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1 Research in Vestibular Science Vol. 14, No. 4, December 2015 Original Article pissn , eissn 전정신경염에서비디오두부충동검사를이용한전정기능회복평가 순천향대학교의과대학 1 부천병원신경과학교실, 2 서울병원신경과학교실, 3 천안병원신경과학교실 김준현 1, 이태경 1, 이상우 1, 최나리 2, 이승철 3, 성기범 1 Assessment of Vestibular Functional Recovery Using Video Head Impulse Test in Vestibular Neuritis Jun-Hyun Kim 1, Tae-Kyeong Lee 1, Sang-Woo Lee 1, Nari Choi 2, Seungcheol Lee 3, Ki-Bum Sung 1 1 Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon; 2 Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul; 3 Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea Received Oct 16, 2015 Revised Nov 26, 2015 Accepted Nov 27, 2015 Corresponding Author: Tae-Kyeong Lee Department of Neurology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: Fax: xorudoc@schmc.ac.kr Copyright c 2015 by The Korean Balance Society. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective: The video head impulse test (vhit) is useful for evaluation of high frequency vestibulo-ocular reflex. There are a few reports regarding the recovery of head impulse test in vestibular neuritis (VN) but the factors for the recovery were not studied. The study aimed to identify the recovery patterns of vhit in VN and the factors influencing the recovery. Methods: Among 31 patients with acute VN, 18 patients with identified recovery pattern were selected. We conducted serial checks of subjective vertigo and spontaneous nystagmus until discharged (1 8 days), and scheduled vhits. We found three patterns in serial vhits during follow-ups and analyzed the relationship of initial vestibular function tests, serial check-ups of subjective vertigo, bedside neuro-otologic tests, and vhits. Results: Five patients showed normal vhit gain in acute stage (non-damaged pattern) and 8 patients gains were recovered after 30 days after symptom onset (early recovered pattern). Poor recovery pattern was found in 5 patients (poorly recovered pattern). There were relationship between vhit recovery patterns and the severity of vestibular dysfunctions. Duration of spontaneous nystagmus (until grade 1), degree of subjective visual vertical tilt, ocular vestibular myogenic potential abnormalities, and abnormality of rotatory chair test were all related to poorly recovered vhit patterns. All poor recovery patients had residual symptom at 30 days after symptom onset. Conclusion: The vhit may give clinicians useful hints in predicting prognosis in VN, and the recovery of vhit would be delayed if the damage were more extensive. Res Vestib Sci 2015;14(4): Keywords: Head impulse test; Reflex; Vestibulo-ocular; Vestibular neuronitis 서론전정신경염은현훈, 자세불균형, 오심구토를동반하는흔한전정장애이다. 