Zusammenfassung
Der vestibulocollische Reflex (VCR) hat sich in den letzten Jahren zu einem standardisierten
Otolithenfunktionstest in der Neurootologie entwickelt. Er stellt ein weiteres nichtinvasives
Diagnostikum in Beurteilung und Verlaufskontrolle von hauptsächlich peripher-vestibulären
Erkrankungen dar. Mit dem VCR kann die seitengetrennte Funktion des Sacculus, die
Integrität des inferioren Vestibularnerven und der medialen vestibulospinalen Projektionen
nach Umschaltung im Vestibulariskerngebiet beurteilt werden. Er gehört im Rahmen der
Kontrolle von Stand und Gang zu den Haltungsreflexen und wird in der klinischen Routine
vom mittleren Drittel des ipsilateralen, vorinnervierten M. sternocleidomastoideus
nach monauraler akustischer Stimulation abgeleitet. Als gleichwertige Stimuli können
dabei Rechteck-Klicks (0,1 ms Dauer, 95 dB oberhalb der Hörschwelle, max. 145 dB Schalldruck)
oder Burst-Reize (500 Hz, 80 db oberhalb der Hörschwelle, max. 130 db Schalldruck)
verwendet werden. Die Amplitude des gemittelten P13/N23-Komplexes (mindestens 128
Wiederholungen) sollte beim gesunden Erwachsenen bis 60 Jahre größer als 100 μV sein.
Die Latenzen gehen nicht in die Befundung ein. Eine Seitendifferenz der Amplitude
von mehr als 50% zuungunsten der kleineren Antwort ist als pathologisch anzusehen.
Die wichtigsten Anwendungsgebiete für den VCR sind die Detektion von Labyrinthfisteln,
der Ausschluss einer Mitbeteiligung des inferioren Vestibularnerven bei einer Neuritis
vestibularis, einem Akustikusneurinom oder einer bilateralen Vestibulopathie und die
Beurteilung der Sacculusfunktion im Rahmen eines M. Menière. Der VCR kann auch zur
Verlaufsbeurteilung einer schweren basilären Migräne unter medikamentöser Prophylaxe
oder zur prognostischen Einschätzung von Schalltraumen zu Rate gezogen werden. Die
Interpretation des VCR sollte nur in Zusammenschau von Klinik und Anamnese des Patienten
und zusätzlichen elektrophysiologischen Untersuchungen (z. B. Elektronystagmografie
mit kalorischer Spülung, akustisch evozierte Potenziale) erfolgen.
Abstract
The vestibulocollic reflex (VCR) and/or the vestibular-evoked myogenic potentials
(VEMP) have become a routine diagnostic tool to assess otolith function in recent
years. The VCR belongs to the group of vestibulo-spinal reflexes that control posture
and stance. The reflex is usually recorded from the ipsilateral sternocleidomastoid
muscle (SCM) after monaural acoustic stimulation. It is elicited by intense square-wave
click-tones (0.1 ms duration, 95 dB sound pressure level (SPL) above the normal hearing
threshold) or short tone-bursts (STB) (80 dB SPL above normal hearing threshold).
The VCR represents an unphysiological stimulation of the saccculus that reaches the
vestibular nuclei in the lateral pons via the inferior vestibular nerve. After a switch-over
in the medial vestibular nuclei, it travels by means of the medial vestibulospinal
tract to the ipsilateral motorneurons of the SCM. There, it modulates a tonic baseline
activity of the muscle. The VCR has its strength in the detection of fistulas of the
semicircular canals, the dysfunction of the sacculus in Menière's disease as well
as the involvement of the inferior vestibular nerve in vestibular neuritis. It is
also a good clinical method to evaluate acoustic neurinoma, the extent of a bilateral
vestibulopathy and to monitor the course of therapy in basilary migraine.
Schlüsselwörter
VCR - vestibulocollischer Reflex - Sacculus - Otolithenfunktionstest
Key words
VCR - VEMP - otolith function - sacculus
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Korrespondenzadresse
Dr. med. P. Schlindwein
Klinik und Poliklinik für Neurologie
Johannes Gutenberg-Universität
Langenbeckstraße 1
55101 Mainz
Email: schlindw@uni-mainz.de
