后循环卒中的眼震表型

文献信息

中文摘要

背景： 急性前庭综合征（AVS）的特征是突发、持续性眩晕或头晕，伴有恶心、呕吐、姿势不稳和自发性眼震。在急诊神经病学中，区分周围性前庭疾病与后循环卒中仍是一项重大诊断挑战，因为前庭小脑梗死可表现为“中枢性假性神经炎”，模仿周围性前庭疾病。尽管HINTS检查是一种有价值的床旁工具，但其可靠性取决于眼震的存在及其特征，并且在无自发性眼震的患者中其可靠性降低。
目的： 利用视频眼动图（VOG）描述后循环卒中患者的眼震表型，并确定有助于提高AVS患者中枢性前庭病理识别能力的特征。
方法： 回顾性单中心描述性队列研究，纳入34例经神经影像学确诊的后循环卒中患者，这些患者在2014年至2026年间接受了VOG检查。使用VOG评估眼球运动，并将眼震特征（方向、凝视依赖性、固视抑制、摇头反应）与病灶位置进行相关性分析。
结果： 共纳入34例患者；70%（24/35）存在眼震。其中，50%表现为多种眼震表型，50%表现为单一模式。自发性眼震（水平或垂直）和摇头眼震（HSN）均见于62%，而凝视诱发性眼震罕见（12%）。PICA梗死中HSN患病率有升高趋势，但无统计学意义（OR 4.81），且80%的患者HSN表现为交叉耦合或方向改变特征。未发现病灶侧别与眼震方向之间存在明确相关性，也未发现固视与眼震慢相速度（SPV）之间存在相关性。
结论： 眼震是后循环卒中的常见临床特征，且表型异质。病灶偏侧性与眼震方向不相关，固视也未一致性地改变SPV。HSN是中枢性前庭功能障碍的常见体征。进行摇头试验可能提高中枢性前庭病理的检出率，并在急性眩晕中补充HINTS检查。

英文摘要

BACKGROUND: Acute vestibular syndrome (AVS) is characterized by sudden, persistent vertigo or dizziness with nausea, vomiting, postural instability, and spontaneous nystagmus. Differentiating peripheral vestibular disorders from posterior circulation stroke remains a major diagnostic challenge in emergency neurology, as vestibulo-cerebellar infarcts may present as "central pseudo-neuritis," mimicking peripheral vestibular disease. Although the HINTS examination is a valuable bedside tool, its reliability depends on the presence and characterization of nystagmus and is reduced in patients without spontaneous nystagmus.
OBJECTIVE: To characterize nystagmus phenotypes in posterior circulation stroke using videooculography (VOG) and to identify features that improve recognition of central vestibular pathology in patients with AVS.
METHODS: Retrospective single-center descriptive cohort study of 34 patients with posterior circulation stroke confirmed by neuroimaging, who underwent VOG between 2014 and 2026. Eye movements were assessed using VOG and nystagmus features (direction, gaze dependence, fixation suppression, head-shaking responses) were correlated with lesion location.
RESULTS: Thirty-four patients were included; nystagmus was present in 70% (24/35). Of these, 50% showed multiple nystagmus phenotypes and 50% a single pattern. Spontaneous nystagmus (horizontal or vertical) and Head-shaking nystagmus (HSN) both occurred in 62%, while gaze-evoked nystagmus was rare (12%). There was a non-significant trend toward a higher prevalence of HSN in PICA infarctions (OR 4.81) and HSN showed cross-coupled or direction changing features in 80% of patients. No clear correlation was found between the side of the lesion and the direction of nystagmus, nor between fixation and the slow-phase velocity (SPV) of nystagmus.
CONCLUSION: Nystagmus is a frequent clinical feature of posterior circulation stroke with heterogenous phenotypes. Lesion laterality did not correlate with nystagmus direction, and fixation did not consistently alter SPV. HSN was a frequent sign of central vestibular dysfunction. Performance of the head shaking test may improve detection of central vestibular pathology and complement the HINTS examination in acute vertigo.