急性孤立性血管性眩晕的临床特征分析  

Clinical Characteristics of Acute Isolated Vascular Vertigo

作　　者：赵永 常明则 张格娟 王圆圆 韩军良 ZHAO Yong;CHANG Mingze;ZHANG Gejuan;WANG Yuanyuan;HAN Junliang(Department of Neurology,Third Municipal Hospital of Xi′an,Northwestern University,Xi′an 710018,China;Department of Neurology,Xijing Hospital,Fourth Military Medical University,Xi′an 710016,China)

机构地区：[1]西北大学附属医院西安市第三医院神经内科,西安710018 [2]空军军医大学附属西京医院神经内科,西安710016

出　　处：《中华耳科学杂志》2022年第1期26-31,共6页Chinese Journal of Otology

摘　　要：目的归纳分析急性孤立性眩晕的常见病因、主要症状及阳性体征和脑血管病危险因素等,探讨快速识别孤立性血管性眩晕(isolated vascular vertigo,IVV)的有效指标。方法收集2017年01月至2020年01月就诊于西北大学附属医院西安市第三医院神经内科门急诊的急性孤立性眩晕患者详细的临床资料,每例患者均由神经内科眩晕亚专业主治医师完成神经耳科学查体、ABCD2评分和Essen卒中风险评分(Essen stroke risk score,ESRS),疑诊IVV等中枢病变的所有患者均接受颅脑MRI扫描且必要时复查。结果共纳入179例急性孤立性眩晕,其中IVV29例,占全部病因的16.2%。IVV组患者的平均年龄为60.3±11.1岁,显著高于首发前庭性偏头痛(vestibular migraine,VM)组41.8±12.6岁、前庭神经炎(vestibular neuritis,VN)组45.1±10.9岁、首发梅尼埃病(Ménière disease,MD)组49.6±13.5岁(P<0.01)。IVV患者ABCD2评分3.6±1.1分和ESRS评分2.8±1.2分均明显分别高于VN组2.0±0.8分、1.8±1.0分(P<0.01)、首发VM组1.8±0.8分、1.7±1.1分(P<0.01)、首发MD组1.7±0.9分、1.6±0.7分(P<0.01)。IVV组水平自发性眼震37.9%,明显低于VN组88.4%(P<0.01),高于首发VM组12.0%(P<0.05);IVV组凝视诱发性眼震、水平平滑跟踪、扫视试验、眼球反向偏斜的阳性率分别为51.7%、76.8%、79.3%和35.0%,分别明显高于VN组0%、11.6%、0%、2.9%(P<0.01),首发VM组8.0%、8.0%、12.0%、4.0%(P<0.01),首发MD组6.7%、6.7%、0%、0%(P<0.01);IVV组甩头试验阳性率13.8%,明显低于VN组91.3%(P<0.01);IVV组头颅核磁DWI早期阴性2例,阳性27例。结论急性孤立性血管性眩晕较为常见,患者ABCD2评分≥4和(或)ESRS≥3的概率远高于其他原因的孤立性眩晕,甩头试验通常阴性,大多数患者出现凝视诱发性眼震、水平平滑跟踪异常、扫视异常,疾病早期少数患者的头颅核磁阴性。Objective To report common causes,typical symptoms and positive signs of acute isolated vertigo,as well as risk factors for cerebrovascular diseases,for indices effective for rapid identification of isolated vascular vertigo(IVV).Methods Detailed clinical data of patients with acute isolated vertigo admitted to the Department of Neurology of Xi’an Third Hospital,Northwestern University,from January 2017 to January 2020 were collected.Neurootological examination,ABCD2 score and Essen score were completed in each patient.Patients suspected of central lesions such as IVV received craniocerebral MRI scans and reexamined as deemed necessary.Results A total of 179 cases of acute isolated vertigo were included,including 29 cases of IVV(16.2%).The average age of patients with IVV was 60.3±11.1 years,older than that of patients with initial VM(41.8±12.6 years),VN(45.1±10.9 years)or initial MD(49.6±13.5 years)(P<0.01).ABCD2(3.6±1.1)and ESRS(2.8±1.2)scores in patients with IVV were higher than those in patients with VN(2.0±0.8 and 1.8±1.0,respectively,P<0.01),initial VM(1.8±0.8 and 1.7±1.1,respectively,P<0.01)or initial MD(1.7±0.9 and 1.6±0.7,respectively P<0.01).Spontaneous nystagmus was detected in 37.9%of the patients with IVV,less frequent than in those with VN(88.4%,P<0.01),but more frequent than in those with initial VM(12.0%,P<0.05).The rate of gaze-evoked nystagmus and abnormal horizontal smooth pursuit,saccade and skew deviation was 51.7%,76.8%,79.3%and 35.0%in patients with IVV group and higher than in those with VN(0%、11.6%、0%and 2.9%,respectively,P<0.01),VM(8.0%,8.0%,12.0%and 4.0%,respectively,P<0.01)or initial MD(6.7%,6.7%,0%and 0%,respectively,P<0.01).The rate of positive bedside head impulse test in patients with IVV was 13.8%,lower than in those with VN(P<0.01).Initial head nuclear magnetic resonance(diffusion weighted imaging)scan was negative in only 2 patients with IVV.Conclusion Acute isolated vascular vertigo is relatively common.High ABCD2(≥4)or ESRS(≥3)scores are more common in p

关 键 词：孤立性血管性眩晕 神经耳科学体征 ABCD2评分 Essen卒中风险评分量表 

分 类 号：R764[医药卫生—耳鼻咽喉科]