论文部分内容阅读
目的探讨主要症状为位置性眩晕及水平眼震的小脑占位病变患者的临床及病灶分布特征,以提高临床医生对该少见病的认识。方法回顾性分析2016年12月诊治的1例以位置性眩晕及位置性眼震为首发症状的小脑占位病变患者的临床资料及疾病诊治经过,并结合文献复习进行总结。结果患者男性,75岁,以反复眩晕、恶心、呕吐、活动后加重2个月就诊,查体发现水平翻滚试验可见水平背地眼震,首次查头颅CT平扫未见明显异常,诊断右侧水平半规管帽石症,给予Gufoni手法复位治疗无明显效果。4周后患者出现意识淡漠,复查头颅CT显示梗阻性脑积水,头颅CT增强示右侧小脑小结占位病变,先后行侧脑室外引流及小脑肿瘤切除术,术后病理为弥漫大B细胞淋巴瘤。结合既往报道的文献13例和本研究的1例共计14例小脑占位引起的位置性眩晕及水平眼震患者中,有9例初诊为良性阵发性位置性眩晕;肿瘤主要位于小脑小结、舌叶及四脑室底部等小脑中线部位。结论小脑中线部位的占位病变可以表现为位置性眩晕/眼震,临床医生需注意识别,以免漏诊。
Objective To investigate the clinical and focal distribution characteristics of patients with cerebellar lesions with positional vertigo and horizontal nystagmus, and to improve the understanding of this rare disease by clinicians. Methods A retrospective analysis was made on the clinical data and diagnosis and treatment of one case of cerebellar space-occupying lesions with positional vertigo and positional nystagmus as the first symptom in December 2016. The review and summary of the literature were reviewed. Results The patients were 75 years old, with repeated dizziness, nausea and vomiting. The patients were exacerbated for 2 months after the activity. The horizontal tumbling test showed that the level of nystagmus was absent. For the first time, no significant abnormality was found in the CT scan, Semi-standard cap stone disease, giving Gufoni manual reduction therapy no significant effect. After 4 weeks, the patients showed indifferent consciousness. The recurrent head CT showed obstructive hydrocephalus. The cranial CT enhancement showed the right cerebellar tubercle lesions. The lateral cerebral venous drainage and the cerebellar tumor resection were performed one after the other. The postoperative pathology was diffuse large B cells Lymphoma. In combination with 13 previously reported literatures and 1 case of this study, a total of 14 patients with positional vertigo caused by cerebellar mass and 9 patients with nystagmus were initially diagnosed as benign paroxysmal positional vertigo. The tumors mainly located in cerebellar nodules, Tongue and four ventricle at the bottom of the cerebellar midline and other parts. Conclusion The lesions in the midline of the cerebellum can be characterized as positional vertigo / nystagmus. Clinicians should pay attention to identify so as to avoid misdiagnosis.