急性头晕患者的临床和影像特征及其与3个月预后的关系

Association between clinical and imaging features and 3-month prognosis of patients with acute dizziness

目的评估急性头晕患者临床和影像特征及其与3个月预后的关系。方法选择2022年1月1日—5月31日在四川大学华西医院急诊科神经诊断室以急性头晕为主诉就诊并完善头颈部CT血管成像的患者。收集患者临床特征和影像学特征,主要结局指标为头晕急性发作后3个月内头晕复发,次要结局指标为头晕急性发作后3个月内发生脑卒中。结果共纳入急诊科神经诊断室就诊患者1322例,其中617例(46.7%)以急性头晕为主诉。在完成头颈部CT血管成像的222例患者中,排除脑出血1例,对221例患者进行就诊后3个月随访。其中,206例患者完成随访,头晕复发76例,发生脑卒中7例(6例脑梗死,1例脑出血)。多因素logistic回归显示,慢性头晕病程和脑实质低密度影是头晕复发的危险因素。与未发生脑卒中患者相比,发生脑卒中患者合并高血压、头痛、CT显示脑实质低密度影比例较高(P<0.05)。结论在急诊科就诊的头晕患者中,慢性头晕病程、CT显示脑实质低密度影与患者3个月头晕复发风险增加相关。头晕急性发作后3个月发生脑卒中患者多合并高血压、头痛,且CT显示脑实质低密度影。

Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis.Methods We enrolled adult patients with a chief complaint of acute dizziness,who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital,Sichuan University between January 1st and May 31st 2022.We collected clinical and imaging features at baseline for each patient.The primary outcome was recurrent dizziness within 3 months after index dizziness.Secondary outcome was stroke within 3 months after index dizziness.Results A total of 1322 patients who visited the Neurological Clinic were included,of which 617(46.7%)had a chief complaint of acute dizziness.Among 222 patients who performed emergent brain and neck CT angiography,1 patient presented with intracerebral haemorrhage.Among the remaining 221 patients,206 patients completed 3-month follow-up,with 76 patients reported recurrent dizziness and 7 patients had stroke(6 ischaemic,1 hemorrhagic).The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness.Compared with those who did not report stroke,the stroke patients were more likely to present with hypertension,headache symptoms,and exhibit parenchymal hypodensity on baseline CT(P<0.05).Conclusions In patients with acute dizziness,those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness.Acute dizziness patients experiencing 3-month stroke often have hypertension,headache symptoms,and parenchymal hypodensity on baseline CT.