Abstract:

Objective To analyze the causes of patients with isolated vertigo for early identification of isolated posterior circulation ischemia vertigo. Methods The clinical data of 171 patients with isolated vertigo were retrospectively analyzed. The different causes of vertigo were determined by associated medical history, clinical signs and symptoms, and the corresponding auxiliary examination results, such as imaging of the nervous system and cerebrovascular assessment. In order to evaluate anxiety or depression state, methods of Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) were adopted. Besides, Stroke Risk Score (SRS) was used to screen risk factors. Results In 171 cases, there were 19 patients (11%) caused by posterior circulation ischemia, 142 patients (83%) caused by peripheral vestibular vertigo, and 10 patients (6%) caused by anxiety or depression. There were no significant differences in clinical manifestations (position induced or aggregated vertigo, nausea and vomiting, nystagmus, tinnitus and hearing loss) among the three groups. There were statistically significant differences in the onset age (P =0.001), smoking proportion (P =0.004), incidence of diabetes mellitus (P =0.023), hypertension (P =0.015), coronary heart disease (P =0.021), high density lipoprotein cholesterol (P =0.002), history of transient ischemic attack/stroke (P =0.006) and the rate of SRS>7 (P <0.001) between the central vertigo and vestibular peripheral vertigo group. And the onset age (P =0.001), incidence of diabetes mellitus (P =0.011), hypertension (P =0.019), internal artery stenosis (P =0.027), and the rate of SRS>7 (P =0.003) were significantly higher in the central vertigo group compared with that of anxiety/depression group. Besides, the incidence of high density lipoprotein cholesterol was significantly higher in the peripheral group compared with that of anxiety/depression group (P =0.001). Conclusion Isolated vertigo are mainly non-central vascular vertigo, while acute cerebrovascular disease (mostly of posterior circulation ischemia) can be characterized by isolated vertigo. There are significant differences in the onset age, history of stroke risk factors between the central and non-central vertigo. In the clinical diagnosis and treatment we should focus on identifying central damage to avoid serious consequences.

Key words: Isolated vertigo; Central vascular vertigo; Vestibular peripheral vertigo; Posterior circulation ischemia; Risk factors

摘要：

目的 分析以眩晕为主诉患者的病因，旨在早期识别后循环缺血性孤立性眩晕。 方法 回顾性分析孤立性眩晕患者171例，根据病史特点、神经影像学检查、脑血管评估等辅助检 查，焦虑抑郁状态通过自评焦虑或抑郁量表评价。采用卒中风险评分（Stroke Risk Score，SRS）确定 眩晕患者病因，筛查危险因素。 结果 171例患者中，中枢性眩晕19例（11%），前庭周围性眩晕142例（83%），焦虑或抑郁10例（6%）。 各组临床表现（体位诱发或加重眩晕，恶心、呕吐，眼球震颤，耳鸣，听力减退）比较无显著差异。中 枢性眩晕组发病年龄、吸烟率、合并糖尿病、高血压、冠状动脉粥样硬化性心脏病、高低密度脂蛋白 胆固醇血症、既往短暂性脑缺血发作/卒中史的发病率以及SRS＞7分的比例等方面均显著高于周围性 眩晕组（P值分别为0.001，0.004，0.023，0.015，0.021，0.002，0.006和＜0.001）。中枢性眩晕组发病 年龄、合并糖尿病、高血压、颈动脉狭窄的发病率以及SRS＞7分的比例等方面均显著高于焦虑/抑郁 组（P值分别为0.001，0.011，0.019，0.027和0.003）。周围性眩晕组合并高低密度脂蛋白胆固醇血症 的发病率显著高于焦虑/抑郁组（P =0.001）。 结论 孤立性眩晕常见为非中枢性眩晕，而急性脑血管病也可表现为孤立性眩晕。中枢性眩晕患者 在年龄、既往血管危险因素病史等方面与非中枢性眩晕有显著差异，临床诊治中应重点识别中枢性损 害，避免严重后果发生。

关键词: 孤立性眩晕; 中枢性眩晕; 前庭周围性眩晕; 后循环缺血; 危险因素