表现为孤立性眩晕的大脑中动脉穿支梗死

Isolated vertigo due to infarction in the territory of the middle cerebral artery perforator

目的孤立性眩晕主要见于前庭周围性病变,罕见于大脑中动脉(MCA)穿支脑梗死,本文探讨MCA穿支梗死出现孤立性眩晕与头晕的临床特征。方法报道3例表现为孤立性眩晕和头晕的MCA穿支急性腔隙性脑梗死患者的临床表现、影像学资料,同时通过PubMed检索之前报道的病例,回顾总结其临床特征。结果包括文献共5例表现为眩晕和头晕的MCA穿支梗死病例。3例表现为孤立性眩晕和头晕,1例表现为持续性头晕伴随短暂性言语不清,1例有轻偏瘫,2例有眼球震颤。眩晕与头晕严重程度均为中度,经治疗后眩晕和头晕多在病程7 d内完全缓解。4例梗死灶位于左侧内囊或放射冠区,1例位于右侧放射冠。颈部及头部增强血管成像有2例显示右侧椎动脉纤细狭窄,4例完成了头部增强CTA检查均提示前循环血管正常。本文3例患者在核磁共振成像(MRI)检查证实为急性腔隙性脑梗死之前,均未有明确诊断。结论 MCA穿支脑梗死可以表现为孤立性眩晕和头晕,严重程度较轻,持续时间通常数日,自主神经症状不明显。为了避免漏诊或误诊,推荐神经影像学检查,特别是MRI弥散成像(DWI)可作为老年首次眩晕和头晕的常规检查项目。

bObjective Isolated vertigo is most often associated with acute peripheral vestibular disorders,but is rarely seen as a symptom of acute infarction in the middle cerebral artery（ MCA） perforators. The aim of this study was to describe the clinical features of vertigo in acute MCA perforator infarction. Methods We reported three patients＇ clinical manifestations and imaging datum presenting isolated vertigo and dizziness in acute MCA perforator infarction,and retrieved similar case reports and literatures by PubMed online,then studied retrospectively their clinical features. Results A total of five acute MCA perforator infarction cases with vertigo and dizziness. In all patients,three cases manifested isolated vertigo and dizziness,one presented persistent dizziness with transient dysarthria and one with hemiparesis. Only two patients in literatures had nystagmus. All of the patients had moderate vertigo and dizziness. Vertigo and dizziness were disappeared within seven days. Magnetic resonance imaging（ MRI） scan found four lesions located in the left internal capsule or corona radiata and one in the right corona radiata. All had normal arteries of anterior circulation and two had stenoses of the right vertebral artery by contrasted magnetic resonance or CT angiography. All our patients had an equivocal diagnosis before acute lacunar infarction was confirmed by MRI. Conclusion MCA perforators infarction can be characterized by isolated vertigo and dizziness with mild autonomic nerve symptom,but the symptoms was moderate and short-term. In order to avoid misdiagnosis,neuro-imaging examination,especially diffusion-weighted imaging can be recommended as the routine examination for first episode of vertigo and dizziness in the elderly.