| 【Background】Acute vestibular syndrome is a group of vestibular dysfunction with acute vertigo accompanied by nausea,vomiting,and imbalance.The most common form of acute peripheral vertigo is vestibular neuritis(VN),while acute central vestibular syndrome is posterior circulation cerebral infarction.Although acute peripheral vertigo is common,acute central vertigo is always more urgent,so clinicians need to be extra vigilant.In recent years,with the new development of vestibular function detection technology,a new otolith function evaluation system has been developed based on previous ENG.Among them,vestibular evoked myogenic potential(VEMPs)plays an important role in the field of diagnosis and treatment of vertigo because of its accurate detection,objective evaluation,convenient operation,and short time-consuming.However,there are few studies in vertigo patients with acute posterior circulation cerebral infarction,so it is worth an in-depth study of its vestibular function characteristics.Vestibular-evoked myogenic potential(VEMPs)is one of the common tests for quantifying vestibular function.Because it can detect the function of peripheral utricle and saccule,it has been widely used in the diagnosis of peripheral vestibular diseases and vestibular function evaluation.In the central nervous system,c VEMPs is mediated by the vestibular nucleus and its descending medial vestibular tract,while o VEMPs is mediated by the vestibular nucleus and the medial longitudinal tract(MLF).Abnormal VEMPs detection can be caused when brainstem lesions involve the above structures.At the same time,there is projection between the efferent fibers of the vestibular nucleus and the cerebellum,and cerebellar lesions can also cause abnormal VEMPs results.Based on the above studies,an in-depth study of the characteristics of VMEPs results in patients with brainstem and cerebellar infarction are helpful to evaluate the central vestibular function and reveal the role of VEMPs in evaluating central vestibular function.Vestibular rehabilitation(VRT),as a non-invasive,efficient,and easy-to-operate rehabilitation method,has demonstrated its advantages in the treatment of unilateral vestibular dysfunction,persistent postural-perceptual vertigo,benign paroxysmal positional vertigo,vestibular migraine,multiple sclerosis,and concussion,but the research on vestibular rehabilitation in central vertigo is insufficient in research.In this study,the Vertigo Disability scale(DHI)was used as a tool to evaluate the improvement of vertigo symptoms before and after the treatment.At the same time,for acute vestibular syndrome,patients are often associated with neuropsychological disorders such as vertigo-related emotional disorders and cognitive impairment.Vestibular rehabilitation is applied to acute central vestibular syndrome to explore its effectiveness in improving vertigo associated with emotional and cognitive impairment in patients with acute posterior circulation cerebral infarction.Therefore,the emotional and cognitive disorders of patients before and after VRT treatment are evaluated by scale.It is helpful to study the neuropsychological benefits of patients with vertigo,to provide a basis for the treatment of vestibular rehabilitation.【Objective】By Using vestibular function examination technique-VEMPs,we are going to explore its diagnostic value in acute central vestibular lesions,analyze its value in evaluating the central vestibular function,and explore the effectiveness of VRT in improving balance function,emotional and cognitive impairment in patients with acute posterior circulation cerebral infarction.【Subjects and method】1.The patients with acute posterior circulation cerebral infarction were divided into three subgroups: pontine group(n = 63),medulla oblongata group(n = 16)and cerebellar group(n = 53).The abnormal rate of vestibular evoked myogenic potential(VEMPs)and the specific amplitude,latency,latency difference,and asymmetry ratio were compared with those of the vestibular neuritis group(n = 53)and normal control group(n = 63).2.Each subgroup of the acute posterior circulation cerebral infarction group was divided into the simple drug treatment group and the drug combined with the vestibular rehabilitation group.The changes in VEMPs,DHI score,and NVI score at onset,1 week,and 1 month after treatment were compared and analyzed.【Results】1.The abnormal detection rate of VEMPs in acute posterior circulation cerebral infarction involving pontine and medulla oblongata,cerebellar flocculus,and vermis were higher,and the abnormal rate of c VEMPs and VEMPs in the posterior circulation cerebral infarction group was higher than that in two control groups(P< 0.0167).The amplitude of VEMPs in the posterior circulation cerebral infarction group was lower than that in the normal control group(P< 0.0167).The bilateral asymmetry of VEMPs in the posterior circulation cerebral infarction group was higher than that in the other two control groups(P< 0.0167).2.After different treatments,the amplitude of VEMPs in each subgroup of posterior circulation cerebral infarction increased with the extension of recovery time,and the bilateral asymmetry ratio gradually decreased from abnormal to normal,but there was no statistical difference in vestibular function between pontine group and medulla oblongata group after 1 week and 1 month after simple drug therapy and drug combined with vestibular rehabilitation therapy.The vestibular function of the cerebellum group was improved 1 week and 1 month after treatment,and the improvement was more obvious after VRT treatment.There was no significant difference in the improvement of DHI score and NVI score among the three study groups after one week of treatment,but there was a significant difference in the improvement of DHI score and NVI score one month after treatment.【Conclusions】1.Cervical muscle-derived and ophthalmic muscle-derived VEMPs have a certain value in the evaluation of central vestibular dysfunction,especially in evaluating the effect of brainstem or cerebellar lesions on the central vestibule.2.The abnormality of vestibular function in patients with cerebellar infarction was characterized by the change of VEMPs amplitude.3.Vestibular rehabilitation is beneficial to the recovery of vestibular function in patients with acute posterior circulation cerebral infarction.Patients with central vertigo are often accompanied by neuropsychological disorders such as emotional and cognitive disorders,and their recovery can also benefit from vestibular rehabilitation. |
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