An Observation And Analysis Of Posterior Circulation Infarction And Perfusion In Patients With Isolated Acute Vestibular Syndrome

Objective: Posterior circulation infarction(PCI)could be missed or misdiagnosed in patients of isolated Acute Vestibular Syndrome(AVS),leading to losing the opportunity of thrombolysis and intravascular interventional therapy,delay of secondary preventio n,which increased the incidence of poor prognosis and mortality.We aimed to find the risk factors of PCI and posterior circulation hypoperfusion(PCH)in patients with isolated AVS by analyzing the demog raphic data,risk factors of cerebrovascular disease,clinical symptoms and vascular stenosis in posterior circulation.Methods: We enrolled the patients with isolated AVS admitted at the second Department of Neurology at Th e People’s Hospital of Liaoning Province from October 2018 to December 2019.According to the presence of acute PCI,all the enrolled patients were divided into PCI group and non-PCI group,between whom demographic data,risk factors of cerebrovascular disease,clinical symptoms and vasc ular stenosis in posterior circulation were compared.The mean signal intensity of bilateral cerebellar hemispheres was measured on the original images of arterial spin labeling sequence.The asymmetry index = The absolute v alue of(The difference of mean signal intensity between two sides of cerebellum)/The mean signal intensity of cerebellum on the sides of higher perfusion.A symmetry index>0.20 was defined as PCH.According to the presence of PCH,the patients non-PCI group were divided into PCH group and non-PCH group,between whom demographic data,risk factors of cerebrovascular disease,clinical symptoms and vascular stenosis in posterior circulation were compared.Results: 1.We enrolled 226 patients with isolated AVS,with mean age of66.72 ±10.67 years old,45.58%(103/226)being male patients,and 54.42% (123/226)female.Among the 226 patients with isolated AVS,51(22.6%) had acute PCI and 175 did not have acute PCI.2.Compared with the non-PCI group,the proport ion of hypertension,the levels of homocysteine and creatinine,the levels of systolic and diastolic blood pressure on admission,the incidence of gait instability,the incidence of vertebral artery stenosis(unilateral or bilateral),basilar artery stenos is and posterior cerebral artery stenosis(unilateral or bilateral)were significantly higher in PCI group(P < 0.05).There was no significant difference in age,diabetes,coronary artery disease,stroke,vertigo,hyperlipidemia,smoking,drinking,trigly ceride,fasting blood glucose,neutrophil / lymphocyte,body mass index,uric acid and cholesterol(P >0.05).Multivariate logistic regression analysis showed that vertebral artery stenosis(OR=2.683,95%CI:1.010-7.128,P=0.030),basilar artery stenosis(OR=2.798,95%CI:1.015-7.708,P=0.047)and posterior cerebral artery stenosis(OR=2.683,95%CI:1.126-6.508,P=0.026)were independently associated with acute PCI.3.In non-PCI group,there were 127 patients completed arterial spin labeling sequence,of whom there were 48 patients(37.8%)h ad PCH.Compared with non-PCH group,PCH group had an older mean age,higher proportion of male,history of smoking,drinking,diabetes and stroke,higher levels of homocysteine,fasting blood glucose and creatinine.The incidence of basilar artery stenos is and subclavian artery stenosis was significantly higher(P < 0.05)in PCH group.Multivariate logistic regression analysis showed that age(OR=1.073,95%CI:1.012-1.130)and stroke history(OR=3.467,95%CI:1.222-9.831)were independent risk factors for PCH in AVS patients.Conclusion: Vertebral artery,basilar artery and posterior cerebral artery stenosis were independent risk factors for acute PCI in isolated AVS patients.Age and stroke history are independent risk factors for PCH in isolated AVS patients.