대부분의환자는수일내에증상이호 전되지만일부환자에서는수개월에서수년후에도잔존어지럼이남기도한다. 1,2 전정신경염의진단에는자발안진, 두진후안진, 두부충동검사등수기진찰과함께온도안진검사, 전정유발근전 132

2 김준현외 5 인. 비디오두부충동검사를이용한전정신경염의회복 위검사등의검사가쓰인다. 두부충동검사는검사자가쉽게시행할수있고별다른도구가필요하지않으며말초전정질환에서높은양성율을보이기때문에전정질환의진단에유용한검사이지만 3 짧은시간에환자의안구움직임을육안으로관찰해야하므로검사자의경험에따라결과가다르게나타나는경우가많아객관적측정이어렵다. 4 그러나비디오처리기술의발달에힘입어비디오두부충동검사가개발되어최근에전정질환진단에도입되고있다. 전정신경염에서온도안진검사와두부충동도수검사를포함한전정기능검사의회복양상에대한연구에서두부충동검사의회복은환자에따라다양하게나타나지만검사의회복에영향을주는요인에대한연구는없다. 5,6 본연구에서는전정신경염환자들의비디오두부충동검사를추적하여전정신경염에서의고주파수전정안반사의회복을관찰하고, 회복양상과초기전정계검사결과, 환자의주관적어지럼의정도와의관계를분석하여전정안반사의주파수스펙트럼에따른손상정도와기타전정소기관기능의손상이전정기능회복과연관성이있는지확인하고자하였다. 대상및방법 1. 대상 2014년 8월부터 2015년 6월까지전정신경염으로입원한환자 31명중비디오두부충동검사를추적하여회복패턴을확인할수있었던 18명을대상으로하였다. 환자들은 24시간이상의회전성어지럼과수평자발안진을보였으나두부충동검사, 두진후안진검사및자세변환검사에서중추성안구운동이상을보이지않았고청력저하가없었으며온도안진검사에서반고리관마비가 25% 이상이었다. 환자들은이과적수술병력이없었고양측고막이정상이었으며나이, 허혈위험인자를고려하여중추성어지럼의가능성이있는 9명의환자들은확산강조영상을포함한뇌자기공명영상을시행하여뇌병변이없음을확인하였다. 모든환자들은전정기능에영향을줄수있는약제를투여받지않았다. 2. 전정기능검사입원중매일오전에자발안진의강도 (grade 1 3) 와주관적현훈강도 (0 10점) 을측정하였고, 입원중한차례의비 디오두부충동검사, 회전의자검사, 경부및안구전정유발근전위검사, 주관적시수직검사, 온도안진검사, 안저사진촬영, 청력검사를하였다. 퇴원후 1주, 5주, 13주, 25주에외래추적하여자발안진과잔존증상을확인하고비디오두부충동검사를하였다. 환자의어지럼정도를확인하기위한변수로자발안진의기간, 현훈의기간, 그리고추적진료에서어지럼의정도를측정하였다. 자발안진의기간은입원중매일평가한시선고정자발안진이증상발생일로부터 grade 1이될때까지걸린날수로정의하였고, 현훈의기간은매일평가한주관적인회전성어지럼의강도 (0 10) 가증상발생일로부터 5점이하로감소할때까지의날수로정의하였다. 비디오두부충동검사를위해환자는 ICS impulse 비디오고글 (GN otometrics, Taastrup, Demark) 을착용하고 1 m 거리의흰벽에그려진 5 mm 직경의검은점을주시하게하였다. 모든환자는한명의검사자 (Kim JH) 가각반고리관당약 50회의회전자극을주었고회전최고속도는수평반고리관에서초당 도, 수직반고리관에서초당 도였다. 검사자는수평반고리관검사시에고글고정띠가손에닿지않도록양손으로머리위쪽을잡았으며, 수직반고리관검사시에는오른손으로정수리를, 왼손으로턱밑을잡고머리를회전시켰다. 수직반고리관검사오른손의손가락을환자시상면에서 45도각도로잡고, 검사중손가락이목표물을향하도록주의하여머리회전의각도가 45도로유지되도록하였다. 각반고리관이득의측정에 impulse goggle 구동 software인 OTOsuite Vestibular를이용하였다. 회전의자검사는 System 2000 (Micromedical, Chatham, IL, USA) 를이용하였으며 0.02, 0.16, 0.32, 0.64 Hz의정현파검사 (sinusoidal harmonic acceleration test, SHA test) 에서전정안반사이득을측정하였다. 안구회선은안저사진을찍은뒤중심유두의수평선과중심오목-중심유두사이의각도를측정하였다. 수평선보다중심유두가아래에있을때 (+), 중심유두가수평선보다위에있어내회선되어있을때 ( ) 로하였다. 온도안진검사는환자를눕힌상태에서외이도에섭씨 25도와 50도의공기로 1분간온도자극을주었으며 Jonkee 공식을이용하여반고리관마비를계산하였다. 전정유발근전위검사는 500 Hz tone burst 자극을이용하여동측흉쇄유돌근에서경부전정유발근전위를, 반대측눈밑에서안구전정유발근전위를검사하였다. 133

