Objective To investigate the application of video head impulse test( VHIT)in differentiating vertigo caused by vestibular migraine and posterior circulation ischemia. Methods From 2013 to 2015,enrolled 60 patients with vestibular migraine(VM)who received treatment in the First Affiliated Hospital of Xinjiang Medical University as VM group, and enrolled 50 patients with posterior circulation ischemia(PCI)〔cerebellar infarction and transient ischemic attack(TIA)in vertebral basilar artery system〕as PCI group. Also enrolled 60 healthy people who received physical examination in the hospital in the same period as control group. VHIT and caloric test were undertaken on the subjects. Results Among patients of VM group, the gain value of vestibular - ocular reflex(VOR)slow phase on the lesion side was lower than that on the normal side and the positive rate of compensatory saccade on the lesion side was higher than that on the normal side(P < 0. 05). Among patients of PCI group,the gain value of VOR slow phase on the lesion side was not significantly different from that on the normal side(P >0. 05);the positive rate of compensatory saccade of the lesion side was higher than that of the normal side(P < 0. 05). The three groups were significantly different in the gain value of VOR slow phase and the positive rate of compensatory saccade(P <0. 05);VM group was lower than control group and PCI group in the gain value of VOR slow phase(P < 0. 01);VM group was higher than control group and PCI group in the positive rate of compensatory saccade( P < 0. 05). The three groups were significantly different in the abnormality rate of caloric test(P < 0. 05);VM group was higher than control group and PCI group in the abnormality rate of the caloric test(P < 0. 01). Conclusion VM patients are lower in the gain value of VOR slow phrase by VHIT and higher in the positive rate of compensatory saccade than controls and PCI patients. VHIT can be used to differentiate the vertigo caused by VM and PCI.%目的：探讨视频头脉冲试验在鉴别前庭性偏头痛与后循环缺血导致眩晕中的应用。方法选取2013—2015年在新疆医科大学第一附属医院就诊的前庭性偏头痛患者60例为前庭性偏头痛组，后循环缺血〔包括小脑梗死、椎-基底动脉系统短暂性脑缺血发作（TIA）〕患者50例为后循环缺血组，另选取同时期体检中心体检健康者60例为对照组，分别行视频头脉冲试验和冷热试验。结果前庭性偏头痛组患者病变侧前庭-眼动反射（VOR）慢相的增益值低于正常侧，代偿性扫视阳性率高于正常侧（P <0.05）。后循环缺血组患者病变侧 VOR 慢相的增益值与正常侧比较，差异无统计学意义（P >0.05）；后循环缺血组患者病变侧代偿性扫视阳性率高于正常侧（ P <0.05）。3组 VOR慢相的增益值与代偿性扫视阳性率比较，差异有统计学意义（ P <0.05）；其中前庭性偏头痛组 VOR 慢相的增益值较对照组和后循环缺血组降低（ P <0.05）；前庭性偏头痛组代偿性扫视阳性率较对照组和后循环缺血组升高（ P <0.01）。3组冷热试验异常率比较，差异有统计学意义（P <0.05）；其中前庭性偏头痛组冷热试验异常率高于对照组和后循环缺血组（P <0.01）。结论前庭性偏头痛组患者视频头脉冲试验 VOR 慢相的增益值较对照组和后循环缺血组降低，代偿性扫视阳性率较对照组和后循环缺血组升高，视频头脉冲试验可用于鉴别前庭性偏头痛与后循环缺血导致的眩晕。
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