【摘要】 中枢性位置性眼震（CPN）是一种由中枢前庭通路病变引起的位置性眼震。由于CPN的临床表现和眼震特征与良性阵发性位置性眩晕高度相似，其诊断颇具挑战性。CPN的病因复杂，既可见于脑卒中、肿瘤等结构性病变，也可见于前庭性偏头痛等无明显结构性病变的疾病。CPN的病变部位主要集中在小脑小结叶、蚓垂和扁桃体等区域。CPN可分为阵发性（短暂性）和持续性两种类型。阵发性CPN的临床特征（包括潜伏期、持续时间、眼震方向和眼震强度与变位试验类型及速度之间的相关性）提示其为半规管起源，其发生机制被认为是中枢损伤（多涉及小脑小结叶和蚓垂）导致对前庭神经核不规则传入信号的失抑制，从而产生的旋转后反弹性眼震。持续性CPN可能源于速度储存通路受损，引起重力和惯性评估错误。本文旨在总结国内外关于CPN的病因、病变部位、发生机制、临床特征、鉴别诊断及治疗的最新进展，以期帮助临床医师更好地理解和识别CPN，从而实现及时诊断和有效治疗。更多还原

【Abstract】 Central positional nystagmus(CPN) is a form of positional nystagmus caused by lesions of the central vestibular system. Since the clinical manifestations and nystagmus features of CPN are highly similar with those of benign paroxysmal positional vertigo, the diagnosis of CPN is highly challenging. The etiology of CPN is complex, involving both structural lesions such as stroke and tumors and non-structural disorders such as vestibular migraine. The primary lesion sites of CPN included the cerebellar nodulus, the uvula, and the tonsil. CPN can be classified into paroxysmal(transient) CPN and persistent CPN. The clinical features of paroxysmal CPN(including latency, duration, direction, intensity, and their correlation with the type and speed of positional maneuvers) suggest that it originates from the semicircular canal, and its pathogenesis involves post-rotatory rebound nystagmus caused by the disinhibition of irregular afferent signals transmitted to the vestibular nuclei due to central damage(often involving the cerebellar nodulus and the uvula). Persistent CPN may be caused by damage to the velocity storage pathway, resulting in an erroneous assessment of gravity direction and inertia. This article summarizes the latest advances in the etiology, lesion sites, pathogenesis, clinical features, differential diagnosis, and treatment of CPN in China and globally, in order to help clinicians better understand and identify CPN and thus achieve timely diagnosis and effective treatment.更多还原