Choi Jae-Hwan, Park Min-Gyu, Choi Seo Young, Park Kyung-Pil, Baik Seung Kug, Kim Ji-Soo, Choi Kwang-Dong
From the Department of Neurology (J.-H.C., M.-G.P., K.-P.P.) and Radiology (S.K.B.), Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea; Department of Neurology, Seoul National University Bundang Hospital, South Korea (S.Y.C., J.-S.K.); and Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, South Korea (K.-D.C.).
Stroke. 2017 Mar;48(3):556-562. doi: 10.1161/STROKEAHA.116.015507. Epub 2017 Jan 18.
The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS).
We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings. Patients without an obvious cause further received perfusion-weighted imaging. Multivariable logistic regression was used to determine clinical parameters to identify stroke in ATVS.
The prevalence of stroke was 27% in ATVS. HINTS plus could not be applied to the majority of patients because of the resolution of the vestibular symptoms, and magnetic resonance imagings were falsely negative in 43% of confirmed strokes. Ten patients (12%) showed unilateral cerebellar hypoperfusion on perfusion-weighted imaging without an infarction on diffusion-weighted imaging, and 8 of them had a focal stenosis or hypoplasia of the corresponding vertebral artery. The higher risk of stroke in ATVS was found in association with craniocervical pain (odds ratio, 9.6; 95% confidence interval, 2.0-45.2) and focal neurological symptoms/signs (odds ratio, 15.2; 95% confidence interval, 2.5-93.8).
Bedside examination and routine magnetic resonance imagings have a limitation in diagnosing strokes presenting with ATVS, and perfusion imaging may help to identify strokes in ATVS of unknown cause. Associated craniocervical pain and focal neurological symptoms/signs are the useful clues for strokes in ATVS.
本研究旨在确定急性短暂性前庭综合征（ATVS）中卒中的患病率以及床旁评估对诊断卒中的有效性。
我们进行了一项前瞻性、单中心观察性研究，于2014年1月至12月连续招募了86例因ATVS就诊于釜山国立大学杨山医院急诊科的患者。所有患者均接受了包括HINTS加项（头部脉冲试验、眼震模式、斜视试验和指鼻试验）及脑部磁共振成像在内的综合评估。无明显病因的患者进一步接受灌注加权成像检查。采用多变量逻辑回归分析来确定ATVS中识别卒中的临床参数。
ATVS中卒中的患病率为27%。由于前庭症状缓解，大多数患者无法进行HINTS加项检查，且在43%的确诊卒中病例中磁共振成像呈假阴性。10例患者（12%）在灌注加权成像上显示单侧小脑灌注不足，但弥散加权成像上无梗死灶，其中8例患者相应椎动脉存在局灶性狭窄或发育不全。ATVS中卒中风险较高与颅颈疼痛（比值比，9.6；95%置信区间，2.0 - 45.2）和局灶性神经症状/体征（比值比，15.2；95%置信区间，2.5 - 93.8）相关。
床旁检查和常规磁共振成像在诊断ATVS伴发的卒中方面存在局限性，灌注成像可能有助于识别病因不明的ATVS中的卒中。相关的颅颈疼痛和局灶性神经症状/体征是ATVS中卒中的有用线索。
