Zhao Jing, Xu Yuan, Chen Jia, Shi Chong, Liu Xuefang, Wang Guihua, Zhang Hongmei, Ma Shaochen, Candelaresi Paolo, Li Jilai, Wang Peifu, Du Jichen, Wan Zhirong
Department of Neurology, Aerospace Center Hospital, Beijing, 100049, People's Republic of China.
Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, People's Republic of China.
Int J Gen Med. 2025 Sep 4;18:5105-5113. doi: 10.2147/IJGM.S538594. eCollection 2025.
Acute vestibular syndrome (AVS) is characterized by the sudden onset of dizziness or vertigo, accompanied by nausea, vomiting, gait instability, and nystagmus, lasting for more than 24 hours and often persisting for several days to weeks. Central AVS primarily involves central vestibular structures, such as the brainstem and cerebellum, and is most commonly caused by ischemic stroke in the posterior circulation. When acute posterior circulation infarction presents solely with isolated dizziness or vertigo, without other symptoms of central nervous system damage, it is often misdiagnosed as a peripheral vestibular disorder, this can lead to serious consequences. Therefore, distinguishing between central AVS and peripheral AVS in clinical practice is crucial, as the treatment strategies and prognosis differ significantly. Early identification of central AVS helps in adopting specific diagnostic and therapeutic measures. With advancements in vestibular and oculomotor theories, as well as neuroimaging, it is now possible to rapidly identify and diagnose central AVS of a vascular cause. This article summarizes recent diagnostic strategies, and discusses the progress in clinical and laboratory examinations for central AVS of a vascular cause presenting as isolated vertigo.
急性前庭综合征(AVS)的特征是突然发作头晕或眩晕,伴有恶心、呕吐、步态不稳和眼球震颤,持续超过24小时,且常持续数天至数周。中枢性AVS主要累及中枢前庭结构,如脑干和小脑,最常见的病因是后循环缺血性卒中。当急性后循环梗死仅表现为孤立的头晕或眩晕,而无中枢神经系统损伤的其他症状时,常被误诊为外周前庭疾病,这可能导致严重后果。因此,在临床实践中区分中枢性AVS和外周性AVS至关重要,因为治疗策略和预后差异显著。早期识别中枢性AVS有助于采取特定的诊断和治疗措施。随着前庭和动眼神经理论以及神经影像学的发展,现在能够快速识别和诊断血管性病因的中枢性AVS。本文总结了近期的诊断策略,并讨论了以孤立性眩晕为表现的血管性病因中枢性AVS的临床和实验室检查进展。