3 Res Vestib Sci Vol. 14, No. 4, Dec 통계적방법 PASW ver. 18 (SPSS Inc., Chicago, IL, USA) 를이용하여통계를수행하였다. 연속변수의분석을위해 Shapiro-Wilk 검정을이용하여정규성검정을하였고, 군간의차이를분석하기위해연속변수는정규성과등분산성을만족한경우 analysis of variance, 만족하지못한경우 Kruskal- Wallis 검정, 사후검정은 Bonferroni 검정을하였다. 척도변수는 Fisher s exact 검정을이용하였다. 두연속변수의상관관계평가에는정규성검정결과에따라 Pearson 혹은 Spearman rank 상관분석을이용하였다. p-value<0.05를유의한것으로판별하였다. 그래프작성에는 R: A Language and Environment for Statistical Computing (Vienna, Austria) 와 ggplot2 package를이용하였다. Table 1. Demographic information and laboratory results of groups by video head impulse test recovery pattern Parameter Poor recovery (n=5) Recovery (n=8) Unimpaired (n=5) Total (n=18) p-value Age (yr) [52.00;58.00] [39.00;56.00] [49.00;59.00] [45.00;58.00] 0.52 Male 1 (20) 4 (50) 3 (60) 8 (44.4) LOS (day) 5.80± ± ± ± SN ( Grade I), length (day) 5.00± ± ± ± Vertigo (10 5), length (day) 2.50± ± ± ± CP (%) [43.74;51.96] [31.14;64.79] [30.46;48.93] [31.93;51.96] Ipsilesional OT ( o ) 20.32± ± ± ± Contralesional OT ( o ) 6.42± ± ± ± SVV tilt ( o ) 10.22± ± ± ± Ipsilesional ovemp Abnormal 5 (100.00) 5 (62.50) 1 (20.00) 11 (61.10) Normal 0 3 (37.50) 4 (80.00) 7 (38.90) Contralesional ovemp Abnormal 0 3 (37.50) 1 (20.00) 4 (22.22) Normal 5 (100.00) 5 (62.50) 4 (80.00) 14 (77.78) Ipsilesional cvemp Abnormal 1 (20.00) 2 (25.00) 2 (40.00) 5 (27.80) Normal 4 (80.00) 6 (75.00) 3 (60.00) 13 (72.22) Contralesional cvemp Abnormal 0 2 (25.00) 1 (20.00) 3 (16.67) Normal 5 (100.00) 6 (75.00) 4 (80.00) 15 (83.33) SHA gain 0.01 Hz 0.14± ± ± ± Hz 0.22± ± ± ± Hz 0.38± ± ± ± Hz 0.45± ± ± ± Hz 0.50± ± ± ± Hz 0.48± ± ± ± Residual symptom 5 (100.00) 1 (12.50) 1 (25.00) 7 (41.18) Initial vhit gain Ipsilesional horizontal 0.18± ± ± ±0.37 <0.001 Contralesional horizontal 0.86± ± ± ± Ipsilesional anterior 0.23± ± ± ±0.27 <0.001 Contralesional anterior 0.62± ± ± ± Ipsilesional posterior 0.54± ± ± ± Contralesional posterior 0.54± ± ± ± Values are presented as median [interquartile range] or number (%). LOS, length of stay; SN, spontaneous nystagmus; CP, caloric paresis; OT, ocular torsion; SVV, subjective visual vertical; ovemp, ocular vestibular myogenic potential; cvemp, cervical vestibular myogenic potential; SHA, sinusoidal harmonic acceleration; vhit, video head impulse test. 134

