中老年人孤立性短暂性眩晕的床旁诊断

Bedside diagnosis of isolated transient vertigo in middle-aged and elderly patients

目的旨在探讨孤立性短暂性眩晕(isolated transient vertigo,ITV)的常见病因构成及床旁识别技巧。方法从2017年1月-2020年1月在上海市同济医院神经内科诊治的眩晕/头晕患者中,提取每次发作时间<3 min的中老年ITV患者共计424人,按照既定格式收集其临床特征并对病因进行分析,同时使用二元Logistic回归分析判断临床特征与良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)和血管性ITV(vascular ITV,vITV)的关系。结果424例ITV患者中,BPPV占65.09%(n=276),其次是vITV,占20.51%(n=87)。52例(18.84%)BPPV被诊断为后循环缺血,12例(14.63%)vITV起初被诊断为BPPV。Logistic回归分析发现眩晕发作时间<30 s、仅床上变位诱发及变位试验阳性是诊断BPPV的独立预测因子(P<0.001)。在vITV中,活动不耐受、躯干平衡障碍、自发眼震及变位不耐受是其重要的预判因子(P<0.001),未发现血管危险因素与其独立相关(P>0.05)。结论中老年ITV最常见的病因是BPPV和vITV。通过某些特异性临床特征和针对性床旁检查可以快速有效地对ITV的病因进行鉴别。

Objective To study the common etiological components and bedside diagnostic skills of isolated transient vertigo(ITV).Methods We performed a single-center observational study that had consecutively recruited 424 middle-aged and elderly patients presenting with vertigo episodes lasted less than three minutes in the Neurology Department of Shanghai Tongji Hospital from January 2018 to January 2020.The clinical characteristics were collected and analyzed according to the established format and vertigo causes were analyzed.Binary Logistic regression analysis was used to determine some clinical parameters to benign paroxysmal positional vertigo(BPPV)and vascular ITV(vITV).Results In all 424 patients,BPPV accounted for 65.09%(n=276),vITV for 20.51%(n=87).Fifty-two cases(18.84%)of BPPV were diagnosed as posterior circulation ischemia(PCI)and 12 cases(14.63%)of vITV were suspected as BPPV.Logistic Regression analysis showed that onset time of vertigo<30 s,vertigo provoked by lying down or turning over in the supine position and typical nystagmus by positional maneuver were the independent predicted factors of BPPV(P<0.001).The higher risk of vITV was found in association with intolerance of head movement,trunk balance disturbance,spontaneous nystagmus and intolerance by positional maneuver(P<0.001).There was no independent correlation between vascular risk factors and vITV(P>0.05).Conclusion BPPV and vITV are the most common etiologies of ITV in the middle-aged and elderly patients.The etiology of ITV can be quickly and effectively distinguished by some specific clinical features and target bedside examinations.