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

##吴子明1张素珍1刘兴健1陈艾婷1冀飞1杨伟炎1韩东一1[]:2,(PCIV)(MV):MV60PCIV64,:(PCI)(ABR)MRI:64PCIV,29;()14;37;14;ABR22;4MRI()60MV,45,20,()32,45,16,MRI3,ABR40ABRPCIVMV34%(22/64),67%(40/60):MVPCIVMV(2.75B1.00),PCIV(1.46B1.00)MV()PCIV;PCIV();MRI,ABRPCIVMV,PCIVMV[];;;[]R764.34[]A[]1001-1781(2007)16-0721-03DifferentialdiagnosisbetweenvertigoofposteriorcirculationischemiaandmigrainousvertigoWUZimingZHANGSuzhenLiuXingjianCHENAitingJIFeiYANGWeiyanHANDongyi(DepartmentofOtolaryngologyHeadandNeckSurgery,ChinesePLAGeneralHospital,theO-tolaryngologyInstituteofChinesePLA,Beijing,100853,China)AbstractObjective:Toanalyzetwogroupsofpatientswithmigrainousvertigo(MV)andvertigoresultingfromposteriorcirculationischemia(PCIV)andinvestigatethedifferentialdiagnosisbetweenthem.Method:Therewere60patientswithMVand64patientswithPCIV.Clinicaltestsincludehighriskfactorsofposteriorcirculationischemia(PCI),cerebralMRI,oculormotionandhighstimulatingrateABR.Result:Among64patientswithPCIV,29hadabnormalbloodpressureand14hadabnormalbloodfatand/orpathoglycemia;37hadabnormalityincervicalvascularultrasound;14sufferedfromamaurosisordizzinessuponfastgettingup.Twentytwohadabnor-malhighstimulatingrateABRand4hadcerebrallacunarinfarctioninMRI.Asfor60patientswithMV,45suf-feredfrommotionsckness;20weresensitivetomotion;32hadphotophobiaand(or)phonophobia;45hadm-igraine;16hadabnormalocularmotionfunction;3hadabnormalcerebralMRIand40hadabnormalresultsinhighstimulatingrateABR.ThepercentageofabnormalhighstimulatingrateABRinMVandPCIVwere53%(22/42)and67%(40/60)respectively.Coclusion:ThemeanageofMVisyoungerthanthatofPCIV.FemaleismorepronetoMVthanmale(2.75B1.00);thesexdifferenceinPCIVislesser(1.46B1.00).Motionsickness,motionsensitivity,photophobiaand(or)phonophobiaareprincipaldifferentialhighlightstoMV.Themajorchar-acteristicsofPCIVincludeabnormalbloodpressure,abnormalbloodfat,pathoglycemiaandarteriosclerosis.Ves-tibularfunctiontestscouldnotserveasadiffrentialpoint;CerebralMRImightbehelpfultodifferentialdiagnosis.TheresultsofhighstimulatingrateABRisnotadifferentialpointbetweenPCIVandMV,butitmightplayaroleindifferentiatingotherkindsofvertigo.KeywordsVertigo;Posteriorcirculationischemia;Migrainousvertigo;Vertebrobasilarinsufficiency1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:[e-mail]):3,,,(VBI),(PCI),(PCIV)(MV),PCIVMV,#721#20078211611.120046~200612MV60,,16,44;34.5(8~62)PCIV64,,26,38;56.9(34~75)1.2MVMVNeuhauser112:¹;º122;»2:;¼MVNeuhauser112:¹1;º:;;:;1.3PCIV2006132,:,,();ABR;,,MRIABR1.4(ABR):ABR11.1Hz51.1Hz,Ñ~Õ,0.28ms(0.28ms):30b,44e,30e,4\25%2PCIV64,29;()14;37;14;ABR22,34%(22/64);10MRI,4();57,23,33:(),MV60,45(25),20,()32,45(31),11,VEMP30,16,MRI3ABR40,67%(40/60)10MRI,PCIVMV::MVPCIVMV(2.75B1.00),,PCIV(1.46B1.00):MV,()()PCIV;PCIV():ABRMRI,PCIV()ABRPCIVMV,MVPCIV:PCIVMV32006PCI,,,,,,,,,,,,,,MRI,,,,,142,MVVBI,PCIPCI?PCI:¹PCI#722#JClinOtorhinolaryngolHeadNeckSurg(China),Aug2007,Vol21,No16;ºPCI;»:,PCI,,PCI,,VBI,132PCIV:¹,,;ºHorner;»,VBI,()VBI,,,PCIV152,16~112,MV,1102,MV7%19,102,MV122MV,MV,MVMV192,162,MV,MV,21%~83%17,8,112,17%~65%19,112,31%~77%182MV,,11,112MV:¹,,MV192;º1122;»(PET),1132,,,,,,,,,ABR,,PCIV,PCI,[1]NEUHAUSERH,LEOPOLDM,VONBREVERNM,etal.Theinterrelationsofmigraine,vertigoandmigrainousvertigo[J].Neurology,2001,56:436-441.[2]HeadacheClassificationSubcommitteeOfTheInter-nationalHeadacheSociety.TheInternationalClassif-icationofHeadacheDisorders,2ndedition[J].Cepha-lalgia,2004,24(Suppl1):9-160.[3].[J].,2006,45(9):786-787.[4]MISRAM,ALPMS,HIERD,etal.Multidiscipl-inarytreamentofposteriorcirculationischemia[J].NeurolRes,2004,344:898-913.[5].[J].(),2007,22(2):89-91.[6]LEMPERTT,MENZHAUSENL,TIEL-WILCKK.Migraine:adifferentialdiagnosisofepisodicvertigo[J].Nervenarzt,1993,64:121-126.[7]BIKHAZIP,JACKSONC,RUCKENSTEINMJ.Efficacyofantimigrainoustherapyinthetreatmentofmigraine-associateddizziness[J].AmJOtol,1997,18:350-354.[8]CASSSP,FURMANJM,ANKERSTJERNEJKP,etal.Migraine-relatedvestibulopathy[J].AnnOtolRhinolLaryngol,1997,106:182-189.[9]DIETERICHM,BRANDTT.Episodicvertigorelat-edtomigraine(90cases):vestibularmigraine[J]?JNeurol,1999,246:883-892.[10]LIAOLJ,YOUNGYH.Vestibularevokedmyogenicpotentialsinbasilararterymigraine[J].Laryngo-scope,2004,114:1305-1309.[11]JOHNSONGD.Medicalmanagementofmigraine-re-lateddizzinessandvertigo[J].Laryngoscope,1998,108(Suppl85):1-28.[12]BALOHRW.Neurotologyofmigraine[J].Head-ache,1997,37:615-621.[13]WEILLERC,MAYA,LIMMROTHV,etal.Brainstemactivationinspontaneoushumanmigraineattacks[J].NatMed,1995,1:658-660.(收稿日期:2007-01-24修回日期:2007-04-01)#723#200782116