4 김준현외 5 인. 비디오두부충동검사를이용한전정신경염의회복 결과전체환자의평균나이는 49.2세였고남자 8명, 여자 10 명이었다 (Table 1). 입원중시행한검사에서병변측수평반고리관이득이 0.8 이상이었던환자가 5명 ( 비손상군 ) 이었고, 나머지 13명은 0.8 미만이었다. 이중 8명은증상발생후 30일이내에이득이 0.8 이상으로회복되었고 ( 회복군 ), 5명은 30일이후에도이득이 0.8 미만이었다 ( 회복군 ). 회복군에서는대개증상발생 10일에서 20일사이에이득이회복됨을확인할수있었고, 이득이 30일이후에도회복되지않은 5명중 2명은 90일이후에도이득이회복되지않았다 (Figure 1A). 초기검사에서병변측수평반고리관이득은비손상군 1.06, 회복군 0.57, 비회복군 0.18으로차이가있었으며 (p< 0.001), 사후검정에서회복군과비회복군사이에도유의한차이가있었다 (p=0.001). 전반고리관의비디오충동검사이득은발병초기에는수평반고리관의이득과뚜렷한상관관계를보였으나 (Spearman r=0.79, p<0.001) 추적검사에서회복군의이득회복이수평반고리관에비해뚜렷하지않았으며비손상군과비회복군의차이도뚜렷하지않았다 (Figure 1B). 후반고리관의이득은군간의차이가없었으며수평반고리관이득과의상관관계도보이지않았다 (Spearman r=0.33, p=0.18) (Figure 1C). 증상발생초기에시행한여러전정검사가비디오충동검사로나눈군에따라보이는차이를확인하고자각군의전정검사결과를비교하였다. 자발안진의평균지속기간은비손상군 1.6일, 회복군 3.9일, 비회복군 5.0일이었다. 군간의차이는유의하였으며 (p=0.029), Bonferroni 사후검정에서비회복군과비손상군사이에유의한차이를보였고 (p=0.03) 회복군과비회복군사이에는유의한차이가없었다. 입원중현훈의지속기간은비손상군 1.6일, 회복군 3.0일, 비회복군 2.5일로군간차이는없었다. 주관적시수직각도는비손상군 1.0 o, 회복군 5.6 o, 비회복군 10.2 o 로, 군간에유의한차이를보였다 (p=0.017). 온도안진검사반고리관마비율은비손상군 47.9%, 회복군은 36.7%, 비회복군은 45.7% 로군간차이는없었다. 안구회선은병변측과병변반대측으로나누어평가하였다. 병변측안구회선의평균각도는비손상군 8.2 o, 회복군 10.5 o, 비회복군 20.3 o 로유의한차이는없었다 (p=0.221). 병변반대측역시비손상군 3.8 o, 회복군 0.7 o, 비회복군에서 6.4 o 로군간에차이가없었다 (p= 0.197). 안구전정유발근전위검사에서병변측자극시비손상군에서는정상 4명, 비정상 1명, 회복군에서는정상 3명, 비정상 5명이었고, 비회복군에서는모두파형형성이불량하여군간에유의한차이가있었지만 (p=0.035), 반대쪽안구전정유발근전위는군간에차이가없었다. 경부전정유발근전위검사에서병변측자극시비손상군에서는정상 3명, 비정상 2명, 회복군에서는정상 6명, 비정상 2명, 비회복군에서는정상 4명, 비정상 1명으로각군간차이는없었다. 반대쪽은 3명의비정상을제외한모두가정상이었다. 정현파회전의자검사에서각주파수별전정안반사이득은 Table 1과같다. 비손상군은모든주파수에서높은이득을보였고비회복군은낮은이득을보였으며 0.01 Hz, 0.08 Hz, 0.64 Hz에서비손상군과비회복군사이에유의한차이를보였다. 수평반고리관두부충동검사이득과정현파회전의자검사의주파수별이득의상관관계를확인하기위해 Pearson 상관분석을시행한결과 0.01 Hz (r=0.7, p=0.002), 0.02 Hz (r=0.6, p=0.003), 0.64 Hz (r=0.5, p=0.017) Figure 1. Follow-up of video head impulse gain from vestibular neuritis. (A) Ipsilesional horizontal canal gain. Unimpaired, initial gain>0.8; Recover, initial gain<0.8 but recovered within 30 days; Poor recovery, gain<0.8 after 30 days. (B) Anterior canal, (C) Posterior canal. ihc, ipsilesional horizontal canal; iac, ipsilesional anterior canal; ipc, ipsilesional posterior canal. 135

5 Res Vestib Sci Vol. 14, No. 4, Dec 로저주파에서강한상관관계를, 고주파에서중간강도의상관관계를보였다 (Figure 2). 외래추적결과비손상군에서 1명 ( 발병후 40일 ), 회복군에서 1명 (41일) 을제외한모두가일상생활에남아있는장애가없었으나, 비회복군에서는 5명모두가외래추적결과 (30 107일) 움직일때어지럼을느끼는등일상생활에서경도이상의장애를가지고있었다. 고 본연구는전정신경염환자를비디오두부충동검사로추적하여회복의패턴을확인하고, 예후에따른환자군의발병초기전정검사결과를비교한연구이다. 비손상군, 손상후회복군, 비회복군으로나누었을때전정신경염발병초기의수평반고리관비디오두부충동검사에서이득이감소하지않은비손상군환자가 28% (8/18) 로적지않았고, 회복군은대부분 10일에서 20일사이에정상이득을회복하는것으로나타났다. 