Early Identification And Diagnosis Model Of Central Vertigo In The Elderly

PART ONE : CLASSIFICATION AND CLINICAL CHARACTERISTICS OF VESTIBULAR DISORDERS IN NEUROLOGY CLINICObjective:(1)To analyze the classification of vestibular disorders in neurology clinics,and clarify the composition and clinical features of central vertigo.(2)To study the clinical features of common vestibular diseases-Meniere's disease and vestibular migraine,and provide evidence for clinical differential diagnosis.Methods: From January 2016 to June 2017,the patients with vertigo or dizziness were collected in the neurological clinic of the first affiliated Hospital of Chongqing Medical University.A self-administered questionnaire was used to collect vertigo history,and a neurologist performed a bedside neuro-otological bedside examination of all patients.Pure-tone audiometry,caloric test,neurological imaging and other related examination were performed when appropriate.Diagnose according to international vestibular disease diagnosis standards and expert consensusResults:(1)A total of 392 patients complained of vertigo or dizzinessfor the first time in neurology clinic,the average age was 52.4 ±13.9 years old,mainly female(69%),the patients over 60 years old accounted for32.9%.Peripheral vertigo was the most common(54.6%),central vertigo(22.4%)and psychogenic dizziness(16.3%)were diagnosed.BPPV(30.8%),psychiatric dizziness(20.5%),and vestibular migraine(14.4%)were the three major vestibular diseases in the patients under 60 years of age;however,BPPV(27.9%)central vertigo(21.7%)and Meniere's disease(11.7%)were more common in patients over 60 years of age.(2)There was obvious female preponderance in 47 patients with vestibular migraine than 35 patients with Meniere's disease(93.6% VS62.9%,p=0.001),and the average age of onset was earlier(36.9 ±11.8 VS44.6 ±12.1 years old,p=0.005).38.3% VM patients complained of positional vertigo,while patients with Meniere's disease had less triggered vertigo.Accompanying symptoms such as phonophobia(44.7%)and photophobia(36.2%)were more common in vestibular migraine,23.4%patients with vestibular migraine complained of tinnitus,12.8% patients complained of aural fullness,but only 4 patients with mild sensorineural hearing loss.The family history of headache in patients with vestibular migraine was significantly more than that of Meniere's disease(63.8% vs25.7%,p<0.001),but there was no difference in family history of vertigo(p=0.876).Conclusion: The study found that(1)in the neurology clinic,peripheral vestibular disease was more common,accounted for 54.6%,central vertigo accounted for 22.4%,and psychogenic dizziness was 16.3%,which is consistent with previous reports.The classification of common vestibular diseases in different age groups has certain characteristics.Central vertigo is the second most common cause classification in elderly patients older than 60 years old,and should be paid special attention in clinical diagnosis and treatment.(2)Vestibular migraine had the following characteristics compared with Meniere's disease: 1.vestibular migraine was more common in female,and the onset age was earlier;2.migraine and migraine-related symptoms were more common,such as phonophobia;3.The family history of headache in patients with vestibular migraine was significantly higher than that in patients with Meniere's disease.However,there were also many overlapping symptoms between the two diseases,suggesting that the two diseases may involve the same pathophysiological mechanism.PART TWO: EARLY IDENTIFICATION AND DIAGNOSIS MODEL OF CENTRAL VERTIGO IN THE ELDERLYObjective:(1)To clarify the etiological classification of central vertigo in the elderly and the early warning indication of central vertigo(2)To explore the diagnostic mode of early identification of central vertigo in the elderly,so as to provide basis for early clinical identification.Methods: From July 2017 to July 2018,inpatients with acute isolated vertigo or dizziness were collected in the Department of Neurology,the first affiliated Hospital of Chongqing Medical University.Firstly,a detailed medical history was first collected for all enrolled vertigo patients.Bedside examinations were performed,including general nervous system examination and bedside HINTS test(Head impulse test-nystagmus-skew deviation,HINTS).All patients completed cranial CT within 24 hours after admission.Patients completed cranial magnetic resonance imaging(MRI+DWI)and head angiography(CTA or MRA)within 3-5 days of admission.65.8% of the patients completed videonystagmograph examination.The final diagnosis was made by combining the clinical symptoms and imaging examination of the patients,and the results were compared with those of bedside HINTS.Results:(1)this study included 76 elderly patients with acute isolated vertigo,including 39 males(51.3%),with an average age of 71.0±7.0 years old.Combined with clinical manifestations and imaging examination,26cases(34%)of central vertigo were diagnosed with an average age of 73.3± 6.1 years older,higher than peripheral vertigo patients(69.8 ± 7.0 years,p = 0.035),and 21 patients with hypertension(80.8%,p ? 0.001).Seven patients(26.9%,p = 0.003)had a history of TIA or stroke,and 4(15.4%)had a brief history of vertigo in the last 60 days.The average ABCD2 score was 4.3±0.7,which was significantly higher than that in patients with peripheral vertigo(p = 0.006).Of the 26 patients with central vertigo,10(38.5%)had vertebrobasilar artery stenosis,9(34.6%)had cerebellar infarction,followed by brainstem infarction(11.5%)and cerebellar hemorrhage(7.7%).Acute infarction in the posterior horn of the right ventricle and acute infarction in the left frontal lobe were one case(7.7%)each.(2)In the early identification of elderly patients with isolated central vertigo,the sensitivity and specificity of HINTS were 91.7%(95% CI:59.8%-99.6%)and 84.4%(95% CI: 66.5%-94.1%),respectively.The positive predictive value was 68.75%(95% CI: 41.5%-87.9%),the negative predictive value was 96.4%(95% CI: 79.8%-99.8%),and the accuracy was86.4%.Conclusion:(1)Central vertigo accounted for 34% of the elderly patients with vestibular dysfunction complained of isolated vertigo,which was higher than that of outpatients(21.7%).Among them,cerebellar stroke and brainstem infarction are the most important causes.In addition,elderly patients with ABCD2 3 4 should be alert to central vertigo,especially cerebellar stroke.(2)The bedside HINTS has high specificity and sensitivity for early identification of elderly central vertigo,and can be used in clinical work.