后循环缺血单发性眩晕与偏头痛性眩晕的鉴别诊断_吴子明

#临床研究#

后循环缺血单发性眩晕与偏头痛性眩晕的鉴别诊断

吴子明1

张素珍1

刘兴健1

陈艾婷1

冀飞1

杨伟炎1

韩东一

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[摘要] 目的:通过2组病例分析,探讨后循环缺血单发性眩晕(P CIV )与偏头痛性眩晕(M V )的鉴别诊断。方法:选取眩晕门诊M V 患者60例和P CI V 患者64例,分析其临床的特征性表现。检查方法包括:后循环缺血(PCI)的高危因素检查、眼动检查和高刺激率听性脑干反应(ABR)检查及头颅M RI 。结果:64例P CI V 患者,血压异常29例;血脂或(和)血糖异常14例;血管超声异常37例;突然起身眼前发黑或头晕14例;高刺激ABR 异常22例;4例头颅M R I 异常(腔隙梗死)。60例M V 患者,运动病45例,运动敏感20例,畏光或(和)畏声32例,偏头痛45例,眼动异常16例,M R I 异常3例,高刺激A BR 异常40例。高刺激ABR 在P CIV 和M V 的阳性率分别为34%(22/64),67%(40/60)。结论:M V 平均年龄小于PCIV 患者。M V 患者女性发病多于男性(2.75B 1.00),P CI V 性别比例差异减小(1.46B 1.00)。M V 的运动病、运动敏感、发作时畏光或(和)畏声是与PCIV 的重要鉴别点;P CIV 的主要特点包括血压、血脂或(和)血糖异常、动脉硬化等。前庭功能检查不能作为鉴别的依据;头颅M R I 对于鉴别诊断有一定的帮助,高刺激A BR 不能作为PCIV 与M V 的鉴别点,但对与其他类型眩晕的鉴别有一定意义。前庭功能检查无助于PCIV 与M V 的鉴别诊断。

[关键词] 眩晕;后循环缺血;偏头痛;椎底动脉供血不足

[中图分类号] R764.34 [文献标志码] A [文章编号] 1001-1781(2007)16-0721-03

Differential diagnosis between vertigo of posterior circulation

ischemia and migrainous vertigo

W U Ziming ZH A N G Suz hen L iu X ingj ian CH EN Aiting

J I F ei YA N G Weiy an H AN Dongy i

(Departm ent of Otolary ng olog y H ead and Neck Surg er y,Chinese PLA General H ospital,the O -to lary ng olog y Institute of Chinese PLA,Beijing,100853,China)

Abstract Objective:T o analy ze two g roups of patients w ith migr ainous ver tig o (M V )and ver tig o resulting

f rom poster ior circulat ion ischemia (P CI V)and inv est igat e the differential diagnosis betw een t hem.Method:T her e w ere 60patients with M V and 64patients with PCIV.Clinical tests include hi

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h risk fact ors of po st erio r circulation ischemia (PCI ),cerebral M RI,oculo r mo tion and high stimulating rate A BR.Result:Amo ng 64patients w ith PCIV ,29had abno rmal blo od pr essure and 14had abnorma l bloo d fat and/o r patho glycemia;37had abnor malit y in cer vical v ascular ultraso und;14suff er ed fro m amaur osis o r dizziness upo n fast g etting up.T w enty tw o had abno r -mal high stimulating rate A BR and 4had cer ebr al lacunar infarction in M R I.A s fo r 60pat ients w ith M V ,45suf -fer ed fr om motion sckness;20wer e sensitiv e to motion;32had photo pho bia and (o r)phonophobia;45had m-

i g raine ;16had abnor mal ocular mot ion function;3had abno rmal cer ebr al M RI and 40had abnor mal results in high stimulating rat e A BR.T he per centag e of abno rmal hig h stimulating r ate A BR in M V and PCIV w ere 53%(22/42)and 67%(40/60)respect ively.Coclusion:T he mean age of M V is y oung er than that of PCIV.F ema le is mo re pro ne to M V than male(2.75B 1.00);the sex difference in PCIV is lesser(1.46B 1.00).M o tion sickness,mo tio n sensitivity,phot opho bia and (or )phonopho bia a re pr incipal differential highlights to M V.T he majo r char -acter istics of PCIV include abnor mal blo od pressur e,abno rmal blo od fat,pathog ly cem ia and ar terio sclero sis.Ves -tibula r function test s could no t ser ve as a diffrentia l po int ;Cer ebr al M RI mig ht be helpful to differ ent ial diagnosis.T he results of hig h stimulat ing rate ABR is not a differ ential po int between P CIV and M V ,but it m ight play a r ole in differ ent iating o ther kinds of v ertigo.

Key words V ertigo ;Po sterio r cir culatio n ischemia;M ig rainous ver tig o;Ver tebr obasilar insufficiency

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解放军总医院耳鼻咽喉-头颈外科解放军耳鼻咽喉科研究所(北京,100853)

通讯作者:吴子明(Email:ziming wu@)

急性发作性眩晕常见的疾病包括:良性阵发性位置性眩晕、梅尼埃病和前庭神经元炎。这3种发作性眩晕由于临床特征鲜明,临床鉴别诊断非常明

确。近年来,由于对偏头痛认识的深入,也由于摒弃了椎基底动脉缺血(VBI)的临床诊断,确立后循环缺血(PCI)的临床诊断,在临床上凸现单发性后循环缺血性眩晕(PCIV)与偏头痛性眩晕(M V)两者鉴别诊断的必要。所以,本文围绕PCIV 与M V 的诊断与鉴别诊断,探讨这两类眩晕的临床诊断与

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721#临床耳鼻咽喉头颈外科杂志2007年8月第21卷第16期