卒中相关前庭症状

doi:10.3969/j.issn.1673-5765.2021.09.013

摘要/Abstract

摘要： 头晕和眩晕等前庭症状是社区人群和急诊科患者就诊的常见主诉，卒中是引起前庭症状的重要原因，而前庭症状的持续存在可能延缓或加重卒中患者其他功能的恢复。此外，患者既往长期存在的或卒中前新发的前庭症状可能影响患者卒中后的神经功能恢复。目前卒中相关前庭症状的临床特点、演变形式和发生机制尚不完全明了，患者的预后，尤其是卒中后持续存在的前庭症状与情绪情感障碍的关系还有待进一步研究。本文首次提出“卒中相关前庭症状”这一概念，围绕卒中事件发生前、中、后三个时期，对其临床特点、演变规律和相应的辅助检查方法的研究现状和进展进行综述。

文章导读： 本文首次提出“卒中相关前庭症状”这一概念，并对其临床特点、演变形式、检查方法及其对卒中预后的影响进行了总结。

关键词: 前庭症状; 卒中; 脑血管病; 眩晕; 头晕

Abstract: Vestibular symptoms such as dizziness and vertigo are common complaints in community population and emergency patients. Stroke is one of the main causes of vestibular symptoms and the persistence of vestibular symptoms may delay the recovery of other functions in stroke patients. In addition, the long-term or new-onset vestibular symptoms may influence the neurological function recovery of patients after stroke. At present, the clinical characteristics, evolution and pathogenesis of stroke-related vestibular symptoms are still unclear, especially the relationship between persistent vestibular symptoms and emotional disorders. We firstly proposed the concept of "stroke-related vestibular symptoms" and reviewed its clinical characteristics, evolution and auxiliary examinations before, during and after stroke in order to better guide the clinical diagnosis and treatment.

Key words: Vestibular symptom; Stroke; Cerebrovascular disease; Vertigo; Dizziness

李佳树, 王琰, 李菁晶, 李娜, 方瑞乐, 熊云云, 刘改芬, 赵性泉, 鞠奕. 卒中相关前庭症状[J]. 中国卒中杂志, 2021, 16(09): 954-959.

LI Jia-Shu, WANG Yan, LI Jing-Jing, LI Na, FANG Rui-Le, XIONG Yun-Yun, LIU Gai-Fen, ZHAO Xing-Quan, JU Yi. Stroke-Related Vestibular Symptoms[J]. Chinese Journal of Stroke, 2021, 16(09): 954-959.