여러전정검사에서기능손상은비회복군, 회복군, 비손상군순서로많았다. 자발안진의지속기간, 주관적시수직, 안구전정유발근전위, 정현파회전의자검사의결과가환자군사이에유의한차이를보였으나현훈의지속기간, 온도안진검사, 안구회선에서는통계적으로차이가없었다. 전정신경염은발병후수주이내에회복되는양성질환으로알려졌으나전정검사를장기추적한연구들은다양한예후를보고하였다. 한보고에서전정신경염환자 20명의 Figure 2. Gain of rotatory chair sinusoidal harmonic acceleration test according to video head impulse test recovery group. Highest SHA gain in vhit unimpaired group, lowest gain in poor recovery group. SHA, sinusoidal harmonic accleration; vhit, video head impulse test. 찰 다양한전정검사변화를관찰하였을때전정기능의회복은각전정검사별로차이가있어서두부충동검사는온도안진검사에비해회복속도가빠르며, 비디오를이용하지않은단순두부충동검사에서발병초기에도 10% 는교정단속운동을보이지않았고, 1개월후에는 40% 가교정단속운동을보이지않았다. 5 본연구에서도전정신경염발병초기에두부충동검사이득이정상인환자가있는것과 1개월후회복이전체환자중 44% 인것을확인할수있었다. Palla와 Straumann 7 은횡단면적으로발병시기가다양한 37명의전정신경염환자를자기탐색코일두부충동검사하여평균이득을발병 1주이내 (0.35), 1 4주 (0.33), 4 40주 (0.55), 주 (0.50) 에서구한결과전정신경염에서두부충동검사가발병 4주이내에는회복이적다고하였지만, 이연구는추적검사하여얻은이득변화의관찰이아닌발병시기별평균전정안반사이득을보여주므로환자를추적검사한본연구에서의 20일이내이득호전이더의미가있을것으로생각된다. Okinaka 등 8 은전정신경염환자 60 명의온도안진검사를장기추적하였을때발병 1개월후 10%, 6개월후 20%, 2년후 33% 만이온도안진검사가정상화되며증상의회복도 57% 에서만보이므로전정신경염에서저주파전정안반사는고주파에비해회복이느리며불완전함을시사하였다. 반면 Schmid-Priscoveanu 등 9 의연구에서는만성기 (>2개월, 14명 ) 환자의두부충동비대칭이연구대상의 100%, 반고리관마비가 64% 에서보이므로만성기온도안진검사가두부충동검사보다회복이많음을보고하였다. 그러나이역시추적검사가아닌횡단면연구라는한계가있다. Adamec 등 10 은전정신경염환자 26명중 12명 (46%) 이발병 6개월후안구전정유발근전위진폭의호전이없었다고하였고 Magliulo 등 1 은 28명중 8명 (28.6%) 이 1년후안구전정유발근전위혹은비디오두부충동검사에서이상을보였고그중 5명이잔존증상이있었다고보고하여 1 반고리관뿐아니라이석기관의기능손상도전정안반사와마찬가지로회복이불완전할수있으며잔존증상이 1년이상지속될수있다는것을보여준다. 수평반고리관의전정안반사이득은온도안진검사와회전의자검사, 두부충동검사로측정할수있다. 온도안진검사는 Hz의낮은주파수영역, 회전의자검사는 Hz 영역, 두부충동검사는일상생활의움직임과유사한고주파 (5 7 Hz) 영역의이득을평가한다. 11,12 이번연구에서온도안진검사의반고리관마비율은두부충동검사의수평반고리관이득과상관관계가없었으나회전의자 136

6 김준현외 5 인. 비디오두부충동검사를이용한전정신경염의회복 검사에서 0.02 Hz, 0.08 Hz, 0.64 Hz 평균이득이두부충동검사군에따라차이가있었고, 각환자의두부충동검사이득과 0.01 Hz, 0.02 Hz, 0.64 Hz 정현파이득이양의상관관계를보여 0.01 Hz에서 7 Hz는공통의신경기제를가지는것으로추측된다. 온도안진검사와두부충동검사가급성기전정신경염환자에서상관관계가없으며, 9 회복속도도두부충동검사가온도안진검사보다빠른것으로알려져있다. 5,6 이번연구에서도급성기에시행한두검사에서상관관계가없는것으로나타나전정신경염은주파수에따라전정안반사에다른영향을미치는것을확인하였다. 이에대한실험적근거로 regular vestibular afferent fiber는낮은주파수회전에민감하고 irregular afferent는높은주파수에민감하다는동물실험결과가제시된다. 13,14 따라서온도안진검사주파수범위에서는 regular afferent가담당하고, 회전의자검사와두부충동검사의주파수범위는 irregular afferent가전정안반사를담당하며, 전정신경염이후 regular afferent fiber의회복이 irregular afferent fiber에비해느릴것으로추측할수있다. 전정신경은상전정신경과하전정신경으로나뉘며전정신경염은주로상전정신경을침범하여 15 이의신경지배를받는수평반고리관과전반고리관의기능에영향을미치는반면후반고리관을신경지배하는하전정신경은잘침범하지않는다. 16 이번연구에서도발병초기의수평반고리관과전반고리관의이득사이에뚜렷한상관관계가있고회복군의전반고리관이득회복이수평반고리관과유사하게나타나상전정신경의침범을확인할수있었다. 