Research Of Rapid Identification Of Patients With Isolated Acute Vestibular Syndrome Originating From Central And Vascular Disease

Objectives: Aim to find special clinical features helpful to differentiate peripheral and central vestibular lesions.To evaluate the value of Essen Stroke Risk Score(ESRS)screening and the STANDING test of central acute vestibular syndrome.Method: Consecutive enroll patients with isolated AVS who admitted to the Hebei general hospital from August 2019 to January 2020,of which clinical characters were recorded and analyzed.Record the ESRS and use the STANDING test to evaluate.The patients were initially diagnosed of central and vascular AVS or non-central and vascular AVS according to the 2 methods.Then a final diagnosis was made by two neurologists,according to which patients were finally divided into central and vascular AVS group and non-central and vascular AVS group.Comparative analysis of clinical date between the two groups,the initial diagnosis and final diagnosis was performed.Result: The study included 257 cases with AVS,all of which underwent both 2 algorithms and were given a definite diagnosis of central and vascular AVS or non-central and vascular AVS.1.There were 23 patients with central and vascular AVS and 234 patients with non-central and vascular AVS.There is significant difference in average age between the central and vascular AVS group(68.96±10.69)and the non-central and vascular AVS group(62.18±12.35).There patients of central and vascular AVS group with history of hypertension,diabetes,stroke/TIA,Smoking,drinking or with ESRS > 3 were significantly more than those in non-central and vascular AVS group.There were no significant difference in gender,some risk factors of cerebrovascular diseases(hyperlipidemia,history of ischemic heart disease,overweight)(P > 0.05)between the two groups.Of the central and vascular AVS patients,56.51% were cerebellar infarction,including cerebellar hemisphere infarction(43.47%)and vermis cerebelli infarction(13.04%),and 3 cases of pontine infarction,2 cases of pedunculus cerebellaris medius infarction,and 1 cases of pons and medulla bulbar junction infarction,2 cases of frontal lobe infarction,1case of temporal lobe infarction,1case of parietal lobe infarction.In patients with non-central and vascular AVS,the highest proportion of patients diagnosed with benign paroxysmal positional vertigo(BPPV)(209 cases,89.31%),followed by vestibular neuritis(VN),Migrainous vertigo(MV),Vestibular Paroxysmia(VP),Meniere’s disease(MD),respectively,11,5,5 and 4 cases.2.There were significant difference in clinical characters including vertigo related to position,standing and gait instability,positive position test,the duration of dizziness and vertigo between central and vascular AVS and non-central and vascular AVS groups(P < 0.05).While there were no significant difference in nausea/ vomiting,visual rotation/self rotation,nystagmus,tinnitus/hearing loss(P > 0.05).3.There was significant difference in the abnormal proportion both anterior and posterior circulation involved of head magnetic resonance including angiography(MRA)(P < 0.05).4.There was significant difference in random blood glucose(P < 0.05).While there were not in other serological markers(P > 0.05).5.The clinical diagnosis by the ESRS,STANDING,serial test and parallel test were respectively consistent with final diagnosis in 212 cases,236 cases,240 cases and 180 cases.The value for the diagnosis of central and vascular AVS of the STANDING test was highest.The sensitivity was 91.3%,the specificity was 91.88%,the negative predictive value was 99.08%,the positive predictive value was 52.50%,and the diagnostic accuracy for the cause of vertigo was 91.83%.6.Possible related to definite diagnosis were used in multivariate logistic regression analysis,which showed that age,vertigo related to position,position test,the duration of dizziness or vertigo,random blood glucose were the factors influencing the definite diagnosis(P < 0.05),and the remaining influencing factors showed no statistical significance.(P > 0.05).Conclusion:1.The majority of patients with isolated AVS is due to peripheral vestibulopathy,while central lesions were in the minority.central and vascular AVS manly due to cerebellar infarction.non-central and vascular AVS mainly due to BPPV.2.Age,vertigo related to position,the duration of dizziness or vertigo,random blood glucose are the factors influencing the definite diagnosis.3.With ideal sensitivity and specificity for diagnosing central lesions in AVS,STANDING test may help to reduce medical cost,avoid missed diagnosis of central and vascular AVS,and have good clinical practical value.