Yamada Shinichiro, Yasui Keizo, Kawakami Yu, Hasegawa Yasuhiro, Katsuno Masahisa
Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Neurology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
Department of Neurology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1561-1570. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.005. Epub 2019 Mar 28.
Dizziness is the most common posterior circulation symptom; however, diagnosing a posterior circulation infarction is difficult due to a lack of typical symptoms. We aimed to investigate the frequency of misdiagnosis of a posterior circulation infarction in patients who presented with dizziness and to develop a new stroke scale that increased the diagnostic accuracy for stroke among these subjects.
We retrospectively analyzed consecutive data from subjects hospitalized with ischemic stroke who presented with dizziness (the developmental phase). Based on these results, we created a novel stroke scale, which was used as a diagnostic procedure in the prospective validation phase. We compared the rate of misdiagnosis of ischemic stroke between phases.
During the development phase, 115 subjects were hospitalized for ischemic stroke accompanied by dizziness. Six ischemic stroke subjects were not properly diagnosed (6/115, 5.2%). We created the new DisEquilibrium, Floating sEnsation, Non-Specific dizziness, Imbalance, and VErtigo (DEFENSIVE) stroke scale to prevent underdiagnosis of a posterior circulation infarction. During the validation phase, 949 subjects with dizziness were examined with the DEFENSIVE stroke scale; among these subjects, 100 were hospitalized for ischemic stroke accompanied by dizziness. No subject with ischemic stroke was overlooked. The new DEFENSIVE stroke scale had a sensitivity of 100% and decreased the rate of improper diagnosis of stroke (5.2% versus 0%; P = .022).
Our new stroke recognition instrument for a posterior circulation infarction presenting with dizziness and related symptoms (the DEFENSIVE stroke scale) is easy to administer and has good diagnostic accuracy.
头晕是后循环最常见的症状；然而，由于缺乏典型症状，后循环梗死的诊断较为困难。我们旨在调查以头晕为表现的患者中后循环梗死的误诊频率，并开发一种新的卒中量表，以提高这些患者中卒中的诊断准确性。
我们回顾性分析了因缺血性卒中伴头晕住院患者的连续数据（开发阶段）。基于这些结果，我们创建了一种新的卒中量表，并在前瞻性验证阶段将其用作诊断程序。我们比较了各阶段缺血性卒中的误诊率。
在开发阶段，115名因缺血性卒中伴头晕住院。6例缺血性卒中患者未得到正确诊断（6/115，5.2%）。我们创建了新的平衡失调、漂浮感、非特异性头晕、失衡和眩晕（DEFENSIVE）卒中量表，以防止后循环梗死的漏诊。在验证阶段，949例头晕患者使用DEFENSIVE卒中量表进行检查；其中，100例因缺血性卒中伴头晕住院。没有缺血性卒中患者被漏诊。新的DEFENSIVE卒中量表敏感性为100%，降低了卒中的误诊率（5.2%对0%；P = 0.022）。
我们针对以头晕及相关症状为表现的后循环梗死的新卒中识别工具（DEFENSIVE卒中量表）易于实施，且具有良好的诊断准确性。
