Доброкачественное пароксизмальное позиционное головокружение: современное представление о клинике, диагностике, лечении

Зайцева О.В. Доброкачественное пароксизмальное позиционное головокружение: современное представление о клинике, диагностике, лечении. Consilium Medicum. 2018; 20 (9): 47–50. DOI: 10.26442/2075-1753_2018.9.47-50

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Zaytseva O.V. Benign paroxysmal positional vertigo: modern approach to clinical presentation, diagnostics and treatment. Consilium Medicum. 2018; 20 (9): 47–50. DOI: 10.26442/2075-1753_2018.9.47-50

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Аннотация

Доброкачественное пароксизмальное позиционное головокружение (ДППГ) – наиболее встречающееся вестибулярное расстройство, характеризующееся спонтанными ремиссиями спустя несколько дней или несколько недель от начала заболевания и частыми рецидивами. При ДППГ головокружение системного характера (вестибулярное или истинное) возникает при изменении положения головы (повороты в кровати, запрокидывание головы назад или наклоны вперед) и продолжается, как правило, не более 1 мин. Ежедневные вестибулярные атаки ДППГ могут продолжаться от нескольких дней до нескольких лет. Основной причиной развития ДППГ является отолитиаз. Диагноз ДППГ устанавливается по результатам позиционных тестов. Лечение в виде специфических упражнений (маневров) редко требует длительного медикаментозного сопровождения. При плохой переносимости маневров (яркая вестибуловегетативная симптоматика в виде вращательного головокружения с тошнотой и рвотой) оправдано применение вестибулярных супрессантов.

Ключевые слова: доброкачественное пароксизмальное позиционное головокружение.

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Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder characterized by spontaneous remissions several days or weeks after the onset of the disease and frequent relapses. In BPPV, dizziness of a systemic nature (vestibular or true) occurs when the position of the head changes (turning in the bed, tipping the head backwards or tilting forward) and lasts, as a rule, no more than 1 min. Daily vestibular attacks of BPPV can last from several days to several years. The main cause of development of BPPV is otolithiasis. Diagnosis of BPPV is determined by the results of positional tests. Treatment in the form of specific exercises (maneuvers) rarely requires prolonged drug support. With poor tolerance of maneuvers (bright vestibular-vegetative symptoms in the form of rotational vertigo with nausea and vomiting), it is justified to use vestibular suppressants.

Key words: benign paroxysmal positional vertigo.

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Список литературы

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2. Imai T, Ito M, Takeda N et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64 (5): 920–1.

3. Nunez RA, Cass SP, Furman JM. Short and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngology Head Neck Surg 2000; 122: 647–52.
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7. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61: 987–1016.
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9. Asprella-Libonati G. Pseudo-spontaneous nystagmus: A new sign to diagnose the affected side in lateral semicircular canal benign paroxysmal positional vertigo. Acta Otorhinolaryngol Ital 2008; 28: 73–8.
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11. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: Clinical and oculographic features in 240 cases. Neurology 1987; 37: 371–8.
12. Baloh RW, Jacobson KM, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993; 43: 2542–9.
13. Baloh RW, Yue Q, Jacobson KM, Honrubia V. Persistent direction-changing positional nystagmus: another variant of benign paroxysmal positional vertigo? Neurology 1995; 45: 1297–301.
14. Bertholon P, Bronstein AM, Davies RA et al. Positional down beating nystagmus in 50 patients: Cerebellar disorders and possible anterior canal semicircular canalolithiasis. J Neurol Neurosurg Psychiatry 2002; 72: 366–72.
15. Bertholon P, Antoine JC, Martin C, Michel D. Simultaneous occurrence of a central and a peripheral positional nystagmus during the Dix-Hallpike maneuver. Eur Neurol 2003; 50: 248–50.
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17. Bertholon P, Tringali S, Faye MB et al. Prospective study of positional nystagmus in 100 consecutive patients. Ann Otol Rhinol Laryngol 2006; 115: 587–94.
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23. Rahko T. The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC). Clin Otolaryngol Allied Sci 2002; 27 (5): 392–5.
24. Maslovara S, Soldo SB, Puksec M et al. Benign paroxysmal positional vertigo (BPPV): influence of pharmacotherapy and rehabilitation therapy on patients’ recovery rate and life quality. Neuro Rehabilitation 2012; 31 (4): 435–41.
25. Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngology Ital 2005; 25: 107–12.

