Study On The Differentiation Of Vestibular Central Vertigo And Peripheral Vertigo By Vestibular Function Examination

Objective:Vertigo is a common clinical symptom,which involves many disciplines such as neurology,otorhinolaryngology,surgery and so on.in the process of clinical treatment,vertigo is divided into vestibular vertigo and non-vestibular vertigo.Vestibular vertigo can be further divided into vestibular central vertigo and vestibular peripheral vertigo.Posterior circulation ischemia is a common representative disease of vestibular central vertigo.In this study,vestibular function test was used to distinguish posterior circulation ischemic isolated vertigo from vestibular peripheral vertigo,including optokinetic test,saccade test and smooth follow-up test,and vestibular eye movement system examination based on hot and cold test and speed ladder test.To find the difference of clinical characteristics between peripheral and central vestibular patients,in order to obtain a simple and effective method of diagnosis and differentiation.Methods:In this study,the basic data of patients with vertigo were collected according to strict inclusion and exclusion criteria.A total of 223 patients with vertigo were collected from the affiliated Hospital of Qingdao University,including 79 cases of cerebral infarction and transient ischemic attack in the posterior circulation blood supply area,including 64 cases of cerebral infarction in the posterior circulation blood supply area and 15 cases of transient ischemic attack.There were 114 patients with vestibular peripheral vertigo,including 102 patients with benign paroxysmal positional vertigo,7patients with Meniere’s disease and 5 patients with vestibular neuritis.Collect the patient’s basic information such as age,sex,past medical history such as hypertension,diabetes,personal history such as smoking,drinking and so on.The results of Magnetic Resonance Imaging,Magnetic Resonance Angiography and CT Angiography of cerebral infarction and transient ischemic attack in the posterior circulation supply area were collected.After preparing the external auditory canal,the patients were examined by spontaneous nystagmus,saccade test,smooth tracking test,optokinetic test,speed ladder test and hot and cold test.The measurement data in accordance with normal distribution were expressed by mean±standard deviation(xˉ±s),independent sample t test was used for comparison between the two groups,median and its quartile interval were used for skewness distribution or rank variables,and Mann-Whitney U test was used for comparison between the two groups.Multi-group independent sample rank sum test is used for one-way ordered data.χ~2 test,χ~2 test of continuity correction or Fisher exact probability test were used to compare the counting data between the two groups.Logistic regression analysis was used to analyze the risk factors.Results:1.Univariate analysis showed that there were significant differences between patients with posterior circulation ischemic isolated vertigo and patients with vestibular peripheral vertigo in age(t=191 P<0.01),history of hypertension(χ~2=8.789P<0.003),history of diabetes(χ~2=4.807 P=0.028),hyperlipidemia(χ~2=7.097 P<0.008)and smoking history(χ~2=8.1 P<0.004).Logistic regression analysis showed that hypertension(OR=2.581,P=0.002),diabetes mellitus(OR=3.308,P=0.001)and hyperlipidemia(OR=2.391,P=0.006)were independent risk factors for posterior circulation ischemic isolated vertigo.Patients with posterior circulation ischemic isolated vertigo showed longer duration of vertigo(H=32.683 P<0.001)and had nothing to do with postural changes(χ~2=99.519 P<0.001).2.The positive rate of eye movement test represented by saccade test,smooth follow-up test and optokinetic test in the posterior circulation ischemic isolated vertigo group was more significant than that in the vestibular peripheral vertigo group,and the difference was statistically significant(P<0.001).The positive rate of speed ladder test and hot and cold test in the vestibular peripheral vertigo group was significantly higher than that in the posterior circulation ischemic isolated vertigo group(P<0.001).3.Imaging analysis of patients with posterior circulation ischemic isolated vertigo showed that 70%of the patients’infarction was located in the cerebellum,and most of them were located in the blood supply area of the posterior inferior cerebellar artery.62%of the patients had vertebral artery stenosis.Conclusion:Elderly male patients with isolated vertigo,history of diabetes,hypertension and risk factors of hyperlipidemia should be alert to the occurrence of posterior circulation infarction.vestibular function examination,including central visual eye movement system examination and vestibular eye movement system examination,is of significance for the differentiation of posterior circulation ischemic isolated vertigo and vestibular peripheral vertigo.Most of the patients with posterior circulation ischemic isolated vertigo were located in the cerebellum,and vertebral artery stenosis accounted for the largest proportion of vascular stenosis.