儿童前庭性偏头痛谱系疾病的临床与听前庭检查发现

文献信息

中文摘要

目的： 儿童前庭性偏头痛（VMC）及相关发作性眩晕疾病是儿童复发性头晕的主要原因，但其听前庭特征仍未完全明确。本研究评估VMC、可能VMC（pVMC）或儿童复发性眩晕（RVC）患儿的 demographic 和听前庭检查发现。
方法： 对2024年1月至2025年12月期间诊断的儿科患者进行回顾性队列研究。数据包括人口统计学、偏头痛家族史以及听力测试、视频眼震图（VNG）和视频头脉冲试验（VHIT）的结果。已获得伦理批准。
结果： 共纳入32例患者：43.8%为VMC，53.1%为pVMC，3%为RVC。平均年龄为12.8±3.5岁（范围5-17岁），59.3%为女性。诊断延迟平均为9.5个月；31%曾接受神经科评估，53.1%接受了脑部影像学检查，21.2%接受了脑电图检查。听力测试（n=17）显示3例患者存在单侧轻中度听力损失。VNG（n=24）异常率为70.8%，最常见的是中枢性位置性眼震（50%）。VHIT（71.8%）异常率为43.7%。81.3%有偏头痛家族史（一级亲属68.8%）。
结论： 儿童前庭性偏头痛谱系疾病常表现出客观前庭异常，而听力损失相对少见。中枢性位置性眼震占优势以及VHIT异常频繁，提示主要为中枢性前庭受累，与偏头痛病理生理学一致。既往检查率高和诊断延迟时间长凸显了识别方面的挑战。早期识别和针对性的听前庭评估可能提高诊断效率并减少不必要的检查。

英文摘要

OBJECTIVE: Vestibular migraine of childhood (VMC) and related episodic vertigo disorders are leading causes of recurrent pediatric dizziness, yet audiovestibular profiles remain incompletely defined. This study evaluates demographic and audiovestibular findings in children with VMC, probable VMC (pVMC), or recurrent vertigo of childhood (RVC).
METHODS: Retrospective cohort study of pediatric patients diagnosed between January 2024 and December 2025. Data included demographics, migraine family history, and results of audiometry, videonystagmography (VNG), and video head impulse test (VHIT). Ethics approval was obtained.
RESULTS: Thirty-two patients were included: 43.8% VMC, 53.1% pVMC, and 3% RVC. Mean age was 12.8 ± 3.5 years (range 5-17), with 59.3% female. Diagnostic delay averaged 9.5 months; 31% had prior neurology evaluation, 53.1% underwent brain imaging, and 21.2% electroencephalography. Audiometry (n = 17) showed unilateral mild-moderate hearing loss in three patients. VNG (n = 24) was abnormal in 70.8%, most commonly central positional nystagmus (50%). VHIT (71.8%) was abnormal in 43.7%. Migraine family history was present in 81.3% (first-degree 68.8%).
CONCLUSION: Pediatric vestibular migraine spectrum disorders frequently demonstrate objective vestibular abnormalities with relatively infrequent hearing loss. Predominance of central positional nystagmus and frequent VHIT abnormalities suggest largely central vestibular involvement consistent with migraine pathophysiology. High rates of prior investigations and prolonged diagnostic delay highlight challenges in recognition. Earlier recognition and targeted audiovestibular evaluation may improve diagnostic efficiency and reduce unnecessary testing.