Die elektrophysiologische Untersuchung des vestibulo-collischen Reflexes (VCR)

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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