急性单侧前庭疾患中过度换气诱发眼震的演变--解释模型和病因假设

IF 2.1 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY Audiology Research Pub Date : 2024-05-18 DOI:10.3390/audiolres14030037
Francesco Frati, Alessandra D'Orazio, V. Gambacorta, Giacomo Ciacca, Giampietro Ricci, M. Faralli
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引用次数: 0

摘要

过度换气会诱发新陈代谢的变化,从而在各种前庭疾病中引起眼球震颤(过度换气诱发的眼球震颤,HVIN),显示前庭失衡并带来中枢或外周不对称。在急性单侧前庭病(AUVP,即前庭神经炎)中,过度通气可诱发不同模式的眼震(兴奋性、抑制性或负性),通过其使代偿失效或增加外周兴奋性的能力,揭示或改变现有的静态前庭不对称。在这种情况下,我们对连续 35 例 AUVP 患者的 HVIN 演变阶段进行了跟踪研究,目的是评估过度通气对眼球运动模式随时间推移所造成的改变。在急性期,兴奋型眼球运动模式(以及由过度通气诱发的反向眼球震颤构成的强兴奋型眼球运动模式)的发生率明显高于抑制型眼球运动模式;随后,在随访期间观察到兴奋型眼球运动模式的发生率逐渐降低,而抑制型眼球运动模式的发生率随之逐渐升高。假设突触效应和前庭补偿的短暂丧失分别是兴奋和抑制的对立机制,那么过度通气诱发的眼球运动模式就是这两个因素相互作用的结果。根据所获得的数据,我们可以就过度通气所诱发反应的病理方面和疾病的病因提出一个解释模型:根据我们的假设,兴奋型模式意味着神经性(病毒性)AUVP;相反,抑制型(和负性)模式可能是神经性(病毒性)和血管性疾病的一种表现形式。
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Evolution of Hyperventilation-Induced Nystagmus in Acute Unilateral Vestibulopathy—Interpretative Model and Etiopathogenetic Hypotheses
Hyperventilation induces metabolic changes that can elicit nystagmus (hyperventilation-induced nystagmus, HVIN) in various vestibular disorders, revealing vestibular imbalance and bringing out central or peripheral asymmetries. In acute unilateral vestibulopathy (AUVP, namely vestibular neuritis), hyperventilation can induce different patterns of nystagmus (excitatory, inhibitory, or negative), disclosing or modifying existing static vestibular asymmetries through its ability to invalidate compensation or increase peripheral excitability. In this context, we followed the evolutionary stages of HVIN in AUVP across 35 consecutive patients, with the goal of assessing alterations in the oculomotor pattern caused by hyperventilation over time. In the acute phase, the incidence of the excitatory pattern (and the strongly excitatory one, consisting of a reversal nystagmus evoked by hyperventilation) was significantly higher compared to the inhibitory pattern; then, a progressive reduction in the incidence of the excitatory pattern and a concomitant gradual increase in the incidence of the inhibitory one were observed in the follow-up period. Assuming the role of the ephaptic effect and the transient loss of vestibular compensation as opposing mechanisms, i.e., excitatory and inhibitory, respectively, the oculomotor pattern evoked by hyperventilation is the result of the interaction of these two factors. The data obtained allowed us to hypothesize an interpretative model regarding the pathogenetic aspects of responses evoked by hyperventilation and the etiologies of the disease: according to our hypotheses, the excitatory pattern implies a neuritic (viral) form of AUVP; instead, the inhibitory (and negative) one can be an expression of both the neuritic (viral) and vascular forms of the disease.
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来源期刊
Audiology Research
Audiology Research AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-
CiteScore
2.30
自引率
23.50%
发文量
56
审稿时长
11 weeks
期刊介绍: The mission of Audiology Research is to publish contemporary, ethical, clinically relevant scientific researches related to the basic science and clinical aspects of the auditory and vestibular system and diseases of the ear that can be used by clinicians, scientists and specialists to improve understanding and treatment of patients with audiological and neurotological disorders.
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