Coriolis-Experiment
description
Transcript of Coriolis-Experiment
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Der vestibulo-okuläre Reflex (VOR) und seine klinische Bedeutung
Dominik StraumannNeurologische Klinik
Universitätsspital Zürich
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Coriolis-Experiment
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Bockisch et al. 2003
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accelerometer
„No rotation.“
1 minute
„No rotation.“
„Rotation about intraaural axis.“
constant velocity
Tilt
„Rotation aboutoblique axis.“
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Syd Mead
Gaspard-Gustave de Coriolis (Paris, 1792-1843)
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okulärer Schwindel
psychophysiologischer Schwindel
internistischer Schwindel
vestibuläre Migräne
zentrale Vestibulopathie
bilaterale Vestibulopathie
unilaterale Vestibulopathie
multisensorischer Schwindel
unklarer Schwindel
benigner paroxysmalerLagerungsschwindel
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0
Prozent
> 65 Jahre < 65 Jahre
häufigste Schwindeldiagnosen
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Orientierungssinn
• In welche Richtung bewege ich mich?
• Um welche Achse drehe ich mich?
• Wie stehe / sitze / liege ich zur Schwerkraft?
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vestibuläres vestibuläres Labyrinth Labyrinth
PropriozeptionPropriozeption(Druck, Position) (Druck, Position)
visuelles visuelles SystemSystem
Orientierungs-Orientierungs-sinnsinn
motorisches motorisches SystemSystem
NavigationNavigation BlickstabilisierungBlickstabilisierungKörperbalanceKörperbalance
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horizontaler semizirkulärer Kanal
Ncl. vestibularis
VI
III
Augenmuskel
Reflex-Latenz:8-10 ms
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Ferner &Staubesand 1982
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Ferner und Staubesand 1982
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Ferner und Staubesand 1982
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Bewegung
Translation
Rotation
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Leigh & Zee 1999
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Baloh & Honrubia 1990
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Leigh & Zee 1999
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R. Nieuwenhuys et al. 1988
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Normaler Kopf-Impuls-Test*
*Halmagyi G.M., Curthoys I.S (1988) Archives of Neurology
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Pathologischer Kopf-Impuls-Test
Korrektur-Sakkade
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asymmetrisch bilaterale oder rechtsseitige Läsion?
Video
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Beeinflusst ein einseitiger vestibulärer Ausfall den
VOR auf die andere Seite?
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-30 -20 -10 0 10 20 30 40-40
-30
-20
-10
0
10
20
30
40
Head in space [°]
Eye
in s
pace
[°]
5 Tage nach vestibulärer Neuritis
GL = 0.34
GR = 0.65
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0 2 4 60
0.5
1
Gai
n ip
sile
sion
al
II III VIIC
Time [log (weeks)]
Palla et al. (2005)
I-IV: patients
C: normals
Vestibuläre Neuritis: Zeitverlauf
Gai
n co
ntr
ale
sio
nal
0 2 4 60
0.5
1
Time [log (weeks)]
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Leigh & Zee 2006
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h•
linear
nonlinear
linear
nonlinear
kl
kn
R
e•
kl
kn
R
NI TdEye
Plant
peripheral zentral
Lasker et al. 2000(modified)
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h = 0•
linear
non-linear
linear
non-linear
90
0
0
90
90
90
0 h = 200 º/s•
linear
non-linear
linear
non-linear
150
20
0
30
170
30
140
43%
57 %
Head not moving Head impulse to the right
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h•
linear
nonlinear
linear
nonlinear
kl
kn
R
e•
kl
kn
R
NI TdEye
Plant
peripher zentral
Lasker et al. 2000(modified)
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h = 200 º/s•
linear
non-linear
linear
non-linear
90
0
0
30
90
30
60
Head impulse to the right
h = 200 º/s•
linear
non-linear
linear
non-linear
150
20
0
30
170
30
140
Head impulse to the right
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h•
linear
nonlinear
linear
nonlinear
kl
kn
R
e•
kl
kn
R
NI TdEye
Plant
peripher zentral
Lasker et al. 2000(modified)
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h = 200 º/s•
linear
non-linear
linear
non-linear
150
20
0
90
170
90
80
Head impulse to the right
h = 200 º/s•
linear
non-linear
linear
non-linear
150
20
0
30
170
30
140
Head impulse to the right
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h•
linear
nonlinear
linear
nonlinear
kl
kn
R
e•
kl
kn
R
NI TdEye
Plant
peripher zentral
Lasker et al. 2000(modifizied)
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h = 200 º/s•
linear
non-linear
linear
non-linear
90
0
0
30
90
30
60norm: 140
Head impulse to the right
h = 200 º/s•
linear
non-linear
linear
non-linear
80
0
0* 2
30* 1.1
80
33
47norm: 140
Head impulse to the right
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h•
linear
nonlinear
linear
nonlinear
kl
kn
R
e•
kl
kn
R
NI TdEye
Plant
peripher zentral
Lasker et al. 2000(modifiziert)
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h = 200 º/s•
linear
non-linear
linear
non-linear
150
20
0
90
170
90
80norm: 140
Head impulse to the right
h = 200 º/s•
linear
non-linear
linear
non-linear
150* 1.1
20* 2
0
80
205
80
125norm: 140
Head impulse to the right
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Ein zu tiefer kontralateraler Gain kann das Resultat einer inkompletten zentralen UPREGULATION auf der
gesunden Seite sein!
