| ObjectiveChronic subjective dizziness(CSD)is one of the most common types of dizziness in clinical practice,which pathogenesis is not clear.Due to lack of objective examination methods,it is easy to be misdiagnosed.This paper is devoted to finding the objective diagnostic indicators of CSD and exploring the possible mechanism of brain injury.First,it describes the main clinical characteristics of CSD patients,by the results of their peripheral blood test as well as carotid and vertebral artery ultrasound.Furthermore,This research project studies the neuroimaging characteristics of CSD,based on different MRI sequences and imaging techniques.Our goal has been to help clinical medicine have better knowledge of CSD and improve the diagnostic rate.MethodsFrom January 2018 to December 2019,189 patients with dizziness as the main complaint were treated in the Department of Neurology of Changhai Hospital,of which 56 were CSD patients,86 were peripheral vertigo patients,42 were central vertigo patients,and 5 were patients with other causes.The clinical characteristics of CSD patients were analyzed and compared with those of peripheral vertigo patients and matched with 30 healthy controls.The general demographic data,clinical manifestations,neuropsychological test,peripheral blood test results such as interleukin,vertebral artery resistance index and flow rate were detected by vascular ultrasound,and the volume of white matter lesions was measured by MRIT2 weighted image of the head.After processing the above results with statistical methods,15 CSD patients and 8 healthy controls were randomly selected for diffusion tensor imaging.The changes of fractional anisotropy(FA)and mean diffusivity(MD)of the whole brain white matter fiber bundle were analyzed with spatial statistical method based on the fiber bundle skeleton.Results1.CSD accounted for 29.6% of patients with dizziness,The average age of CSD patients was 59.93 ± 13.19 years old,and the attack forms of dizziness were recurrent attack(71.43%)and persistent attack(28.57%).The dizziness of 46.43% CSD patients was induced or aggravated by the change of body position,48.21%,44.64%,17.86%,16.07% and 7.14% CSD patients had nausea and vomiting,headache,tinnitus,aural fullness,nystagmus,rotation of vision and other symptoms or signs.62.5% of CSD patients had sleep disorders.2.Comparison of CSD,peripheral dizziness,and healthy controls revealed that the levels of interleukin 8(14.57 ± 6.18 ng / L)and tumor necrosis factor ?(17.49 ± 4.77 ng / L)were higher in patients with CSD than those in peripheral dizziness group.(11.42 ± 5.42,10.04 ± 3.27),and healthy control group(9.55 ± 5.12 ng / L,8.38 ± 3.20 ng / L),p<0.05,with statistical difference.The left vertebral artery resistance index of CSD patients(0.66 ± 0.07)was higher than that of peripheral vertigo group(0.63 ± 0.06)and healthy control group(0.62 ± 0.06),P < 0.05.The SAS anxiety score(50.69 ± 13.52)and SDS depression score(47.94 ± 13.31)of CSD patients were higher than those of peripheral vertigo group(41.93 ± 10.59,42.27 ± 11.10)and healthy control group(42.54 ± 10.54,41.75 ± 10.26),P < 0.05.The anxiety score of CSD patients was positively correlated with the severity of dizziness(r = 0.29,P = 0.03).The score of MOCA cognitive scale of CSD patients was 24.78 ± 3.75,which was lower than that of peripheral vertigo group(25.69 ± 3.63)and healthy control group(26.10 ± 3.13),but the difference was not statistically significant.3.Neuroimaging results: T2 weighted MRI showed that the incidence of white matter injury in CSD patients(78.6%)was higher than that in peripheral vertigo group(45.3%)and healthy control group(50%),P < 0.05.The incidence of moderate and severe white matter injury(Fazekas score of 2 or 3)(50%)was also higher than that of the other two groups(19.8%,23.3%),P < 0.05.The results of correlation analysis showed that the anxiety score of CSD patients was positively correlated with the degree of brain white matter injury(r = 0.38,P < 0.01).The degree of white matter damage in patients with CSD was positively correlated with the severity of dizziness(r = 0.29,p <0.05).DTI showed that in CSD group,compared with the healthy control group,the FA value of the white matter in the left cerebellum,the left superior temporal gyrus,the right middle temporal gyrus,the right angular gyrus,the right lateral globus pallidus and the right temporal fusiform decreased,while the FA value of the white matter in the left lateral occipital,the right precentral gyrus,the right lateral occipital and the right frontal pole increased.In CSD group,compared with peripheral vertigo group,the MD value of white matter in the right cuneal cortex,the left cerebellum,the left lateral occipital cortex,the left middle temporal gyrus and the brain stem decreased.The white matter fibers of the corpus callosum,the super longitudinal fasciculus,the inferior longitudinal fasciculus,the anterior area of the corona radiata and the posterior limb of the internal capsule changed.ConclusionsCSD accounts for a high proportion of various types of dizziness,and the patients are mostly middle-aged and elderly women.The attack form of dizziness is recurrent or persistent,easily induced by an upright posture,and often accompanied by headache and anxiety,depression and sleep disturbance.The increase of peripheral blood interleukin 8 and tumor necrosis factor alpha,and vascular ultrasound suggest that the increase of vertebral artery resistance index can be used as the auxiliary diagnosis basis for CSD.For CSD patients,their brain MRI shows that there are different degrees of white matter damage.Meanwhile,DTI shows changes appear in their fine structure of white matter,especially FA values in area related to vestibular function decreases,FA values in area related to visual processing increases,the white matter FA value of the area related to the regulation of exercise and posture increases,and the MD value of white matter in some brain regions decreases.The imaging results shows that CSD patients,although their dizziness symptoms are not typical and often accompanies with anxiety and depression,still have the possibility of brain organic damage,which should not be simply considered as a "functional disease",and the changes of white matter bundles in some functional brain area can be related to the symptoms of dizziness. |
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