表现为孤立性眩晕的急性脑梗死患者临床特点
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摘要
目的探讨表现为孤立性眩晕的急性脑梗死患者临床特点。方法选择2016年9月～2018年9月在北京市顺义区医院神经内科门诊、急诊及住院部的262例孤立性眩晕患者,根据头颅CT或核磁共振有无脑梗死,分为脑梗死组及非脑梗死组,脑梗死组53例,非脑梗死组209例,分析两组的临床症状体征及脑血管病危险因素,进行Logistic回归分析。结果在临床症状体征方面,与脑梗死组相比,非脑梗死组体位诱发眩晕、耳鸣、听力减退及水平甩头试验阳性更常见,差异有统计学意义(P<0.05)。与非脑梗死组相比,脑梗死组中的扭转偏斜的变向性眼球震颤更常见,差异有统计学意义(P<0.01)。在脑血管病危险因素方面,与非脑梗死组相比,脑梗死组年龄、高血压、糖尿病、卒中/短暂性脑缺血发作史、ESRS>3分更常见,差异有统计学意义(P<0.05或P<0.01)。以脑梗死为因变量,以年龄、高血压、糖尿病、卒中/TIA史、ESRS>3分为因变量进行Logistic回归分析,ESRS>3分为表现为孤立性眩晕脑梗死患者的独立的危险因素(P<0.01)。结论在非脑梗死组体位诱发眩晕、耳鸣、听力减退及水平甩头试验阳性更常见,而在脑梗死组扭转偏斜的变向性眼球震颤、年龄、高血压、糖尿病、卒中/短暂性脑缺血发作史、ESRS>3分更常见。ESRS>3分是表现为孤立性眩晕脑梗死患者的独立危险因素。
Objective To explore the clinical features of patients with acute cerebral infarction manifested as isolated vertigo. Methods 262 patients with isolated vertigo treated in our hospital from Sep 2016 to Sep 2018 were selected and divided into the cerebral infarction group(53 cases) and the non-infarction group(209 cases) based on results of CT or MRI. The clinical features and the risk factors of cerebral infarction were analyzed between the two groups by Logistic regression. Results As to the clinical features, compared with the infarction group, postural vertigo, tinnitus, hearing loss, and positive result of horizontal head thrust test were more common in the non-infarction group, and the differences were significant(P<0.05); while anisotropic nystagmus was more common in the infarction group, and the difference was significant(P<0.05). As to the risk factors of cerebral infarction, compared with the non-infarction group, age, hypertension, diabetes, history of stoke/transient cerebral ischemia, and ESRS>3 scores were more common in the cerebral infarction group, and the differences were significant(P<0.05 or P<0.01). Logistic regression analysis was performed with cerebral infarction as the dependent variable and age, hypertension, diabetes, stroke/TIA history, and ESRS>3 scores as the independent variables. The results showed that ESRS>3 scores was an independent risk factor for patients with acute cerebral infarction manifested as isolated vertigo(P<0.01). Conclusion Postural vertigo, tinnitus, hearing loss, and positive result of horizontal head thrust test are more common in the non-infarction group, while anisotropic nystagmus,age, hypertension, diabetes, history of stoke/transient cerebral ischemia, and ESRS>3 scores are more common in the cerebral infarction group. ESRS>3 scores is an independent risk factor for patients with acute cerebral infarction manifested as isolated vertigo.
Objective To explore the clinical features of patients with acute cerebral infarction manifested as isolated vertigo. Methods 262 patients with isolated vertigo treated in our hospital from Sep 2016 to Sep 2018 were selected and divided into the cerebral infarction group(53 cases) and the non-infarction group(209 cases) based on results of CT or MRI. The clinical features and the risk factors of cerebral infarction were analyzed between the two groups by Logistic regression. Results As to the clinical features, compared with the infarction group, postural vertigo, tinnitus, hearing loss, and positive result of horizontal head thrust test were more common in the non-infarction group, and the differences were significant(P<0.05); while anisotropic nystagmus was more common in the infarction group, and the difference was significant(P<0.05). As to the risk factors of cerebral infarction, compared with the non-infarction group, age, hypertension, diabetes, history of stoke/transient cerebral ischemia, and ESRS>3 scores were more common in the cerebral infarction group, and the differences were significant(P<0.05 or P<0.01). Logistic regression analysis was performed with cerebral infarction as the dependent variable and age, hypertension, diabetes, stroke/TIA history, and ESRS>3 scores as the independent variables. The results showed that ESRS>3 scores was an independent risk factor for patients with acute cerebral infarction manifested as isolated vertigo(P<0.01). Conclusion Postural vertigo, tinnitus, hearing loss, and positive result of horizontal head thrust test are more common in the non-infarction group, while anisotropic nystagmus,age, hypertension, diabetes, history of stoke/transient cerebral ischemia, and ESRS>3 scores are more common in the cerebral infarction group. ESRS>3 scores is an independent risk factor for patients with acute cerebral infarction manifested as isolated vertigo.
