| Vertigo is a sense of abnormal self-rotation or the rotation of external objects under non-self-movement condition, as well as is an illusion of movement and a common clinical symptom. The cause of vertigo is numerous and the pathogenesis is complex, often involving considerable interdisciplinary knowledge of the fields of otology, neurology and ophthalmology, which results in a difficulty in diagnosis and high rates of misdiagnosis and missed diagnosis. Therefore, the present study retrospectively analyzed the clinical data of the patients who complained of vertigo and visited the Vertigo-oriented Outpatient of the Department of Neurology in Xi'jing Hospital, to preliminarily clarify the spectrum of vertigo in patients with vertigo in our hospital and to investigate the clinical features of various pathogenies and possible problems during diagnosis, aiming to provide a certain reference for further clinical practice. ObjectiveThrough the retrospective analysis of the data of the patients in the Vertigo-oriented Outpatient of the Department of Neurology, the constituent ratio of various vertigo diseases in our hospital was preliminarily clarified, as well as the clinical features of various pathogenies and possible problems during diagnosis were explored, in order to provide a reference for clinical diagnosis in the future. MethodsPatients with vertigo or dizziness visiting the Vertigo-oriented Outpatient of the Department of Neurology in our hospital were collected continuously from January 2014 to November 2015; all included patients had detailed medical history, physical examination record and complete auxiliary examination data. The clinical data of the patients with vertigo or dizziness were analyzed comprehensively, and etiological diagnosis was conducted strictly referring to guidelines or internationally accepted standards. Finally, statistical analysis was performed for age, gender, the constituent ratio of various pathogenies, and some clinical features of patients. Results1.In this study, a total of 2578 patients were enrolled, the ratio of male-female is 1:1.6; their age ranged from 5 to 87 years with the mean of 51.8±11.6 years. The percentage of patients in the age groups of 18 years and below, 19~29 years, 30~39 years, 40~49 years, 50~59 years, 60~69 years, and 70 years and above were 2.6%, 3.5%, 10.3%, 26.8%, 32.1%, 15.5% and 9.2%;40 to 59 age group accounted for 58.9% of the total.2.Among the patient of vertigo/dizziness, the number of women is far more than men, this gender difference in the VM more significant(?2 = 96.43, P = 0.00).Compared with the rest of the group, the average age of central vertigo is biggest(F = 10.89, P = 0.00), indicating that the central vertigo is more common in the elderly population.3.Peripheral vestibular disease is much greater than central vestibular disease, the vestibular peripheral accounted for 65.4%, whereas the most common five diseases were BPPV(29.1%), VN(7.5%), PPPD(5.5%), BVP(5.1%) and MD(4.8%), respectively; vestibular central vertigo accounted for 17.8%, where VM was the most common condition and accounted for 11.6%, whereas vertigo/dizziness patients of unknown causes reached a higher proportion of 16.8%.4.Dizziness etiology of different ages constitute a certain distinction, BPPV remained to be the first cause, where the highest suffers were reported in the age group of 50-59 years and accounted for 35.9% in all BPPV patients; VM, VN, PPPD are more commom middle-aged patients; furthermore; the ratio of CV patients gradually increased with age.5.The main etiology of CV is cerebral infarction, accounted for 82.0%; Isolation central vertigo accounted for 6.3%.6.Up to 78.5% of etiology with bilateral vestibular pathology remain unknown, followed by the aminoglycoside ototoxicity(11.5%), post-meningitis(6.1%), bilateral Meniere's disease(1.6%), labyrinth shock( 2.3%).7.The most of presyncope were patients with orthostatic hypotension(65.3%),followed by the proportion of other patients suffering reflex syncope, unexplained syncope and cardiogenic syncope were 23.9%, 2.2% and 17.4%. Of all the orthostatic hypotension, drug induced orthostatic hypotension exhibited the highest proportion(40.8%), the autonomic nerve dysfunction exhibited the secondary cause(including 20.4% of