神经内科急诊室急性头晕/眩晕临床特征及病因分析

doi:10.3969/j.issn.1673-5765.2021.09.007

摘要/Abstract

摘要： 目的探讨急诊室就诊的急性头晕/眩晕患者的临床特征及病因分布，比较前庭中枢性和前庭周围性疾病所致头晕/眩晕的临床特点差异，以更有效地区别急性头晕/眩晕的前庭中枢性和周围性病因。方法前瞻性连续收集2017年1月-2018年12月神经内科急诊以急性头晕/眩晕为主诉就诊患者，记录基线人口学信息、现病史和既往史、神经系统查体和前庭功能床旁查体，并随访影像学信息、前庭功能检查和最终诊断等。根据患者病因，将患者分组为前庭中枢性（central vestibular system，CVS）和前庭周围性（peripheral vestibular system，PVS）疾病组，比较不同组别的人口学信息和临床特点等。结果最终共纳入660例急性头晕/眩晕患者。男性多于女性，50～69岁为高发年龄，春季和冬季为高发季节。按病因分组，CVS组共422例，PVS组共238例。CVS组男性（70.1% vs 42.4%，P＜0.001）、吸烟（30.3% vs 9.2%，P＜0.001）、饮酒（27.3% vs 5.5%，P＜0.001）比例，既往高血压（59.7% vs 42.9%， P＜0.001）、脂代谢紊乱（18.5% vs 12.2%，P =0.035）、脑血管病（20.9% vs 10.9%，P =0.001）、周围血管病（7.3% vs 1.3%，P =0.001）和心血管病史（5.5% vs 0.8%，P =0.003）发生率高于PVS组。PVS组的平均年龄（60.19±12.77岁 vs 57.44±12.73岁，P =0.008）、既往有内耳疾病（5.9% vs 0.5%，P＜0.001）的比例高于CVS组。病因诊断方面，CVS组最终诊断后循环梗死256例（60.7%），脑出血87例（20.6%），蛛网膜下腔出血34例（8.1%），前庭性偏头痛13例（3.1%），TIA 13例（3.1%），海绵状血管瘤9例（2.1%），肿瘤8例（1.9%），小脑扁桃体下疝畸形1例（0.2%）和多发性硬化1例（0.2%）；PVS组中良性阵发性位置性眩晕121例（50.8%），梅尼埃病38例（16.0%），前庭神经炎14例（5.9%），突发性聋伴眩晕 3例（1.3%），不确定病因为62例（26.1%，排除中枢性病因）。结论神经内科急诊室表现为急性头晕/眩晕患者中，最常见的前庭周围性疾病为良性阵发性位置性眩晕，最常见的前庭中枢性疾病为后循环梗死，前庭中枢性疾病患者更可能合并有血管危险因素如高血压、脂代谢紊乱、吸烟、饮酒等。

文章导读： 本研究针对神经内科急诊就诊的急性头晕/眩晕患者进行了前瞻性调查研究，结果显示此类人群中，CVS
较PVS更多见，CVS中以后循环梗死最多，PVS中最常见的为良性阵发性位置性眩晕。

关键词: 头晕; 眩晕; 前庭疾病; 脑血管病

Abstract: Objective To investigate the clinical characteristics and etiology distribution of patients with acute dizziness or vertigo in emergency department, to compare the difference in clinical characteristics of central (CVS) and peripheral (PVS) vestibular system disease so as to effectively differentiate the etiology of acute vertigo.

Methods From January 2017 to December 2018, patients with chief complaint of acute dizziness

or vertigo in emergency department were included in the study. Baseline demographic information, medical history, routine examination, neurological examination, vestibular function examination, radiographic data and final diagnosis were collected. Patients were divided into CVS or PVS group according to the etiology diagnosis. The demographic information and clinical characteristics of the two groups were compared. Results A total of 660 patients (60.2% male, mean age 58.4±12.8 years) with acute dizziness or vertigo were analyzed. 50-69 years were the age of high risk, and spring and winter were the peak seasons. There were 422 cases in the CVS group and 238 cases in the PVS group. The proportion of men (70.1% vs 42.4%, P <0.001), smokers (30.3% vs 9.2%, P <0.001), alcohol consumption (27.3% vs 5.5%, P <0.001), the incidence of hypertension (59.7% vs 42.9%, P <0.001), dyslipidemia (18.5% vs 12.2%, P =0.035), cerebrovascular disease (20.9% vs 10.9%, P =0.001), peripheral vascular disease (7.3% vs 1.3%, P =0.001) and cardiovascular disease (5.5% vs 0.8 %, P =0.003) in CVS group were significantly higher than that in PVS group. The age (60.19±12.77 years vs 57.44±12.73 years, P =0.008), and proportion of previous inner ear disease (5.9% vs 0.5%, P <0.001) in the PVS group were higher than that in CVS group. For etiology diagnosis, in CVS group, 256 cases (60.7%) for posterior circulation infarction, 87 (20.6%) for cerebral hemorrhage, 34 (8.1%) for subarachnoid hemorrhage, 13 (3.1%) for vestibular migraine, 13 (3.1%) for transient ischemic attack, 9 (2.1%) for cavernoma, 8 (1.9%) for tumor, 1 case (0.2%) for arnold-chiari malformation and 1 case (0.2%) for multiple sclerosis; in PVS group, 121 cases (50.8%) for benign paroxysmal positional vertigo (BBPV), 38 (16.0%) for Meniere's disease, 14 (5.9%) for vestibular neuronitis, 3 cases (1.3%) for sudden deafness, and 62 cases (26.1%) with uncertain cause. Conclusions For patients who presented with acute dizziness or vertigo in neurology emergency department, posterior circulation infarction was the most common cause for CVS, and BBPV for PVS. The patients with CVS were more likely to have vascular risk factors such as hypertension, dyslipidemia, smoking, and drinking.

Key words: Vertigo; Dizziness; Vestibular disorders; Cerebrovascular disease

姜睿璇, 吕肖玉, 曹振汤, 朱翠婷, 鞠奕, 赵性泉. 神经内科急诊室急性头晕/眩晕临床特征及病因分析[J]. 中国卒中杂志, 2021, 16(09): 909-914.

JIANG Rui-Xuan, LYU Xiao-Yu, CAO Zhen-Tang, ZHU Cui-Ting, JU Yi, ZHAO Xing-Quan. Clinical Characteristics and Etiology of Patients with Acute Vertigo in Emergency Department[J]. Chinese Journal of Stroke, 2021, 16(09): 909-914.

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