Retrospective Analysis And Re-evaluation Of The Medical Records Of The Cases With Vertebrobasilar Insufficiency For A Decade

【Objective】The latest research abroad and at home has shown that the past diagnosis of vertebrobasilar insufficiency (VBI) was significantly magnified, and we are also aware of this problem in clinical works, but up to now the correlated clinical research with large samples which is emergency requested has not been appeared. To solve these issues, by collecting and analyzing the medical records of patients with VBI in the past 10 years, we try to clarify the distinct concept of vertigo from lightheadedness, dizziness and apsychia,carry exactly out the new diagnostic criteria for VBI or instead of posterior circulation ischemia(PCI), benign paroxysmal positional vertigo(BPPV), Meniere's disease, vestibular neuronitis, and other vertigo related diseases, and at last, to obtain a lot our own useful data and make a infarctate basis for improve the levels of clinical work and researcher about vertigo.【Methods】Based on the design, firstly, we collected and analyzed the medical records of patients with vertebrobasilar insufficiency in the First Affiliated Hospital of Soochow University between November 1997 and November 2007, and then identity the chief complaint in detail and make sure these are vertigo, lightheadedness, dizziness or apsychia. According to the new diagnostic criteria of vertigo and related diseases, we re-evaluated, analyzed and made diagnosis of these medical records to find out problems, build up experience and improve diagnosis and treatment of the vertigo diseases.【Results】1. There are 773 cases (414 male and 359 female) used to be diagnosed as VBI in all. The average age was 64.18±11.85 years,most of them in 60 to 79 years old. They were suffered from the so-called vertigo from half an hour to several decades, lived in our hospital between 1 and 74 (12.25±8.92) days. Patients distributed in 16 departments, but 70.5 percent in neurology department. There were 647 cases with VBI as the first diagnosis (83.70%).2. According to their chief complaints, there were 140 vertigo cases (18.11%), 474 lightheadedness cases (61.32%), 91 dizziness (11.77%) and 68 cases (8.80%) with others.3. Re-diagnostic results: True vertigo are 462 cases(59.77%), further 318 as peripheral vertigo and 113 as central vertigo,31cases are unclassified; Nonsystemic vertigo are 142 cases(18.37%) and 125 cases(16.17%) can not be classified for their unclear records ; 44cases have no symptoms of vertigo and dizziness and lightheadedness. 67 cases (8.67%) are accord with WHO diagnostic criteria for VBI, but 72 cases (9.31%) can be diagnosed as posterior circulation ischemia. Interestingly, 41 cases (5.30%) turned out to be benign paroxysmal positional vertigo, 35 (4.50%) Meniere's disease, 17 (2.20%) sudden deafness, 11 (1.40%) vestibular neuronitis, 6 (0.80%) Migrainous vertigo, and 7 cases (0.91%) the other ear-derived vertigo. 26 cases (3.40%) are related to heart disease, 26 (3.40%) to blood pressure, 21(2.70%) to infections, and 25(3.20%) to psychological and psychic factor. Except for 432 cases (55.88%) unclassified, there were 20 (2.60%) syncope and 34 (4.40%) other dizziness.4. Clinical characteristics of vertigo diseases: The vertigo of PCI is acute, paroxysmal and has something with complex symptoms. The vertigo of BPPV occurs as soon as the head position is changed. The vertigo in 34 cases last no more than one minute,5casses range from several minutes to ten minutes, 2 cases range from ten minutes to half an hour, and 38 cases have no symptoms of ear. The vertigo of Meniere's disease is recurrent attacks. The vertigo in 5 cases last no more than one hour,5 cases range from one hour to twenty-four hours,and 11 cases only described as paroxysmal, 33 cases companion with tinnitus, 2 cases companion with fural fullness. The vertigo of migrainous vertigo is also recurrent attacks, all of them companying with headache. The vertigo of vestibular neuronitis is acute, all has infected before vertigo,8 cases with upper respiratory infection and 3 with diarrhea, and the symptom of vertigo range from six to eighteen days, and then obviously lessen or vanish. The vertigo of sudden deafness is acute, all companion with deafness except for 3 cases who are within sequela stage. 【Conclusion】1. The VBI diagnosis used to be serious generalization, almost becoming the refuge of not only all kinds of vertigo diseases but also some disorders like dizziness, lightheadedness and so on, which has been used by as many as 16 clinical departments. But the accuracy of posterior circulation ischemia is only 9.31 percent in fact.2. The main reasons for misdiagnosis of VBI are that the doctors misunderstand the concept of vertigo symptom, not correctly grasp diagnostic criteria of the diseases related to vertigo, and made the VBI at random. Many medical records are described too simply to be classified.3. In the true vertigo cases, peripheral vertigo accounts for 68.83% and central vertigo 24.45 %. The top three of diseases for the peripheral vertigo are BPPV (8.87 %), Meniere's disease (7.58%) and sudden deafness (3.68%). The main reasons for nonsystemic vertigo (lightheadedness and dizziness)are mental disorders and internal medicine diseases.4. Every vertigo disease has its own typical clinical features, motivation, duration and simultaneous phenomenon, which are helpful to our diagnosis.5. Effective suggestions: Whenever dealing with disorders like vertigo, firstly, we should distinguish vertigo from lightheadedness, dizziness and so on, secondly, differentiate true vertigo and nonsystemic vertigo, and lastly, make sure diagnostic criteria satisfied before diagnosing. In addition,it is necessary that vertebrobasilar insufficiency is replaced with posterior circulation ischemia.