参考文献

[1] BISDORFF A，VON BREVERN M，LEMPERT
T，et al. Classification of vestibular symptoms：
towards an international classification of vestibular
disorders[J]. J Vestib Res，2009，19（1/2）：1-13.
[2] POWERS W J，RABINSTEIN A A，ACKERSON
T，et al. 2018 guidelines for the early management of
patients with acute ischemic stroke：a guideline for
healthcare professionals from the American Heart
Association/American Stroke Association[J/OL].
Stroke，2018，49（3）：e46-e110[2020-07-10].
https：//doi.org/10.1161/STR.0000000000000158.
[3] National Institute of Neurological and
Communicative Disorders and Stroke，National
Institutes of Health. A classification and outline of
cerebrovascular diseases Ⅱ[J]. Stroke，1975，6（5）：
564-616.
[4] PAUL N L，SIMONI M，ROTHWELL P M，et al.
Transient isolated brainstem symptoms preceding
posterior circulation stroke：a population-based
study[J]. Lancet Neurol，2013，12（1）：65-71.
[5] CHOI J H，PARK M G，CHOI S Y，et al. Acute
transient vestibular syndrome：prevalence of stroke
and efficacy of bedside evaluation[J]. Stroke，2017，
48（3）：556-562.
[6] KIM H A，OH E H，CHOI S Y，et al. Transient
vestibular symptoms preceding posterior circulation
stroke：a prospective multicenter study[J/OL]. Stroke，
2021，52（6）：e224-e228[2020-07-10]. https：//doi.
org/10.1161/STROKEAHA.120.032488.
[7] QIU D X，ZHANG L，DENG J，et al. New insights
into vertigo attack frequency as a predictor of
ischemic stroke[J/OL]. Front Neurol，2020，11：
593524[2020-07-10]. https：//doi.org/10.3389/fneur.
2020.593524.
[8] SABER TEHRANI A S，KATTAH J C，KERBER
K A，et al. Diagnosing stroke in acute dizziness and
vertigo：pitfalls and pearls[J]. Stroke，2018，49（3）：
788-795.
[9] TARNUTZER A A，BERKOWITZ A L，
ROBINSON K A，et al. Does my dizzy patient have
a stroke? A systematic review of bedside diagnosis
in acute vestibular syndrome[J/OL]. CMAJ，2011，
183（9）：E571-E592[2020-07-10]. https：//doi.org/10.
1503/cmaj.100174.
[10] LEE H，SOHN S I，CHO Y W，et al. Cerebellar
infarction presenting isolated vertigo：frequency and
vascular topographical patterns[J]. Neurology，2006，
67（7）：1178-1183.
[11] LEE H，KIM J S，CHUNG E J，et al. Infarction in
the territory of anterior inferior cerebellar artery：
spectrum of audiovestibular loss[J]. Stroke，2009，40
（12）：3745-3751.
[12] CHEN L，LEE W，CHAMBERS B R，et al.
Diagnostic accuracy of acute vestibular syndrome
at the bedside in a stroke unit[J]. J Neurol，2011，258
（5）：855-861.
[13] LEE H，KIM H A. Nystagmus in SCA territory
cerebellar infarction：pattern and a possible
mechanism[J]. J Neurol Neurosurg Psychiatry，2013，
84（4）：446-451.
[14] ZWERGAL A，MOHWALD K，SALAZAR LOPEZ
E，et al. A prospective analysis of lesion-symptom
relationships in acute vestibular and ocular motor
stroke[J/OL]. Front Neurol，2020，11：822[2020-07-
10]. https：//doi.org/10.3389/fneur.2020.00822.
[15] BRANDT T，DIETERICH M. The dizzy patient：
don't forget disorders of the central vestibular
system[J]. Nat Rev Neurol，2017，13（6）：352-362.
[16] DIETERICH M，GLASAUER S，BRANDT T. Why
acute unilateral vestibular midbrain lesions rarely
manifest with rotational vertigo：a clinical and
modelling approach to head direction cell function[J].
J Neurol，2018，265（5）：1184-1198.
[17] MAN CHAN Y，WONG Y，KHALID N，et al.
Prevalence of acute dizziness and vertigo in cortical
stroke[J]. Eur J Neurol，2021，28（9）：3177-3181.
[18] KIRSCH V，KEESER D，HERGENROEDER T，et
al. Structural and functional connectivity mapping
of the vestibular circuitry from human brainstem to
cortex[J]. Brain Struct Funct，2016，221（3）：1291-
1308.
[19] ELHFNAWY A M，ABD EL-RAOUF M，
VOLKMANN J，et al. Relation of infarction location
and volume to vertigo in vertebrobasilar stroke[J/
OL]. Brain Behav，2020，10（3）：e01564[2020-07-
10]. https：//doi.org/10.1002/brb3.1564.
[20] CONRAD J，HABS M，BOEGLE R，et al. Global
multisensory reorganization after vestibular brain
stem stroke[J]. Ann Clin Transl Neurol，2020，7（10）：
1788-1801.
[21] STAAB J P，ECKHARDT-HENN A，HORII A，
et al. Diagnostic criteria for persistent posturalperceptual
dizziness（PPPD）：consensus document
of the committee for the classification of vestibular
disorders of the Bárány Society[J]. J Vestib Res，
2017，27（4）：191-208.
[22] HABS M，STROBL R，GRILL E，et al. Primary
or secondary chronic functional dizziness：does
it make a difference? A DizzyReg study in 356
patients[J/OL]. J Neurol，2020，267（Suppl 1）：212-

