Preliminary analysis of diagnosis and treatment for positional vertigo with invalid maneuver and negative MRI

Abstract

Objective To analyze the types and characteristics of nystagmus in patients with positional vertigo who were ineffective by particle repositioning maneuver (PRM) and had negative findings in MRI, and try to explore drug treatment and prevention programme. Methods A total of 43 patients with positional nystagmus were randomly treated with clonazepam or flunarizine hydrochloride. The therapeutic effect at acute phase was evaluated by comparing maximum slow phase velocity (SPV) before and after treatment. Among all patients, 21 patients with frequent attacks in recent 2 months were randomly divided into flunarizine hydrochloride prophylaxis treatment group (prophylaxis group) and blank control group (control group), followed up and recorded the average attack days of vertigo per month (days of single attack × number of attacks). The preventive effect of flunarizine hydrochloride was analyzed. Results Among 43 patients, 29 cases met the diagnostic criteria of definite and probable vestibular migraine. The main types of nystagmus were horizontal apogeotropic nystagmus (23 cases, 53.49% ), horizontal geotropic nystagmus (3 cases, 6.98% ), downbeat nystagmus (4 cases, 9.30% ) and mixed nystagmus (13 cases, 30.23%). Nystagmus lasted a longer time and lacked the characteristics of crescendo-decrescendo. After 3 d of treatment, the maximum SPV [2.40 (0.00, 17.15) °/s] of clonazepam group was significantly reduced, and the therapeutic effect at acute phase was better compared with flunarizine hydrochloride group [18.85 (1.58, 35.75) °/s; Z = -2.284, P = 0.022]. After 2 months, the average attack days of vertigo per month in prophylaxis group [1 (0, 2) d] was significantly reduced in comparison with control group [3.50 (1.50, 6.50) d; Z = -2.096, P = 0.036). Conclusions Positional vertigo with ineffective PRM and negative findings in MRI may be related to abnormal central function. After excluding the relevant contraindications, clonazepam can relieve vertigo and nystagmus in the acute phase, especially in vestibular migraine patients. For patients with frequent attacks, flunarizine hydrochloride maybe an available preventive treatment.

DOI: 10.3969/j.issn.1672-6731.2019.02.003