| Objectives 1 To investigate the clinical features of central acute vestibular syndrome in order to identify early malignant vertigo.2 To evaluate the clinical value of beside HINTS(Head impulse-Nystagmus-Test of skew)test in early diagnosis of central acute vestibular syndrome.Methods Collect the clinical data of acute vestibular syndrome in which treated neurology department of Affiliated Hospital of North China University of Science and Technology from November 2018 to November 2019.All patients were tested by the beside HINTS within 24 h,and the test results were recorded.All patients completed the head MRI on the first day,including T1,T2,FLAIR,and DWI sequences,which were reexamined on the third day of admission.The patients were divided into two groups according to the MRI examination results of the third day.The positive group was the central acute vestibular syndrome group,and the negative group was the peripheral acute vestibular syndrome group.The medical history,past history,physical examination and the results of auxiliary examination were collected.Analyze the clinical features and risk factors of patients with central acute vestibular syndrome,and the differences in clinical data between the two groups were compared by the statistical index.Calculated the sensitivity and specificity of HINTS test for early diagnosis of central acute vestibular syndrome and conducted the prospective verification.Results 1 There were 331 cases of acute vestibular syndrome(AVS),which including 81 cases of central AVS(24.5%),and 250 cases of peripheral AVS(75.5%).2 There were 41 cases(50.6%)of cerebellar infarction,27 cases(33.3%)of brainstem infarction,8 cases(9.9%)of brain stem with cerebellar infarction,1 case(1.2%)each of thalamus infarction,occipital lobe infarction,brainstem hemorrhage,cerebellar hemorrhage,and cerebellopontine angle occupation in the etiology of central AVS.There were 27 cases(33.3%)of cerebellar hemisphere,8 cases(9.9%)of cerebellar vermis,4 cases(4.9%)of nodules,and 3 cases(3.7%)of tonsil in the cerebellar lesion.There were 13 cases(16.1%)of medulla,11 cases(13.6%)of pons and 4 cases(4.9%)of midbrain in the brain stem lesion.There were 6 cases(7.5%)of pons and cerebellum,and 3 cases(3.7%)of medulla and cerebellum in the brain stem with cerebellar lesion.There were 51 patients revealed cerebrovascular stenosis or occlusion by the MRA examination of the head,which including 21 cases(41.2%)of posterior inferior cerebellar artery,14 cases(27.5%)of vertebral artery,4 cases(7.8%)of basilar artery,3 cases(5.9%)of anterior inferior cerebellar artery,and 9 cases(17.6%)of mixed vascular lesions.3 There were statistically significant differences between central AVS and peripheral AVS in age,male,history of stroke or TIA,hypertension,diabetes,hypercholesterolemia,and clinical manifestations(P < 0.05),and the average age of central AVS was higher than peripheral AVS,and the peak age of central AVS was 60-69 old.The history of stroke or TIA,hypertension,diabetes,and hypercholesterolemia were independent risk factors for central AVS.4 The sensitivity of initial use of HINTS test for early diagnosis of central AVS were 98.0%,the specificity was 98.1%,the positive predictive value was 94.3%,the Kappa value was 0.949.The sensitivity to the diagnosis of central AVS was 93.3%,the specificity was 95.7%,the positive predictive value was 87.5%,and the Kappa value was 0.870 in validation of the HINTS test again.Conclusions 1 The peak age of central AVS is 60~69 years old,with more males than females.2 History of stroke or TIA,hypertension,diabetes,and hypercholesterolemia are the risk factors for central AVS.3 Dizziness is the common clinical manifestation for central AVS,that can be without concomitant symptoms.4 HINTS examination has clinical value for early diagnosis of central AVS.Figure1;Table14;Reference 153... |
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