后循环缺血单发性眩晕与偏头痛性眩晕的鉴别诊断

Differential diagnosis between vertigo of posterior circulation ischemia and migrainous vertigo

目的:通过2组病例分析,探讨后循环缺血单发性眩晕(PCIV)与偏头痛性眩晕(MV)的鉴别诊断。方法:选取眩晕门诊MV患者60例和PCIV患者64例,分析其临床的特征性表现。检查方法包括:后循环缺血(PCI)的高危因素检查、眼动检查和高刺激率听性脑干反应(ABR)检查及头颅MRI。结果:64例PCIV患者,血压异常29例;血脂或(和)血糖异常14例;血管超声异常37例;突然起身眼前发黑或头晕14例;高刺激ABR异常22例;4例头颅MRI异常(腔隙梗死)。60例MV患者,运动病45例,运动敏感20例,畏光或(和)畏声32例,偏头痛45例,眼动异常16例,MRI异常3例,高刺激ABR异常40例。高刺激ABR在PCIV和MV的阳性率分别为34%(22/64),67%(40/60)。结论:MV平均年龄小于PCIV患者。MV患者女性发病多于男性(2.75∶1.00),PCIV性别比例差异减小(1.46∶1.00)。MV的运动病、运动敏感、发作时畏光或(和)畏声是与PCIV的重要鉴别点;PCIV的主要特点包括血压、血脂或(和)血糖异常、动脉硬化等。前庭功能检查不能作为鉴别的依据;头颅MRI对于鉴别诊断有一定的帮助,高刺激ABR不能作为PCIV与MV的鉴别点,但对与其他类型眩晕的鉴别有一定意义。前庭功能检查无助于PCIV与MV的鉴别诊断。

Objective：To analyze two groups of patients with migrainous vertigo （MV）and vertigo resulting from posterior circulation ischemia （PCIV）and investigate the differential diagnosis between them. Method： There were 60 patients with MV and 64 patients with PCIV. Clinical tests include high risk factors of posterior circulation ischemia（PCI）, cerebral MRI, oculor motion and high stimulating rate ABR. Result： Among 64 patients with PCIV,29 had abnormal blood pressure and 14 had abnormal blood fat and/or pathoglycemia;37 had abnormality in cervical vascular ultrasound; 14 suffered from amaurosis or dizziness upon fast getting up. Twenty two had abnormal high stimulating rate ABR and 4 had cerebral lacunar infarction in MRI. As for 60 patients with MV, 45 suffered from motion sckness; 20 were sensitive to motion; 32 had photophobia and （or） phonophobia; 45 had migraine ; 16 had abnormal ocular motion function; 3 had abnormal cerebral MRI and 40 had abnormal results in high stimulating rate ABR. The percentage of abnormal high stimulating rate ABR in MV and PCIV were 53% （22/42）and 67% （40/60）respectively. Coclnsion： The mean age of MV is younger than that of PCIV. Female is more prone to MV than male（2.75 ： 1.00）;the sex difference in PCIV is lesser（1.46 ： 1.00）. Motion sickness, motion sensitivity,photophobia and （or） phonophobia are principal differential highlights to MV. The major characteristics of PCIV include abnormal blood pressure, abnormal blood fat, pathoglycemia and arteriosclerosis. Vestibular function tests could not serve as a diffrential point; Cerebral MRI might be helpful to differential diagnosis. The results of high stimulating rate ABR is not a differential point between PCIV and MV, but it might play a role in differentiating other kinds of vertigo.