Zusammenfassung
Hintergrund: Zur Beurteilung von Schwindelpatienten mit vermutetem zervikal-somatosensorischen
Defizit wurden bisher schwerpunktmäßig reflektorische Systeme wie der zervikookuläre
Reflex oder die posturalen Haltungssysteme untersucht.
Methode: Wir wollten die zervikale kinästhetische Sensibilität in der Kopf-Körper-Koordination
untersuchen. Dafür wurden zwei vorläufige Testreihen, der „subjektive Nulldurchgang”
der Kopfgelenke und die „Rückstellsakkade bei Rumpfdrehung” eingeführt und als
Untersuchungsinstrumente evaluiert. Die subjektive Erfassung der Schwindelbeschwerden
von Patienten/Probanden erfolgte mittels Dizziness Handycap Inventory-Erhebungsinstrument
(DHI). Die Patientengruppen bestanden aus 24 Patienten mit palpatorisch zervikal-somatosensorischem
Defizit (Gruppe I) sowie 23 Patienten mit einem zentralvestibulär kompensierten
einseitigen Vestibularisdefizit (Gruppe II). In der Kontrollgruppe (Gruppe III)
befanden sich 22 gesunde Probanden. Ziel der vorliegenden Arbeit ist es, den
„subjektiven Nulldurchgang der Kopfgelenke” sowie das Testverfahren der „sakkadischen
Augenrückstellbewegung bei Rumpfdrehung” durch eine dreidimensionale Videookulografie
(3D-VOG) ausführlich zu erläutern.
Ergebnisse: Im ersten Testverfahren konnten Patienten mit einem zervikal-somatosensorischen
Defizit durch die Testparameter von den Gruppen II und III signifikant abgrenzt
werden. Im zweiten Verfahren konnten signifikante Unterschiede zwischen Gruppe
I und III gezeigt werden.
Fazit: Aus den Gruppenunterschieden schlussfolgern wir, dass die Erfassung der zervikozephalen
Kinästhetik einen weiteren Hinweis auf eine gestörte Halspropriozeption liefert.
Abstract
Background: In the assessment of vertigo patients with suspected cervicocephalic somatosensory
deficit, the studies published thus far have focused on reflectory systems like
the cervico-ocular reflex or the postural systems. Our study examines the cervicocephalic
kinesthetic sensibility of head and body coordination. We therefore introduce
two preliminary test series: the „subjective zero chin-knee-angle of the occipital
joints” and the „saccadic repositioning during trunk rotation”. Methods: Subjective recordings of dizziness complaints were done using the Dizziness Handicap
Inventory. Patients: The study population consisted of 24 patients with palpatory cervicocephalic
somatosensory deficit (group I) and 23 patients with a central vestibular compensated
unilateral vestibular deficit (group II). Twenty-two healthy patients served as
controls.
The aim of the study is to provide a detailed examination of the „subjective zero
chin-knee-angle of the occipital joints” as well as a detailed discussion of „saccadic
repositioning with trunk rotation” by three-dimensional videooculography (3D-VOG).
Results: We were able to separate patients with a cervicocephalic somatosensory deficit
with the first test procedure and differentiate them from groups II and III. The
second test procedure shows a significant difference between groups I and III.
Conclusion: We conclude from the group difference that the recording of cervicocephalic kinesthetic
sensibility is a further indication of disturbed cervical proprioception.
Schlüsselwörter
zervikaler Schwindel - zervikozephale kinästhetische Sensibilität - Halspropriozeption
Key words
cervical vertigo - cervicocephalic kinaesthetic sensibility - neck proprioception
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Dr. med. Matthias Hölzl
Oberarzt der HNO-Klinik, Charité Campus Mitte
Universitätsmedizin Berlin
Hals-Nasen-Ohrenklinik und Poliklinik
Schumannstraße 20/21
10117 Berlin
eMail: matthias.hoelzl@charite.de