摘要：

目的 总结以眩晕为主要症状的急性缺血性卒中的临床和影像学特点并探讨其发病机制。方法 回顾分析 2014 年 1 月至 2017 年 10 月共 81 例以眩晕为首发症状的急性后循环缺血性卒中患者的临床症状与体征、实验室指标、头部影像学和 TOAST 病因分型。结果 根据眩晕发作类型分为孤立性眩晕组（18 例）和非孤立性眩晕组（63 例）。孤立性眩晕组患者冠心病［8/18 对 15.87%（10/63）；校正χ² = 5.062，P = 0.024］和心房颤动［7/18 对 14.29%（9/63）；校正χ² = 3.907，P = 0.048］比例高于非孤立性眩晕组；眼震发生率高于［10/18对30.16%（19/63）；χ² = 3.929，P = 0.047］非孤立性眩晕组；影像学检查，弧立性眩晕组有 16/18 例病变位于小脑，高于非孤立性眩晕组（Z = -2.289，P = 0.022）；TOAST 病因分型，孤立性眩晕组大动脉粥样硬化型占 8/18 例、心源性栓塞型占 6/18 例。结论 急性缺血性卒中致孤立性眩晕患者冠心病和心房颤动发生率较高，病灶主要累及小脑，脑卒中发病机制可能倾向于大动脉粥样硬化和心源性栓塞。

关键词: 卒中, 脑缺血, 眩晕, 磁共振成像

Abstract:

Objective To summarize the clinical and neuroimaging features of acute ischemic stroke presented with vertigo and explore its pathogenesis. Methods The clinical data of 81 patients with acute ischemic stroke in posterior circulation initiated as vertigo from January 2014 to October 2017 were retrospectively analyzed, including clinical symptoms and signs, laboratory indexes, neuroimaging and TOAST classification. Results Eighty-one patients were divided into isolated vertigo group (N = 18) and non-isolated vertigo group (N = 63). Compared with non-isolated vertigo group, patients of isolated vertigo group had higher rates of coronary heart disease [8/18 vs. 15.87% (10/63); adjusted χ² = 5.062, P = 0.024] and atrial fibrillation [7/18 vs. 14.29% (9/63); adjusted χ² = 3.907, P = 0.048]. Patients in isolated vertigo group also had higher rate of nystagmus [10/18 vs. 30.16% (19/63); χ² = 3.929, P = 0.047] than that in non-isolated vertigo group. Imaging examination showed the lesion of 16/18 patients of isolated vertigo group was located in cerebellum, and the ratio was significantly higher than that of non-isolated vertigo group (Z = -2.289, P = 0.022). TOAST classification showed the type of 8/18 patients of isolated vertigo group was large artery artherosclerosis (LAA), and 6/18 patients was cardioembolism (CE). Conclusions Patients with isolated vertigo caused by acute ischemic stroke had higher rate of coronary heart disease and atrial fibrillation than those with non-isolated vertigo. The infarcts were mostly located in the cerebellum and mainly caused by large artery artherosclerosis or cardioembolism. 

Key words: Stroke, Brain ischemia, Vertigo, Magnetic resonance imaging