在神经血管冲突存在的情况下，可能的前庭阵发症模拟上半规管良性阵发性位置性眩晕：一例病例报告及文献综述。

文献信息

中文摘要

背景： 位置性眩晕是耳科学和前庭物理治疗中常见的主诉，源于影响外周或中枢前庭系统的功能性或结构性原因。尽管良性阵发性位置性眩晕（BPPV）是最常见的形式，但还应考虑其他病因，如前庭阵发症（VP）、中枢性位置性眩晕或椎基底动脉供血不足。识别这些疾病的特定特征和鉴别诊断对于准确评估至关重要。
病例介绍： 我们描述了一例52岁法国女性，表现为位置性眩晕，最初被诊断为右侧上半规管BPPV。尽管进行了多次复位手法，症状仍持续存在。在右侧Dix-Hallpike试验中观察到的位置性下跳性和右扭转型眼震（视频中展示）以及对治疗无反应，引起了对非典型病因的怀疑。MRI重新评估显示右侧小脑前下动脉与右侧前庭蜗神经之间存在神经血管冲突，支持可能的前庭阵发症模拟上半规管BPPV的诊断。
结论： 类似BPPV的位置性眩晕若对复位手法难治或不典型，应促使重新考虑诊断。特别是，疑似上半规管BPPV需要高度警惕诊断并进行全面的临床评估。

英文摘要

BACKGROUND: Positional vertigo is a frequent complaint in otology and vestibular physiotherapy, arising from functional or structural causes affecting the peripheral or central vestibular systems. Although benign paroxysmal positional vertigo (BPPV) is the most common form, other etiologies such as vestibular paroxysmia (VP), central positional vertigo, or vertebrobasilar insufficiency should be considered. Recognizing the specific features and differential diagnosis of these conditions is crucial for accurate assessment.
CASE PRESENTATION: We describe the case of a 52-year-old French woman presenting with positional vertigo initially diagnosed as a BPPV of the right superior semicircular canal. Despite multiple repositioning maneuvers, symptoms persisted. The positional downbeat and right torsional nystagmus observed in the right Dix-Hallpike test (illustrated in video) and the lack of response to treatment raised suspicion of an atypical etiology. MRI re-evaluation revealed a neurovascular conflict between the right anterior inferior cerebellar artery and the right vestibulocochlear nerve, supporting the diagnosis of probable vestibular paroxysmia mimicking a superior canal BPPV.
CONCLUSIONS: Positional vertigo resembling BPPV that is refractory to repositioning maneuvers or atypical should prompt reconsideration of the diagnosis. In particular, suspected superior canal BPPV requires heightened diagnostic caution and a comprehensive clinical assessment.