Teixeira Jeffrey C, Jackson Paula J
Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
Mil Med. 2020 Sep 18;185(9-10):e1840-e1842. doi: 10.1093/milmed/usaa010.
Distinguishing between central and peripheral causes of vertigo can be challenging not only in an acute setting but also in chronic settings. A thorough review of systems and physical exam can assist providers in differentiating central versus peripheral etiologies and the need for urgent imaging. In this case, a 47-year-old man presented with vertigo, right-sided hearing loss, right-sided headache, and right-sided facial pain that began 4 weeks before while the patient was on a cruise ship. His physical exam findings were notable for anisocoria with right pupil 3.5 and left pupil 4.5, mild ptosis on the right side, positive Romberg test to the right, and Fakuda test with deviation to the right. Urgent magnetic resonance imaging revealed dissection of the right cervical internal carotid artery with a nonocclusive intramural hematoma. This case illustrates the importance of imaging in vertigo patients in which a central etiology is suspected. It further demonstrates that isolated partial Horner's or unilateral headache may indeed be the only presenting sign in a carotid dissection.
区分眩晕的中枢性和外周性病因不仅在急性情况下具有挑战性，在慢性情况下也是如此。全面的系统回顾和体格检查有助于医生区分中枢性与外周性病因以及是否需要紧急成像检查。在本病例中，一名47岁男性出现眩晕、右侧听力丧失、右侧头痛和右侧面部疼痛，这些症状始于4周前患者在游轮上时。他的体格检查结果值得注意，表现为瞳孔不等大，右侧瞳孔3.5，左侧瞳孔4.5，右侧轻度上睑下垂，右侧Romberg试验阳性，Fakuda试验向右偏斜。紧急磁共振成像显示右侧颈内动脉夹层伴非闭塞性壁内血肿。该病例说明了对疑似中枢性病因的眩晕患者进行成像检查的重要性。它进一步表明，孤立性部分霍纳氏征或单侧头痛可能确实是颈动脉夹层的唯一表现体征。
