中枢缺血性急性前庭综合征

Acute vestibular syndrome due to central infarction

急性前庭综合征(acute vestibular syndrome,AVS)的临床发病率高,其孤立性眩晕症状在神经科和五官科门诊及急诊患者中十分常见。中枢缺血尤其是后循环供血区域急性梗死是中枢性AVS的最常见病因,可表现为孤立性眩晕等症状,其与周围性AVS的症状极为相似,因此给诊疗带来了挑战。随着前庭系统病理生理学研究的不断深入,临床医师对中枢缺血性AVS的认识正逐步提高。本文对中枢缺血性AVS的最新进展进行综述,关注于中枢缺血性AVS的责任病灶及其血供、脑干和小脑病变引起的AVS眼震特征以及头脉冲试验(head impulse test,HIT)等床旁检查及评估手段,旨在促进临床医师对中枢缺血性AVS的认识,提高鉴别诊断的水平。

Acute vestibular syndrome(AVS)has a high clinical incidence,and its solitary vertigo symptoms are very common in outpatient and emergency patients from Neurology Department and Ophthalmology and Otorhinolaryngology Department.The ischemia in the brain,especially which in the post-circulation artery supplying area,is the most common cause of central AVS,manifesting as solitary vertigo and other symptoms similar to those of peripheral AVS.Thus,it poses challenges on clinical diagnosis and treatment for clinicians.With the growing understanding on the pathophysiology of the vestibular system,the knowledge about AVS due to central infarction is gradually increasing.This paper reviews the progress in AVS due to central infarction,focusing on the responsible lesions of this disease and its artery supply,as well as the characteristics of nystagmus resulting from brain stem and cerebellar lesions,and bedside examination and evaluation methods such as head impulse test(HIT),so as to promote clinicians’understanding on this disease,and improve the level of differential diagnosis.