반면후반고리관의이득은수평반고리관과상관관계가없었으며하전정신경이신경지배하는구형낭의기능검사인경부전정유발근전위역시군간차이가없어하전정신경의기능은비교적보존된것으로생각된다. 비디오두부충동검사의정상치를구한 McGarvie 등 17 의결과와유사하게이번연구에서도두수직반고리관의이득은회복후에도수평반고리관의이득보다낮게측정되었다. McGarvie는좌우차이에대해머리회전후의각안구위치에서재고정에필요한눈움직임의크기가서로다르고 ICS impulse 고글이오른쪽눈만검사할수있으므로오른쪽수평반고리관과전반고리관의이득이왼쪽보다크다고설명하였다. 그러나수직반고리관의낮은이득은설명되지않았는데저자는이것이안검열의모양과반고리관의각도라는두요소에의해발생한다고추정한다. 안검열 은너비가넓지만높이가낮아수평반고리관검사에서는동공인식의장애물이없는반면수직반고리관검사에서는눈꺼풀과눈썹이동공인식을쉽게방해한다. 본연구에사용한 OTOsuite Vestibular software의동공인식알고리즘이동공의중심을위쪽경계와아래쪽경계의가운데로계산한다면눈꺼풀이동공의일부를가릴때눈의수직움직임을실제보다작게평가하게되므로이득이낮게나타난다. 또한수직반고리관의이득은비디오두부충동검사시안구의위치에따라달라질수있다. 18 안구가 40도옆을볼때가장이상적이나옆보기각도가작아질수록수직성분은작아지고고글이측정하지못하는회선성분이커지게된다. 그러나안검열이옆으로갈수록좁아지므로눈꺼풀가림에의한오류와옆보기각도에의한오류는모순적인관계이다. 이러한문제로인해수직반고리관검사는수평반고리관에비해어려우며오류가많아정확한측정이쉽지않은경우가많다. 이번연구에서는비디오충동검사의자동계산된이득을이용하여분석하였다. 이득은검사후바로얻을수있기에사용하기유용하지만검사의해석에는이득외에도교정단속운동또한관찰의대상이다. 교정단속운동의분석을위한소프트웨어 19 등을이용한다양한분석이향후에환자의전정안반사기능을평가할때추가적인정보를제공할수있을것이다. 이연구의제한점으로는장기추적에실패한환자가많아연구결과를일반화하기에는환자수가부족했던점, 환자의주관적증상을 dizziness handicap inventory 등정량화할수있는도구를이용해평가하지않아주관적어지럼과두부충동검사이득과의관계를적절히평가하지못한점을들수있다. 두부충동검사는시행하기가간편하고일상생활에서의실제머리움직임의주파수영역을검사할수있으며, 전정신경염회복후환자가느끼는잔존증상과일치도가높다. 20 비디오두부충동검사는두부충동검사의장점과함께고주파전정안반사를정량적으로측정할수있고, 수기두부충동검사에서찾아내기어려운 covert saccades를관찰할수있다는점에서임상적으로유용하다. 전정신경염환자에서비디오두부충동검사의추적은환자의전정기능을추적하면서환자의잔존어지럼을예측할수있어전정신경염후어지럼의원인감별과기능적회복의평가에도움을줄수있다. 급성기에시행하는비디오두부충동검사는전정손상을측정하는도구가될수있으며증상발생후

7 Res Vestib Sci Vol. 14, No. 4, Dec 일째에시행하는검사는회전의자검사, 안구전정안반사, 주관적시수직검사와함께환자의장기예후를판단하는지표가될수있다. 결 전정신경염급성기에시행한수평반고리관비디오두부충동검사이득은회전의자검사, 안구전정유발근전위, 주관적시수직결과와상관관계가있으나온도안진검사결과와는관계가없다. 이득감소후회복은대부분 30일이내에나타나므로 1개월후추적검사가전정신경염의예후예측에도움이될수있다. 론 중심단어 : 두부충동검사, 전정안반사, 전정신경염 CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported. REFERENCES 1. Magliulo G, Iannella G, Gagliardi S, Re M. A 1-year follow-up study with C-VEMPs, O-VEMPs and video head impulse testing in vestibular neuritis. Eur Arch Otorhinolaryngol 2015;272: Imate Y, Sekitani T. Vestibular compensation in vestibular neuronitis. Long-term follow-up evaluation. Acta Otolaryngol 1993;113: Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol 1988;45: Jorns-Haderli M, Straumann D, Palla A. Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psychiatry 2007;78: Choi KD, Oh SY, Kim HJ, Koo JW, Cho BM, Kim JS. Recovery of vestibular imbalances after vestibular neuritis. Laryngoscope 2007;117: Zellhuber S, Mahringer A, Rambold HA. Relation of video-head-impulse test and caloric irrigation: a study on the recovery in unilateral vestibular neuritis. Eur Arch Otorhinolaryngol 2014;271: Palla A, Straumann D. Recovery of the high-acceleration vestibulo-ocular reflex after vestibular neuritis. J Assoc Res Otolaryngol 2004;5: Okinaka Y, Sekitani T, Okazaki H, Miura M, Tahara T. Progress of caloric response of vestibular neuronitis. Acta Otolaryngol Suppl 1993;503: Schmid-Priscoveanu A, Bohmer A, Obzina H, Straumann D. Caloric and search-coil head-impulse testing in patients after vestibular neuritis. J Assoc Res Otolaryngol 2001;2: Adamec I, Skoric MK, Handzic J, Barusic AK, Bach I, Gabelic T, et al. The role of cervical and ocular vestibular-evoked myogenic potentials in the follow-up of vestibular neuritis. Clin EEG Neurosci 2014;45: Weber KP, MacDougall HG, Halmagyi GM, Curthoys IS. Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci 2009;1164: McCaslin DL, Jacobson GP, Bennett ML, Gruenwald JM, Green AP. Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap. Ear Hear 2014;35:e Haque A, Angelaki DE, Dickman JD. Spatial tuning and dynamics of vestibular semicircular canal afferents in rhesus monkeys. Exp Brain Res 2004;155: Lasker DM, Hullar TE, Minor LB. Horizontal vestibuloocular reflex evoked by high-acceleration rotations in the squirrel monkey. III. Responses after labyrinthectomy. J Neurophysiol 2000;83: Aw ST, Fetter M, Cremer PD, Karlberg M, Halmagyi GM. Individual semicircular canal function in superior and inferior vestibular neuritis. Neurology 2001;57: Fetter M, Dichgans J. Vestibular neuritis spares the inferior division of the vestibular nerve. Brain 1996;119 (Pt 3): McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The video head impulse test (vhit) of semicircular canal function-age-dependent normative values of vor gain in healthy subjects. Front Neurol 2015;6: McGarvie LA, Martinez-Lopez M, Burgess AM, MacDougall HG, Curthoys IS. Horizontal eye position affects measured vertical vor gain on the video head impulse test. Front Neurol 2015;6: Rey-Martinez J, Batuecas-Caletrio A, Matino E, Perez Fernandez N. HITCal: a software tool for analysis of video head impulse test responses. Acta Otolaryngol 2015;135: Kim HA, Hong JH, Lee H, Yi HA, Lee SR, Lee SY, et al. Otolith dysfunction in vestibular neuritis: recovery pattern and a predictor of symptom recovery. Neurology 2008;70:

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