222[2020-07-10]. https：//doi.org/10.1007/s00415-

020-10150-9.
[23] TOMIMOTO H，IHARA M，WAKITA H，et al.
Chronic cerebral hypoperfusion induces white
matter lesions and loss of oligodendroglia with DNA
fragmentation in the rat[J]. Acta Neuropathol，2003，
106（6）：527-534.
[24] LORBEER R，HETTERICH H，STROBL R，et al.
Lack of association of MRI determined subclinical
cardiovascular disease with dizziness and vertigo
in a cross-sectional population-based study[J/OL].
PLoS One，2017，12（9）：e0184858[2020-07-10].
https：//doi.org/10.1371/journal.pone.0184858.
[25] AHMAD H，CERCHIAI N，MANCUSO M，et
al. Are white matter abnormalities associated with
"unexplained dizziness"?[J]. J Neurol Sci，2015，358
（1/2）：428-431.
[26] OKROGLIC S，WIDMANN C N，URBACH H，et
al. Clinical symptoms and risk factors in cerebral
microangiopathy patients[J/OL]. PLoS One，2013，8
（2）：e53455[2020-07-10]. https：//doi.org/10.1371/
journal.pone.0053455.
[27] CERCHIAI N，MANCUSO M，NAVARI E，et
al. Aging with cerebral small vessel disease and
dizziness：the importance of undiagnosed peripheral
vestibular disorders[J/OL]. Front Neurol，2017，8：
241[2020-07-10]. https：//doi.org/10.3389/fneur.2017.
00241.
[28] CALIC Z，CAPPELEN-SMITH C，CUGANESAN
R，et al. Frequency，aetiology，and outcome of small
cerebellar infarction[J]. Cerebrovasc Dis Extra，2017，
7（3）：173-180.
[29] GOELDLIN M，GASCHEN J，KAMMER C，et
al. Frequency，aetiology，and impact of vestibular
symptoms in the emergency department：a neglected
red flag[J]. J Neurol，2019，266（12）：3076-3086.
[30] TARNUTZER A A，LEE S H，ROBINSON K A，et
al. ED misdiagnosis of cerebrovascular events in
the era of modern neuroimaging：a meta-analysis[J].
Neurology，2017，88（15）：1468-1477.
[31] ATZEMA C L，GREWAL K，LU H，et al. Outcomes
among patients discharged from the emergency
department with a diagnosis of peripheral vertigo[J].
Ann Neurol，2016，79（1）：32-41.
[32] KATTAH J C，TALKAD A V，WANG D Z，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.
[33] CNYRIM C D，NEWMAN-TOKER D，KARCH
C，et al. Bedside differentiation of vestibular neuritis
from central "vestibular pseudoneuritis"[J]. J Neurol
Neurosurg Psychiatry，2008，79（4）：458-460.
[34] DMITRIEW C，REGIS A，BODUNDE O，et
al. Diagnostic accuracy of the hints exam in an
emergency department：a retrospective chart
review[J]. Acad Emerg Med，2021，28（4）：387-393.
[35] HELMCHEN C，KNAUSS J，TRILLENBERG
P，et al. Role of the patient's history of vestibular
symptoms in the clinical evaluation of the bedside
head-impulse test[J/OL]. Front Neurol，2017，8：
51[2020-07-10]. https：//doi.org/10.3389/fneur.2017.
00051.
[36] HANNA J，MALHOTRA A，BRAUER P R，et al.
A comparison of benign positional vertigo and stroke
patients presenting to the emergency department
with vertigo or dizziness[J/OL]. Am J Otolaryngol，
2019，40（6）：102263[2020-07-10]. https：//doi.
org/10.1016/j.amjoto.2019.07.007.
[37] MACHNER B，CHOI J H，TRILLENBERG P，et
al. Risk of acute brain lesions in dizzy patients
presenting to the emergency room：who needs
imaging and who does not?[J/OL]. J Neurol，2020，
267（Suppl 1）：126-135[2020-07-10]. https：//doi.
org/10.1007/s00415-020-09909-x.
[38] WANG Y L，LIU J L，CUI Z J，et al. Analysis of
risk factors in patients with peripheral vertigo or
central vertigo[J]. Neurologist，2018，23（3）：75-78.
[39] ZUO L，ZHAN Y Q，LIU F F，et al. Clinical and
laboratory factors related to acute isolated vertigo or
dizziness and cerebral infarction[J/OL]. Brain Behav，
2018，8（9）：e01092[2020-07-10]. https：//doi.org/10.
1002/brb3.1092.
[40] LEE S H，YUN S J，RYU S，et al. Utility of
neutrophil-to-lymphocyte ratio（NLR）as a
predictor of acute infarction in new-onset acute
vertigo patients without neurologic and computed
tomography abnormalities[J]. J Emerg Med，2018，
54（5）：607-614.
[41] SOHN J H，KIM C H，LEE S H，et al. Diagnostic
value of serum biomarkers for differentiating central
and peripheral causes of acute vertigo[J/OL]. Front
Med（Lausanne），2020，7：84[2020-07-10].
https：//doi.org/10.3389/fmed.2020.00084.