引文
[1] Lee JO,Park SH,Kim HJ,et al.Vulnerability of the vestibular organs to transient ischemia:implications for isolated vascular vertigo[J].Neurosci Lett,2014,558:180-185.
[2] Lee H,Sohn SI,Cho YW,et al.Cerebellar infarction presenting isolated vertigo:frequency and vascular topographical patterns[J].Neurology,2006,67(7):1178-1183.
[3] Venhovens J,Meulstee J,Verhagen WI.Acute vestibular syndrome:a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department[J]. J Neurol,2016,263(11):2151-2157.
[4] Edlow JA,Newm an-Toker DE,Savitz SI. Diagnosis and initial management of cerebellar infarction[J]. Lancet Neurol,2008,7(10):951-964.
[5] Wang Y,Liu J,Cui Z,et al.Analysis of Risk Factors in Patients With Peripheral Vertigo or Central Vertigo[J].Neurologist,2018,23(3):75-78.
[6] Karatas M.Central vertigo and dizziness:epidemiology,differential diagnosis,and common causes[J]. Neurologist,2008,14(6):355-364.
[7] Lammers W,Folmer W,Van Lieshout EM,et al.Demographic analysis of emergency department patients at the ruijin hospital,shanghai[J].Emerg Med Int,2011,2011:748274.
[8] Doijiri R,Uno H,Miyashita K,et al.How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?[J].J Stroke Cerebrovasc Dis,2016,25(10):2549-2552.
[9] Zuo L,Zhan Y,Liu F,et al.Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction[J].Brain Behav,2018,8(9):e01092.
[10] Lee H,Cho YW.Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction[J]. J Neurol Neurosurg Psychiatry,2003,74(12):1644-1648.
[11] Kroenke K,Hoffman RM,Einstadter D.How common are various causes of dizziness? A critical review[J]. South Med J,2000,93(2):160-167.
[12] Kattah JC,Talkad AV,Wang DZ,et al.HINTS to diagnose stroke in the acute vestibular syndrome:Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging[J]. Stroke,2009,40(11):3504-3510.
[13] Chen L,Lee W,Chambers BR,et al.Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit[J].J Neurol,2011,258(5):855-861.
[14] Lee CC,Su YC,Ho HC,et al.Risk of stroke in patients hospitalized for isolated vertigo:a four-year follow-up study[J].Stroke,2011,42(1):48-52.
[15]何育生,李云霞,韩红杰,等.孤立性眩晕型小脑梗死的误诊分析与早期识别[J].中风与神经疾病杂志,2013,30(6):531-534.
[2] Lee H,Sohn SI,Cho YW,et al.Cerebellar infarction presenting isolated vertigo:frequency and vascular topographical patterns[J].Neurology,2006,67(7):1178-1183.
[3] Venhovens J,Meulstee J,Verhagen WI.Acute vestibular syndrome:a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department[J]. J Neurol,2016,263(11):2151-2157.
[4] Edlow JA,Newm an-Toker DE,Savitz SI. Diagnosis and initial management of cerebellar infarction[J]. Lancet Neurol,2008,7(10):951-964.
[5] Wang Y,Liu J,Cui Z,et al.Analysis of Risk Factors in Patients With Peripheral Vertigo or Central Vertigo[J].Neurologist,2018,23(3):75-78.
[6] Karatas M.Central vertigo and dizziness:epidemiology,differential diagnosis,and common causes[J]. Neurologist,2008,14(6):355-364.
[7] Lammers W,Folmer W,Van Lieshout EM,et al.Demographic analysis of emergency department patients at the ruijin hospital,shanghai[J].Emerg Med Int,2011,2011:748274.
[8] Doijiri R,Uno H,Miyashita K,et al.How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?[J].J Stroke Cerebrovasc Dis,2016,25(10):2549-2552.
[9] Zuo L,Zhan Y,Liu F,et al.Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction[J].Brain Behav,2018,8(9):e01092.
[10] Lee H,Cho YW.Auditory disturbance as a prodrome of anterior inferior cerebellar artery infarction[J]. J Neurol Neurosurg Psychiatry,2003,74(12):1644-1648.
[11] Kroenke K,Hoffman RM,Einstadter D.How common are various causes of dizziness? A critical review[J]. South Med J,2000,93(2):160-167.
[12] Kattah JC,Talkad AV,Wang DZ,et al.HINTS to diagnose stroke in the acute vestibular syndrome:Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging[J]. Stroke,2009,40(11):3504-3510.
[13] Chen L,Lee W,Chambers BR,et al.Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit[J].J Neurol,2011,258(5):855-861.
[14] Lee CC,Su YC,Ho HC,et al.Risk of stroke in patients hospitalized for isolated vertigo:a four-year follow-up study[J].Stroke,2011,42(1):48-52.
[15]何育生,李云霞,韩红杰,等.孤立性眩晕型小脑梗死的误诊分析与早期识别[J].中风与神经疾病杂志,2013,30(6):531-534.