Clinical Characteristics And Neuroimaging Evaluation Of 30 Patients With Posterior Circulation Ischemia Vertigo

ObjectiveExplore the relationship between isolated vertigo and posterior circulation ischemia, the clinical features and neuroimaging evaluation methods of posterior circulation ischemia vertigo.MethodsVertigo is defined as an illusion of rotatory or linear movement that demonstrates a functional or lesional disturbance of the vestibular system. Isolated vertigo means only typical vertigo, without other neurological symptoms or signs. We studied 30 in-patients with posterior circulation ischemia vertigo of Shandong University Qilu Hospital Neurology Department from October 2008 to March 2009, collected their general data, clinical manifestation, laboratory examination and neuroimaging examination to make a retrospective analysis.Results1. Clinical ManifestationsThere were 19 men and 11 women in this study (M: F=1.7:1), who were aged 49 to 79, with the average age of 62.8 years. Among these patients, there were 1, 9, 14, 6 patients aged <50, 50-59, 60-69, >70 respectively.17 patients experienced vertigo at the onset (56.7%). In other cases, vertigo appeared after other symptoms. Nobody was found other obvious symptoms of brainstem involvement (table 1). In 16 cases, vertigo occurred suddenly without obvious inducement (53.3%). 6 patients (20%) complained their vertigo were induced by posture changing, and other 8 patients (26.7%) by head and neck flexion or turn. And such positional factors above-mentioned may aggravate the symptoms of vertigo.The subjective feeling of vertigo patients can be quite different. The most common feeling was rotation, complained by 14 patients (46.7%). In addition, 7 patients complained of floating or sinking, 5 patients felt groggy, and other patients felt flipping or shaking.5 patients had similar symptoms before, which usually happened during the cold season. While other patients experienced vertigo for the first time.2. Laboratory ExaminationLaboratory examination showed that most patients have trouble with pathoglycemia and dyslipidemia, and some patients were found abnormal clew in electrocardiogram and ultrasonic cardiogram (table 2).3. Neuroimaging Examination16 patients were given brain CT examination, and 14 patients were given brain MRI examination. The results showed that 3 cases had old cerebral infarction, and 8 cases were found focal ischemia and degeneration in white matter of bilateral brain hemisphere. In addition, 3 patients were given brain MRI again for aggravating condition, which were found acute brainstem infarction on MRI scan in 2 weeks.28 patients were given craniocerebral MRA examination, and 2 patients were given craniocerebral CTA examination. We found 9 cases with vertebral artery stenosis, 8 cases with vertebral artery circuity, 3 cases with basal artery stenosis and 2 cases with internal carotid artery stenosis (table 3).Among 24 patients who were given cervical vascular ultrasound examination, 2 cases were found bilateral carotid artery atheromatous plaque formation, while 6 ,4 cases were found atheromatous plaque formation in the left, right carotid artery respectively, and 5 cases have endarterium thickening in carotid artery.14 patients took examination about cervical vertebra, including X-ray, CT or MRI. And the results demonstrated that cervical spondylopathy exist in 6 patients. Conclusion1. Posterior circulation ischemia vertigo exists in clinical practice indeed, demonstrating posterior circulation ischemia can result in isolated vertigo.2. The clinical features of the isolated vertigo due to posterior circulation ischemia include: most cases occur after 50 years old and in the cold season; the risk factors of cerebrovascular disease, TIA history or cerebral infarction history can be found usually; typical clinical symptom of vertigo; the vertigo appear intermittently and the symptom of vertigo may last for a few minutes to hours ; the vertigo can be accompanied by nausea, vomiting, sweating etc, but without brainstem signs; cerebral vascular structural abnormalities can be found in neuroimaging examination in most cases; the whole course may last for several hours to several days ; the treatment of circulation improvement seem to be effective in clinical practice; some cases can develop into TIA or infarction of posterior circulation area.3. MRA, especially the cervical MRA (above the aortic arch), is significant to the evaluation of the posterior circulation , which is comprehensive and noninvasive.