| Objectives:Through the assessment of subjective visual vertical(SVV)and subjective visual horizon(SVH)of the sitting position head 0°,450 inclined to the left and 450 inclined to the right in healthy volunteers and acute ischemic stroke patients,we evaluated the reliability,normal value and influencing factors of this test in healthy volunteers.The effect of different infarct areas on patients with acute ischemic stroke on deviation degree and direction of SVV and SVH in various angles were observed.We evaluated the SVV45° and SVH45° assessment whether improve detection rate of central vestibular damage in ischemic stroke patients.Methods:Healthy adults were involved in the control group,and 140 patients with acute ischemic stroke were involved in the case group.The reliability of the test was achieved by repeated measurements in control group.The value of SVV and SVH in healthy volunteers in the sitting position head 0°,45° inclined to the left and 45° inclined to the right was collected and analyzed,assuming that the normal range(95%Cl)was the mean±2 Std.And the impact of gender,age and education level on SVV and SVH was explored.In patients with acute ischemic stroke,the deviation Angle of SVV and SVH beyond the normal range of healthy crowd was consider as positive.The deflection reaction(Ocular tilt reaction,OTR)pathway was divided into lower brainstem(pontomedullary),the upper brainstem(pontomesencephalic),thalamus and the brain hemispheres.In addition,cerebellum was involved in vestibular compensation of OTR pathway,analyzing and comparing effect of different infarct areas on SVV and SVH deviation degree and direction of various angles.Comparing the value of head 0° SW and SVH,adding the examine in 45° inclined to the left and 450 inclined to the right,whether can improve the detection rate of central vestibular damage in ischemic stroke patientsResults:1.Reliability analysis:the deflection Angle of SVV head 0°,SW right 45°,SW left 45°,SVH head 0°,SVH right 45° and SVH left 45°in healthy volunteers were measured for two times.Using two independent samples t test,there was no statistically significant difference between data of two measurements(t=0.90,1.61,-1.17,-0.75,-1.14,-0.005,respectively,all p>0.05);r values in pearson correlation analysis of the two values were 0.38,0.59,0.50,0.17,0.64,0.60,respectively and reliability of 45° is better than 0°.2.SVV and SVH results in the normal control group:in normal 62 cases,SVV0°average was-0.18°±1.21°(95%Cl,-2.60°-2.24°),SVV right 45° averages was-4.30°±4.91°(95%CI,-14.12°-5.52°),SW left 450 averages was 3.17°±5.84°(95%CI,-8.51°-4.85°).SVHO° average was-0.17°±1.480(95%CI,-3.13°-2.79°),SVH right 450 average was-3.24°±6.08°(95%CI,-15.40°-8.92°),SVH left 450 average was 3.05°±5.14°(-7.23°-13.33°).3.Single factor analysis in the normal control group:in the control group,SVH right 45°was negatively correlated with educational level(r=-2.9,p=0.023).Multiple factors analysis indicated there was no correlation between the deflection angle of SVV and SVH0°,450 and factors including age,gender,and educational level(p>0.05).4.There were statistically significant differences of absolute values of SW/SVH 00 deflection Angle between case group and control group(Z=4.0 and 3.0,respectively,all p<0.05).5.There were statistically significant differences of SVV0°,SVH right 450 and SVH0° between different ischemic part of patients with left side acute ischemic stroke and healthy people(F=2.30,2.33,3.02,respectively,all p<0.05),and there was statistically significant of SVV0° between the lower brainstem group(average was-3.32°±2.44°)and healthy people group(average was-0.16°±1.47°)(p<0.05).There were statistically significant differences of SVV0° and SVH0° between different part of right acute ischemic stroke patients and healthy people(F value=2.52,2.92,respectively,all p<0.05).6.There was statistically significant differences of SVH0° deflecion Angle in different part of acute ischemic stroke patients(X2=24.08,p<0.05),and the lower brainstem deflected to ipsilateral lesion(100%),the upper brainstem and cerebellum deflected to contralateral side of lesion(100%),thalamus and cerebral hemisphere deflected to both sides of the lesions(the probability of ipsilateral deviation of the lesion was 50%and 42.86%,respectively,and the probability of contralateral deviation of the lesion was 50%and 57.14%respectively).7.In 140 patients with acute ischemic stroke,the positive rate of SVV0° was 32.1%,the positive rate of SW45° was 62.1%,the total positive rate of SVV was 66.4%,the positive rates of SVV 45° and total positive rates of SW were significant higher than the positive rate of SVV0°(X2=23.8,48.0 respectively,p<0.05).In 138 patients with acute ischemic stroke,the positive rate of SVH0° was 47.1%,the positive rate of SVH45° was 62.3%,the total positive rate of SVH was 76.8%,the positive rates of SVH45° and total positive rates of SVH were significant higher than the positive rate of SVH0°(X2=7.23,41.0,p<0.05).Conclusions:1.The detection repeatability of SW and SVH was better Head 450 retest reliability was better than the head 0°.The normal value of SVV 0°,SVV right 45° and SW left 450 were-2.60°-2.24°,-14.12°-5.52° and-8.51°-14.85°,respectively.And the normal value of SVH 0°,SVH right 450 and SVH left 45° were-3.13°-2.79°,-15.40°-8.92°,and-7.23°-13.33°,respectively.Age,gender and education level had no significant effect on deflection Angle of SVV and SVH in healthy population.2.There were statistically significant differences of SVV and SVH head 0°between ischemic stroke patients and healthy people,and there was statistically significant differences of SVH 45° inclined to the right between left side ischemic stroke patients and healthy people.SVV0° value of the left side of the lower brainstem infarction patientsis existed the most obvious change.When the lesion of ischemic stroke was located in the lower brainstem,the sitting position of SVH 00 inclined to ipsilateral lesion.When the lesion was located in the upper brainstem and cerebellum,it was inclined to the contralateral lesion;when the lesion was located in thalamus and cerebral hemisphere,it was inclined to both sides of the lesion.3.Based on the examination of SW and SVH 0° test,adding the head 450 incline examination can improve the detection rate of cerebral vestibular abnormal in ischemic stroke patients. |
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