以眩晕症状为主的急性缺血性卒中临床及影像学特点  

Clinical and neuroimaging features of acute ischemic stroke presented with vertigo

作　　者：杨晓岚[1] 沈沸[1] 华驾略[1] 秦洁行[1] 周洁茹[1] 李焰生[1] YANG Xiao-lan;SHEN Fei;HUA Jia-lüe;QIN Jie-xing;ZHOU Jie-ru;LI Yan-sheng(Department of Neurology,South Campus,Renji Hospital,Shanghai Jiaotong University School of Medicine, Shanghai 201112,China)

机构地区：[1]上海交通大学医学院附属仁济医院南院神经科,201112

出　　处：《中国现代神经疾病杂志》2019年第1期21-26,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的总结以眩晕为主要症状的急性缺血性卒中的临床和影像学特点并探讨其发病机制。方法回顾分析2014年1月至2017年10月共81例以眩晕为首发症状的急性后循环缺血性卒中患者的临床症状与体征、实验室指标、头部影像学和TOAST病因分型。结果根据眩晕发作类型分为孤立性眩晕组(18例)和非孤立性眩晕组(63例)。孤立性眩晕组患者冠心病[8/18对15.87%(10/63);校正χ~2=5.062,P=0.024]和心房颤动[7/18对14.29%(9/63);校正χ~2=3.907,P=0.048]比例高于非孤立性眩晕组;眼震发生率高于[10/18对30.16%(19/63);χ~2=3.929,P=0.047]非孤立性眩晕组;影像学检查,弧立性眩晕组有16/18例病变位于小脑,高于非孤立性眩晕组(Z=-2.289,P=0.022);TOAST病因分型,弧立性眩晕组大动脉粥样硬化型占8/18例、心源性栓塞型占6/18例。结论急性缺血性卒中致孤立性眩晕患者冠心病和心房颤动发生率较高,病灶主要累及小脑,脑卒中发病机制可能倾向于大动脉粥样硬化和心源性栓塞。Objective To summarize the clinical and neuroimaging features of acute ischemicstroke presented with vertigo and explore its pathogenesis. Methods The clinical data of 81 patients withacute ischemic stroke in posterior circulation initiated as vertigo from January 2014 to October 2017 wereretrospectively analyzed, including clinical symptoms and signs, laboratory indexes, neuroimaging andTOAST classification. Results Eighty-one patients were divided into isolated vertigo group(N = 18) andnon-isolated vertigo group(N = 63). Compared with non-isolated vertigo group, patients of isolated vertigogroup had higher rates of coronary heart disease [8/18 vs. 15.87%(10/63);adjusted χ^2= 5.062, P = 0.024]and atrial fibrillation [7/18 vs. 14.29%(9/63);adjusted χ^2= 3.907, P = 0.048]. Patients in isolated vertigogroup also had higher rate of nystagmus [10/18 vs. 30.16%(19/63);χ^2= 3.929, P = 0.047] than that in non-isolated vertigo group. Imaging examination showed the lesion of 16/18 patients of isolated vertigo groupwas located in cerebellum, and the ratio was significantly higher than that of non-isolated vertigo group(Z =-2.289, P = 0.022). TOAST classification showed the type of 8/18 patients of isolated vertigo group waslarge artery artherosclerosis(LAA), and 6/18 patients was cardioembolism(CE). Conclusions Patientswith isolated vertigo caused by acute ischemic stroke had higher rate of coronary heart disease and atrialfibrillation than those with non-isolated vertigo. The infarcts were mostly located in the cerebellum andmainly caused by large artery artherosclerosis or cardioembolism.

关 键 词：卒中 脑缺血 眩晕 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]