Gomez C R, Cruz-Flores S, Malkoff M D, Sauer C M, Burch C M
Souers Stroke Institute, Saint Louis University Health Sciences Center, MO, USA.
Neurology. 1996 Jul;47(1):94-7. doi: 10.1212/wnl.47.1.94.
We sought to demonstrate that isolated episodes of vertigo can be the only manifestation of vertebrobasilar ischemia.
Isolated persistent vertigo is classically ascribed to labyrinthine disorders and is only rarely considered to reflect vertebrobasilar ischemia.
We retrospectively analyzed all of the records of the Saint Louis University Stroke Registry between January 1, 1992 and September 1, 1993. We set out to identify those patients discharged with a diagnosis of transient ischemic attack (TIA) in the vertebrobasilar system. We reviewed their clinical records and the results of their diagnostic studies.
We screened 600 admissions and found 29 patients with vertebrobasilar circulation TIAs. Of these, five men and one woman had episodic vertigo for at least 4 weeks as their only presenting symptom. All six patients had one of two abnormal patterns on magnetic resonance angiography (MRA): focal basilar stenosis or widespread vertebrobasilar slow flow. In three patients, the MRA findings were confirmed by cerebral angiography. Five patients were treated with warfarin and one with aspirin. Two patients developed brainstem infarctions, one of them fatal.
Isolated vertigo can be the only manifestation of vertebrobasilar ischemia. Its frequency may be underestimated in clinical practice. Noninvasive testing is helpful both for diagnosis and follow-up.
我们试图证明孤立性眩晕发作可能是椎基底动脉缺血的唯一表现。
孤立性持续性眩晕传统上归因于迷路疾病，很少被认为反映椎基底动脉缺血。
我们回顾性分析了圣路易斯大学卒中登记处1992年1月1日至1993年9月1日期间的所有记录。我们着手确定那些出院诊断为椎基底动脉系统短暂性脑缺血发作（TIA）的患者。我们审查了他们的临床记录和诊断研究结果。
我们筛查了600例入院患者，发现29例椎基底动脉循环TIA患者。其中，5名男性和1名女性以发作性眩晕至少4周作为唯一的首发症状。所有6例患者在磁共振血管造影（MRA）上有两种异常模式之一：局灶性基底动脉狭窄或广泛性椎基底动脉血流缓慢。3例患者的MRA结果经脑血管造影证实。5例患者接受华法林治疗，1例接受阿司匹林治疗。2例患者发生脑干梗死，其中1例死亡。
孤立性眩晕可能是椎基底动脉缺血的唯一表现。在临床实践中其发生率可能被低估。无创检查有助于诊断和随访。