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1. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: A population based study. J Neurol Neursurg Psychiatry 2007; 78: 710–5.
2. Imai T, Ito M, Takeda N et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64 (5): 920–1.
3. Nunez RA, Cass SP, Furman JM. Short and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngology Head Neck Surg 2000; 122: 647–52.
4. Halmagyi GM. Diagnosis and management of vertigo. Clin Med 2005; 5: 159–65.
5. Belinov S.I. K voprosu o raspoznavanii zabolevanii ushnogo labirinta: o vliianii bokovykh naklonenii golovy na vestibuliarnyi nistagm. Dis. ... d-ra med. nauk. SPb.: Tipografiia V.Ia.Mil'shteina, 1908. [in Russian]
6 . Barany R. Diagnose Krankheitsercheinungen in berciche des otolithenapparates. Acta Otolaryngol 1921; 2: 434–7.
7. Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61: 987–1016.
8. Von Breverna M, Bertholonb P, Brandtc Th et al. Newman-Toker Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestibular Res 2015; 25: 105–17.
9. Asprella-Libonati G. Pseudo-spontaneous nystagmus: A new sign to diagnose the affected side in lateral semicircular canal benign paroxysmal positional vertigo. Acta Otorhinolaryngol Ital 2008; 28: 73–8.
10. Aw ST, Todd MJ, Aw GE et al. Benign paroxysmal nystagmus. A study of its three-dimensional spatio-temporal characteristics. Neurology 2005; 64: 1897–905.
11. Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: Clinical and oculographic features in 240 cases. Neurology 1987; 37: 371–8.
12. Baloh RW, Jacobson KM, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993; 43: 2542–9.
13. Baloh RW, Yue Q, Jacobson KM, Honrubia V. Persistent direction-changing positional nystagmus: another variant of benign paroxysmal positional vertigo? Neurology 1995; 45: 1297–301.
14. Bertholon P, Bronstein AM, Davies RA et al. Positional down beating nystagmus in 50 patients: Cerebellar disorders and possible anterior canal semicircular canalolithiasis. J Neurol Neurosurg Psychiatry 2002; 72: 366–72.
15. Bertholon P, Antoine JC, Martin C, Michel D. Simultaneous occurrence of a central and a peripheral positional nystagmus during the Dix-Hallpike maneuver. Eur Neurol 2003; 50: 248–50.
16. Bertholon P, Chelikh L, Tringali S et al. Combined horizontal and posterior canal benign paroxysmal positional vertigo in three patients with head trauma. Ann Otol Rhinol Laryngol 2005; 114: 105–10.
17. Bertholon P, Tringali S, Faye MB et al. Prospective study of positional nystagmus in 100 consecutive patients. Ann Otol Rhinol Laryngol 2006; 115: 587–94.
18. Beyea JA, Agrawal SK, Parnes LS. Transmastoid semicircular canal occlusion: A safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence. Laryngoscope 2012; 122: 1862–6.
19. Lempert T. Horizontal benign positional vertigo. Neurology 1994; 44: 2213–4.
20. Bronshtein A., Lempert T. Golovokruzhenie. Per. s angl. E.V.Guz'. Pod red. V.A.Parfenova. M., 2010. [in Russian]
21. Buttner U. Vestibular Dysfunction and Its Therapy, edited by Buttner. Adv Otorhino-laryngol 1994; 55: 253.
22. Maranhão ET, Maranhão-Filho P. Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients. Arq Neuropsiquiatr 2015; 73 (6): 487–92.
23. Rahko T. The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC). Clin Otolaryngol Allied Sci 2002; 27 (5): 392–5.
24. Maslovara S, Soldo SB, Puksec M et al. Benign paroxysmal positional vertigo (BPPV): influence of pharmacotherapy and rehabilitation therapy on patients’ recovery rate and life quality. Neuro Rehabilitation 2012; 31 (4): 435–41.
25. Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngology Ital 2005; 25: 107–12.

Авторы

О.В.Зайцева

ФГБУ «Научно-клинический центр оториноларингологии ФМБА России. 123182, Россия, Москва, Волоколамское ш., д. 30, корп. 2
o.v.zaytseva@yandex.ru

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O.V.Zaytseva

Research and Clinical Center of Otorhinolaryngology of FMBA of Russia. 123182, Russian Federation, Moscow, Volokolamskoe sh., d. 30, korp. 2
o.v.zaytseva@yandex.ru

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