Moubayed Sami Pierre, Saliba Issam
Department of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), Montreal University, Montreal, Quebec, Canada.
Laryngoscope. 2009 Oct;119(10):2071-6. doi: 10.1002/lary.20597.
OBJECTIVES/HYPOTHESIS: Vertebral artery (VA) stenosis caused mainly by atherosclerosis accounts for up to 20% of posterior circulation strokes. Isolated positional vertigo or dizziness can be the initial presentation symptom. The objective is to compare the presence of isolated positional vertigo or dizziness in patients with evaluation of VA morphology, thrombotic stroke risk factors, and evolution of symptoms with time.
Double-blind retrospective cohort study.
Magnetic resonance angiography reports describing the VAs of 258 patients were reviewed, and 133 were questioned and their hospital charts reviewed for positional vertigo or dizziness. Neurotologic examination was performed on 75 patients. Vestibular testing using electronystagmography was performed on 46 patients. The prevalence of thrombotic stroke factors was evaluated in all patients. Groups were compared using chi-square statistical analysis.
A total of 72 patients with normal VAs (group A) were compared with a group of 61 patients with stenotic or hypoplastic VAs (group B). When stratifying patients for stroke risk factors, 85.7% of group B patients complaining of isolated positional vertigo on the questionnaire with at least three stroke risk factors had a vertebral artery abnormality (P = .026). A hypothesized mechanism is transient ischemic attack of the semicircular canals or vestibular nucleus during rotation and extension of the neck, which compresses a contralateral stenotic VA in patients with bilateral VA abnormalities.
In patients complaining of isolated positional vertigo or dizziness of unexplained etiology and having at least three thrombotic stroke risk factors, we recommend a vertebrobasilar radiological evaluation for timely treatment accordingly to the results.
目的/假设：主要由动脉粥样硬化引起的椎动脉（VA）狭窄占后循环卒中的20%。孤立性位置性眩晕或头晕可能是最初的表现症状。目的是比较评估VA形态、血栓性卒中危险因素以及症状随时间演变的患者中孤立性位置性眩晕或头晕的存在情况。
双盲回顾性队列研究。
回顾了描述258例患者椎动脉的磁共振血管造影报告，对其中133例进行了询问，并查阅其病历以了解位置性眩晕或头晕情况。对75例患者进行了神经耳科检查。对46例患者进行了使用眼震电图的前庭测试。评估了所有患者中血栓性卒中因素的患病率。使用卡方统计分析对各组进行比较。
将72例椎动脉正常的患者（A组）与61例椎动脉狭窄或发育不全的患者（B组）进行了比较。在根据卒中危险因素对患者进行分层时，问卷中抱怨孤立性位置性眩晕且至少有三个卒中危险因素的B组患者中，85.7%存在椎动脉异常（P = .026）。一种假设机制是在颈部旋转和伸展过程中，半规管或前庭核的短暂性脑缺血发作，这会压迫双侧椎动脉异常患者的对侧狭窄椎动脉。
对于抱怨病因不明的孤立性位置性眩晕或头晕且至少有三个血栓性卒中危险因素的患者，我们建议进行椎基底动脉放射学评估，以便根据结果及时进行治疗。
