UNASSIGNED:探讨眼倾斜反应(OTR)加头部倾斜主观视觉垂直(SVV)对急性中央血管性眩晕(ACVV)患者的定位诊断价值。
未经证实:我们招募了40例急性梗死患者,20例单侧脑干梗死(BI)和20例单侧小脑梗死(CI)。我们还包括20例单侧外周前庭疾病(UPVD)患者作为对照组。参与者在症状发作的1周内头部倾斜(±45°)期间完成了OTR和SVV。
未经证实:在ACVV患者中,包括由髓外侧梗死引起的(100%,2/2),部分脑桥梗死(21%,3/14),和小脑梗死(35%,7/20),我们观察到了同质OTR,与UPVD患者相似(80.0%,16/20)。一些患有延髓内侧梗死的患者(50%,1/2),部分脑桥梗死(42%,6/14),中脑梗塞(100%,2/2),和部分小脑梗死(30.0%,6/20)显示出相反的OTR。ACVVBI组的偏斜偏差(SD)明显大于UPVD组(6.60±2.70°vs.1.80±1.30°,Z=-2.50,P=0.012),因此,脑桥梗死患者的平均SD为9.50°,延髓梗死患者的平均SD为5.00°。在没有小脑损伤的ACVV患者中,使用SD预测脑干损伤所对应的受试者工作特征曲线的曲线下面积为0.92(95CI:0.73-1.00),当SD≥3°时,灵敏度为100%,特异性为80%。我们发现UPVD和CI组之间的SD没有统计学差异(1.33±0.58°vs.1.80±1.30°,Z=-0.344,P=0.73)。与UPVD患者相比,部分脑桥梗死的ACVV患者(43%,6/14,χ2=13.68,P=0.002)或延髓梗死(25%,1/4,χ2=4.94,P=0.103)表现出同质E效应和相反A效应的迹象,而部分延髓梗死的患者(50%,2/4),脑桥梗死(43%,6/14),或小脑梗死(60%,12/20)表现出E效应的病态对称增加。
UNASSIGNED:OTR加头部倾斜SVV(±45°)在眩晕患者中的评估有助于识别和诊断ACVV,特别是当SD≥3°或E效应对称增加时。
UNASSIGNED: To investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV).
UNASSIGNED: We enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 20 with unilateral cerebellar infarction (CI). We also included 20 patients with unilateral peripheral vestibular disorders (UPVD) as the control group. The participants completed the OTR and SVV during head tilt (±45°) within 1 week of symptom onset.
UNASSIGNED: In patients with ACVV, including that caused by lateral medullary infarction (100%, 2/2), partial pontine infarction (21%, 3/14), and cerebellum infarction (35%, 7/20), we observed ipsiversive OTR, similar to that seen in UPVD patients (80.0%, 16/20). Some of the patients with medial medullary infarction (50%, 1/2), partial pons infarction (42%, 6/14), midbrain infarction (100%, 2/2), and partial cerebellum infarction (30.0%, 6/20) showed contraversive OTR. The skew deviation (SD) of the BI group with ACVV was significantly greater than that of the UPVD group (6.60 ± 2.70° vs. 1.80 ± 1.30°, Z = -2.50, P = 0.012), such that the mean SD of the patients with a pons infarction was 9.50° and that of patients with medulla infarction was 5.00°. In ACVV patients with no cerebellar damage, the area under the curve of the receiver operating characteristic curve corresponding to the use of SD to predict brainstem damage was 0.92 (95%CI: 0.73-1.00), with a sensitivity of 100% and a specificity of 80% when SD ≥ 3°. We found no statistical difference in SD between the UPVD and CI groups (1.33 ± 0.58° vs. 1.80 ± 1.30°, Z = -0.344, P = 0.73). Compared with the UPVD patients, the ACVV patients with a partial pons infarction (43%, 6/14, χ2 = 13.68, P = 0.002) or medulla infarction (25%, 1/4, χ2 = 4.94, P = 0.103) exhibited signs of the ipsiversive E-effect with the contraversive A-effect, while those with a partial medulla infarction (50%, 2/4), pons infarction (43%, 6/14), or cerebellar infarction (60%, 12/20) exhibited a pathological symmetrical increase in the E-effect.
UNASSIGNED: The evaluation of OTR plus head tilt SVV (±45°) in vertigo patients is helpful for identifying and diagnosing ACVV, especially when SD is ≥ 3° or the E-effect is symmetrically increased.