈(BENIGN PAROXISMAL POSITIONAL VERTIGO, BPPV)

 

1. 말초성 현훈의 가장 흔한 원인

2. 자세변화에 의해 유발되는 발작성 현훈이 특징
3. 타원낭(UTRICLE)의 편형반(MACULA)에 위치한 이석(OTOLITH)이 변성되면서 부스러기(OTOLITHIC DEBRIS)들이 반고리관(SEMICICULAR CANAL)으로 들어가거나, 팽대마루(CUPULA)에 달라 붙어 발생함. (FIg. 1, FIg. 2)

 

             Fig. 1.Spatial orientation of the semicircular canals. Note how the posterior canal on 1 side is in the same

            plane as the contralateral superior canal. Both lateral canals are in the same plane, 30º above the horizontal.

            (출처: Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV).
             CMAJ. 2003 Sep 30;169(7):681-93. Review.)

 

                                             Fig. 2. Left inner ear. Depiction of canalithiasis of the posterior canal

                                             and cupulolithiasis of the lateral canal.

            (출처: Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV).
             CMAJ. 2003 Sep 30;169(7):681-93. Review.) 

 

 

4. 진단 기준

 

  1) Dix-Hallpike test에 유발된  특징적인 회선성 수직성(a characteristic mixed torsional and vertical nystagmus)의 안구진탕을 동반한 현훈

  2) Dix-Hallpike test 종료 시점과 현훈과 안구진탕의 시작 시점사이의 지연 (특징적으로 1-2초)

  3) 유발된 현훈과 안구진탕의 특발적인 양상 (특히, 10-20초간 증가된 후 감소됨.)

  4) 피로도 (특히, Dix-Hallpike test 반복 후 현훈과 안구진탕의 감소)

 

 1) Vertigo associated with a characteristic mixed torsional and vertical nystagmus provoked by the Dix?Hallpike test

 2) A latency (typically of 1 to 2 seconds) between the completion of the Dix?Hallpike test and the onset of vertigo and nystagmus
 3) Paroxysmal nature of the provoked vertigo and nystagmus (i.e., an increase and then a decline over a period of 10 to 20 seconds)
 4) Fatigability (i.e., a reduction in vertigo and nystagmus if the Dix?Hallpike test is repeated)

 

   Fig. 3. The Dix-Hallpike Test of a Patient with Benign Paroxysmal Positional Vertigo Affecting the Right Ear.
   In Panel A, the examiner stands at the patient’s right side and rotates the patient’s head 45 degrees to the right to align the right posterior semicircular canal with the sagittal plane of the body. In Panel B, the examiner moves the patient, whose eyes are open, from the seated to the supine right-ear-down position and then extends the patient’s neck slightly so that the chin is pointed slightly upward. The latency, duration, and direction of nystagmus, if present, and the latency and duration of vertigo, if present, should be noted. The red arrows in the inset depict the direction of nystagmus in patients with typical benign paroxysmal positional vertigo. The presumed location in the labyrinth of the free-floating debris thought to cause the disorder is also shown.

 (출처: Furman JM, Cass SP.  Benign paroxysmal positional vertigo. N Engl J Med. 1999 Nov 18;341(21):1590-6. Review.)

5. 치료 - 최근 주로 Epley's maneuver를 권고함. (Fig.4., Clip. 1.)

 

 

Fig.4. Bedside Maneuver for the Treatment of a Patient with Benign Paroxysmal Positional Vertigo Affecting the Right Ear.
 The presumed position of the debris within the labyrinth during the maneuver is shown in each panel. The maneuver is a three-step procedure. First, a Dix–Hallpike test is performed with the patient's head rotated 45 degrees toward the right ear and the neck slightly extended with the chin pointed slightly upward. This position results in the patient's head hanging to the right (Panel A). Once the vertigo and nystagmus provoked by the Dix–Hallpike test cease, the patient's head is rotated about the rostral–caudal body axis until the left ear is down (Panel B). Then the head and body are further rotated until the head is face down (Panel C). The vertex of the head is kept tilted downward throughout the rotation. The maneuver usually provokes brief vertigo. The patient should be kept in the final, face-down position for about 10 to 15 seconds. With the head kept turned toward the left shoulder, the patient is brought into the seated position (Panel D). Once the patient is upright, the head is tilted so that the chin is pointed slightly downward.

 

                               Cilp.1. Epley's maneuver

* 참고 문헌
1> Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med. 1999 Nov 18;341(21):1590-6. Review.
2> 문소영, 최광동, 박성호, 김지수. 양성체위성현훈의 임상 양상. J Korean Neurol Assoc. 2003 Dec 21;6:614-621. Original article

출처 : DR. JAM's MEDICAL INFOMATIONs

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