小脑扁桃体下疝畸形Ⅰ型误诊为良性阵发性 位置性眩晕1例及尼麦角林治疗体会

Chiari Malformation Type I Misdiagnosed as Benign Paroxysmal Positional Vertigo: A Case Report with Experience of Nicergoline Treatment

摘要: 小脑扁桃体下疝畸形I型(CMI)以小脑扁桃体经枕骨大孔下疝 ≥ 5 mm为影像学特征，常伴脊髓空洞症。其典型表现为枕颈部疼痛及神经功能障碍，以眩晕为主要或首发表现者较为少见，易被误诊为外周性前庭疾病。本文报道1例以反复发作性眩晕为主要症状的CMI合并脊髓空洞症患者。患者外院曾考虑良性阵发性位置性眩晕(BPPV)并接受手法复位治疗无效。本院完善前庭功能检查未见外周性病变证据，进一步行头颈部MRI确诊CMI。术前短期口服尼麦角林后，患者眩晕症状缓解，随后行后颅窝减压术，术后随访3个月症状未复发。本文总结CMI相关眩晕的临床特点及与BPPV的鉴别要点，并基于本病例观察提出尼麦角林可能具有短期对症缓解作用的假设，为术前过渡期管理提供参考。

Abstract: Chiari malformation type I (CMI) is characterized by cerebellar tonsillar herniation ≥ 5 mm through the foramen magnum on imaging, often accompanied by syringomyelia. Its typical manifestations include occipitocervical pain and neurological dysfunction, while vertigo as the main or initial symptom is relatively rare, making it prone to misidentification as peripheral vestibular disease. This article reports a case of CMI complicated with syringomyelia in a patient presenting with recurrent vertigo as the main symptom. The patient was previously considered to have benign paroxysmal positional vertigo (BPPV) in another hospital and underwent manual reduction, which yielded no effect. In our hospital, comprehensive vestibular function tests revealed no evidence of peripheral lesions, and further head and neck MRI confirmed the diagnosis of CMI. Short-term oral administration of nicergoline before surgery alleviated the patient’s vertigo symptoms, followed by posterior fossa decompression. No recurrence was noted during the 3-month postoperative follow-up. This article summarizes the clinical characteristics of CMI-related vertigo and the key differential points from BPPV, and proposes the hypothesis that nicergoline may exert a short-term symptomatic relief effect based on this case observation, providing a reference for preoperative transitional management.