DD: asymmetrische bilaterale
vestibuläre Läsion
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G
ains
Gain ipsilalteral
-0.2 0 0.2 0.4 0.6 0.8 1-0.2
0
0.2
0.4
0.6
0.8
1
R = 0.66 p < 0.01
full UPREGULATION
no UPREGULATION
Palla et al. (2004)
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Bewegung
Translation
Rotation
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Leigh & Zee 1999
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Linearer vestibulo-okulärer Reflex
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oderacc
„tilt-translationDilemma“
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Tilt-Translation-Dilemma
Äquivalenzprinzip:
Ein Beschleunigungs-messer kann nicht zwischen Schwerkraft und Beschleunigung unterscheiden.
(1907)
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Kopfschlitten
Video
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0 0.2 0.4-5
0
5
10
15
20
0 0.2 0.4-1
0
1
2
3h
ori
zon
tal
[º]
tors
ion
al
[º]
time [s]
time [s]
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SWAY HEAVE
SURGE
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Olasagasti et al. 2008
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Olasagasti et al. 2008
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Besteht ein akutes vestibuläres Ungleichgewicht?
HORIZONTALER SPONTANNYSTAGMUS
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Horizontaler Spontannystagmus
0 1 2 3 4 5
-1
-0.5
0
0.5
1
Zeit [s]
Hor
izon
tale
A
ugen
posi
tions
[°]
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Vertikaler Spontannystagmus
Video
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Spontan-Nystagmus
horizontal vertikal
peripher > zentral(Ausnahme: Rebound-Nystagmus)
zentral
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vertikaler Drift Kopfposition
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Ocular counterpitch
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overacting static ocular counterpitch
+DBN
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Vertikaler Drift bei KH-Atrophie
Body position [°]
Drif
t vel
ocity
[°/s
]
gravity-independent
gravity-dependent
sumMarti S, Palla A, Straumann D (2002) Ann Neurol
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Besteht eine Canalolithiasis?
LAGERUNGSMANÖVER
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Canalolithiasis
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Cupulolithiasis (selten!)
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Canalolithiasis (Hall, Ruby and Mc Clure 1979)
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Benigner paroxysmaler Lagerungsschwindel:
Häufigkeit
• 50% idiopathisch
• 17% posttraumatisch
• 15% nach vestibulärer Neuritis
Baloh et al. 1987
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Commotio / Contusio labyrinthi
Trauma
direkte Loslösung
Zell-Degeneration
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hinterer Bogengang
lateraler Bogengang
Provokations-manöver
Befreiungs-manöver
Hallpike
Epleymodifiziert
Barbecue
GUFONI
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Lagerungsmanöver1. Hallpike bds.
2. Barbecue 90 Grad bds. mit Repetition
3. Hallpike bds.
Achtung!
Lange genug warten!
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Lagerungsmanöver
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Posteriore Canalolithiasis
Video
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Laterale Canalolithiasis – geotrope Variante
Video
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Laterale Canalolithiasis – apogeotrope Variante
Video
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Manoeuvres for BPPV
Daniele Nuti
Dipartimento di Scienze Ortopediche, Radiologiche ed Otorinolaringoiatriche
Università di Siena
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hinterer Bogengang
lateraler Bogengang
Provokations-manöver
Befreiungs-manöver
Hallpike
Epleymodifiziert
Barbecue
GUFONI
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Epley-Manöver
David Solomon
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Epley-Manöver links (1)
45°
vertikal-torsioneller Nystagmus
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Epley-Manöver links (2)
aufsitzen
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Furman 1999
Epley-Manöver
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Furman 1999
Epley-Manöver
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Furman 1999
Epley-Manöver
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Furman 1999
Epley-Manöver
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Epley-Manöver
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Epley-Manöver
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http://www.charite.de/ch/neuro/vertigo.html
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Gufoni Manöver
Video
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Behandlung der lateralen Bogengangsvariante
Gufoni-Mastrosimone 1999
2 minutes
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Gufoni-Manöver
immer zur Seite mit dem geringeren horizontalen Lagerungsnystagmus
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Gufoni-Manöver
immer zur Seite mit dem geringeren horizontalen Lagerungsnystagmus– gesunde Seite in der geotropen Variante– betroffene Seite in der apogeotropen Variante
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Bemerkungen zu den Canalolith-Repositionsmanövern (1)
• „Mobilisation“ der Canalolithen mit Klopfen oder Vibration
• Unmittelbar nach der Reposition verspüren viele Patienten einen Zug in Richtung des betroffenen Labyrinths (Canalolithen auf dem Utriculus?).
• Therapie-Kontrolle: nochmaliges Hallpike-Manöver ev. mit weiterem Epley-Manöver
• Leichte Gleichgewichtsstörungen während der ersten drei Tage sind üblich.
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Bemerkungen zu den Canalolith-Repositionsmanövern (2)
• Der Patient soll danach während drei Tagen Erschütterungen (Joggen, Sprünge) und Kopftieflage (Zahnärzte!) vermeiden.
• Nach drei Tagen telefonische Rückmeldung nach vorgängigem selbstständigem Hallpike-Manöver
• Ev. Wiederholung des Manövers bei Persistenz des Lagerungsschwindels
• Therapieerfolge nach Epley-Manöver: 90%; nach Gufoni: ca. 90%
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73% der Zuweisungsdiagnosen: „unklarer Schwindel“
Enddiagnosen:
%
0 5 10 15 20 25
Canalolithiasis
unklar
unilaterale periphere Vestibulopathie
vestibuläre Migräne
psychophysiologischer Schwindel
zentrale Vestibulopathie
bilaterale periphere Vestibulopathie
multisensorischer Schwindel
präsynkopaler Schwindel
andere
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