| Background/Aims:The incidence of isolated vertigo is high,the identification of isolated vertigo from the central or peripheral lesions is very important,both in the acute phase of treatment programs,secondary prevention and prognosis are very different,so the rapid identification of isolated vertigo caused by posterior circulation ischemia can improve the prognosis of patients,misdiagnosis will greatly increase the morbidity and mortality of patients,and cranial imaging in the etiology of diagnosis has some limitations,to explore practical bedside rapid test is very necessary.Previous studies have shown that bedside HINTS examinations(head impulse,nystagmus,test of skew,HINTS),and Essen stroke risk score(ESRS)for rapid identification of central and Peripheral etiology has important value.Methods:Consecutive enrolled patients with isolated vertigo who admitted to the Department of Neurology,Affiliated Hospital of Yang zhou University from January 2017 to January 2018,of which clinical characters were recorded,including sex,age,previous transient ischemic attack Or stroke,diabetes,hyperlipidemia,hypertension,ischemic heart disease,history of dizziness,history of alcohol use and smoking,family history of migraine.two experienced neurologists evaluated all the patients with two-step bedside algorithm,and make a clinical diagnosis when they reached an agreement.All selected patients underwent brain MRI examination,then a final diagnosis was made according to patients,clinical manifestations and imaging findings.Comparative analysis of clinical diagnosis and final diagnosis was performed.Result:The study included 172 cases with isolated vertigo,of which 112 cas es underwent both two-step bedside algorithm and brain MRI examinations,an d finally made a diagnosis of central vertigo or peripheral vertigo.(1)There w ere 22 patients with central vertigo,of whom 68.2%were male,which was si gnificantly higher than that of peripheral patients(68,2%vs 42.3%,p=0.037).There were 14 patients with hypertension in central vertigo(63.6%VS 40.0,p=0.046).The patients with ESRS>3 in central vertigo were significantly mor e than those in peripheral patients(54.5%vs 21.1%,p=0.002),and there is a si gnificant difference in smoking between central vertigo and peripheral vertigo g roup.(50.0%vs 25.6%,p=0.111).(2)Of the central vertigo patients,72.7%w ere cerebellar infarction,and 2 cases of cerebellar hemorrhage,3 cases of med ullar infarction,and 1 cases of pontine hemorrhage.(3)In patients with periph eral vertigo,the highest proportion of patients diagnosed with VN(25 cases,27.7%),followed by MV and MD patients,respectively,16 and 13 cases.(4)T he clinical diagnosis by Two-step bedside algorithm was consistent with final d iagnosis in 100 cases,including 20 cases of central vertigo,80 cases of periph eral vertigo.The sensitivity of this two-step bedside algorithm for the diagnosis of central vertigo was 90.9%(95%Cl:69.3%-98.9%),the specificity was 88.8%(95%CI:80.0%-94.2%),and the positive predictive value was 66 6%(95%CI:47.1-82.0%),the negative predictive value was 97.5%(95%CI:90.6%-99.5%),and the diagnostic accuracy for the cause of vertigo was 89.2%.Conclusion:(1)Isolated central vertigo is manly duo to cerebellar infarction,especially minor infarction in the territory of the medial branch of the posterior inferior cerebellar artery.(2)Not all patients with isolated vertigo have nystagmus.In such patients,central lesions occupy a significant proportion,and the clinician is concerned.(3)Considering the false negative finding of brain DWI for diagnosing central lesions in isolated central vertigo,multiple repeated brain DWI examinations may be needed occasionally.(4)With ideal sensitivity and specificity for diagnosing central lesions in isolated vertigo,two-step assessment method(ESRS>3 +HINTS)may help to reduce medical cost and avoid missed diagnosis,has good clinical practical value. |
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