orthostatic hypotension induced by disorders involving the autonomic nervous system like diabetic peripheral neuropathy and Parkinson's disease), the remaining induced by unknown etiology(38.8%).8.In various semicircular canal BPPV, posterior semicircular canal BPPV was reported in 595 cases, horizontal semicircular canal BPPV in 104 cases, anterior semicircular canal BPPV in 30 cases, mixed BPPV in 8 cases and subjective BPPV in 13 cases, indicating a ratio of 79.3%, 13.9%, 4.0%, 1.1%, and 1.7%.9. Complained of visual objects rotate them most, accounted for 39.7%, followed by the complaints accounted for than followed by walking instability(19.1%), self rotation(15.2%), depending on the swing of things(8.2%), motor evoked dizziness(5.1%), stand up fall sense of(3.9%), depending on the tilt(3.8%), motor evoked blurred vision(3.2%), walking deviation(1.4%), visual delay(0.4%).10.Each attack duration of common causes have their own characteristics: BPPV most for tens of seconds, more than 98.8%, the last several minutes are rare, accounting for more than 1.2%; VM from tens of seconds to tens of hours, and its proportion in 3.4%, 18.6%, 30.9%, 18.6% and 11.7%; Most for several hours, accounted for 97.8%, only 2.2% of the last several hours; MD onset duration dozens of minutes, a few hours every time, the ratio of dozens of hours are 49.5%, 32.0% and 49.5%;Patients who attack for several hours at a time in CV are most common, accounted for 75.0%, followed by a minute(17.6%), in turn tens of minutes(5.1%), a few hours(1.7%), dozens of seconds(0.7%); Patients who attack for several hours at a time in BVP and UVP can be a few minutes, tens of minutes.11.The positive rate of spontaneous nystagmus during the acute phase of VN and CV are 36% and 43%, other diseases are difficult to see spontaneous nystagmus.The positive rates of soomth pursuit test in CV patients are as high as 93%, respectively,in addition to the positive rate of soomth pursuit test in VM was 9%,the positive rates of other diseases are less than 3%. The positive rate of head impulse test in VN and BVP are 81% and 53%, other diseases is relatively low. The positive rates of head shaking test in CV, VN and MD are 26%, 24% and 21%. The positive rates of ocular tilt reaction in CV and VN are 38% and 19%.The positive rates of tandem Romberg test and unterberger test in four kinds of diseases are upper, in which the oblique direction in patients with VN were most fixed, a few CV appear dumping backdown,the deflection side in patients with PPPD are uncertain. Compared to CV and VN, their positive rate of gaze nystagmus,soomth pursuit test, saccade test, head impulse test, ocular tilt reaction have significant difference(P < 0.01). Conclusions1.The neurological outpatients with peripheral vertigo is more common, accounting for 65.4%,the common vertigo disease followed by BPPV, VM, VN, CV;the patients with vertigo/dizziness of unknown causes reached a higher proportion of 16.8%.2.Vertigo / dizziness occurred in the high incidence of 40 to 59 years old, followed by 60 years of age and older people, young patients at least. Women are more likely than men to suffer from various types of vertigo or dizziness.3.BPPV most commonly involving the posterior semicircular canal and horizontal semicircular canal, anterior semicircular canal and multiple otolith disorders are fewer.4.The main etiology of CV is cerebral infarction,isolated central vertigo is rare.5.Postural hypotension is the most common in the patient with presyncope, followed by reflex syncope and unexplained syncope. Among all the postural hypotension, drug induced postural hypotension was the most common, and autonomic dysfunction was the second.6.The majority etiology of bilateral vestibular pathology remain unknown.7.Symptoms of the scene is mainly outside of a rotating object, walking instability and its sense of rotation, followed by depending on a rocking sensation and motion induced dizziness, heavy feeling, erect the fall, depending on the tilt induced by a sense of movement and blurring of vision sense, walking deviation and visual experience delay are less.8.Gaze evoked nystagmus, soomth pursuit test, head impulse test have a important value in differential diagnosis of ICV. |
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