心血管代谢风险驱动诊断的小脑梗死表现为孤立性短暂性眩晕：一例基于病例的综述

文献信息

中文摘要

背景与临床意义： 眩晕是后循环缺血的常见表现，而肥胖、2型糖尿病、高血压和血脂异常是 underlying 动脉粥样硬化性疾病的既定心血管代谢危险因素。短暂、孤立的发作在诊断上可能具有挑战性，因为症状缓解后床旁检查可正常，尽管存在具有临床意义的脑血管疾病。我们报告一例病例，其不良心血管代谢风险特征——而非临床表现本身——促使进行了确立诊断的血管影像学检查，并附对可比报告的针对性综述；病例介绍：我们调查一例67岁男性，患有2型糖尿病、高血压、血脂异常、肥胖和已知的无症状性右侧颈内动脉（ICA）狭窄，在单次自发性旋转性眩晕发作持续五分钟后就诊，评估前症状已完全缓解。神经系统和结构化神经耳科检查均正常。由于其心血管代谢和血管风险负担，进一步进行了影像学检查：CT血管造影显示右侧ICA狭窄进展至85%、左侧椎动脉慢性闭塞和右侧椎动脉轻度狭窄，脑MRI随后证实左侧小脑半球小急性缺血性病灶。治疗结合了颈动脉支架置入术与针对其完整心血管代谢风险特征的个体化多学科二级预防计划。三个月时，他仍无症状，NIHSS和改良Rankin量表评分均为0。一项以CABARET为指导的针对性文献综述纳入六份可比病例报告，显示我们的患者具有迄今最广泛的心血管代谢负担，但表现最轻微且最短暂，与对照报告中典型的复发性或进展性症状形成对比；结论：单次短暂孤立性眩晕发作可能是急性后循环缺血的唯一表现，即使床旁检查正常。在具有不良心血管代谢和血管风险特征的患者中，令人安心的检查不应排除进一步的神经血管检查，而早期、风险导向的识别——辅以个体化多学科护理——可能为卒中预防提供重要机会。

英文摘要

Background and Clinical Significance: Vertigo is a common manifestation of posterior circulation ischaemia, and obesity, type 2 diabetes mellitus, hypertension, and dyslipidaemia are established cardiometabolic risk factors for the underlying atherosclerotic disease. Brief, isolated episodes may be diagnostically challenging because bedside findings can be normal after symptom resolution, despite clinically significant cerebrovascular disease. We present a case in which an adverse cardiometabolic risk profile-rather than the clinical presentation itself-prompted the vascular imaging that established the diagnosis, together with a targeted review of comparable reports; Case Presentation: We investigate the case of a 67-year-old man with type 2 diabetes mellitus, hypertension, dyslipidaemia, obesity, and known asymptomatic right internal carotid artery (ICA) stenosis presented after a single spontaneous episode of rotatory vertigo lasting five minutes, which resolved completely before assessment. Neurological and structured neuro-otological examinations were normal. Because of his cardiometabolic and vascular risk burden, further imaging was pursued: CT angiography demonstrated progression of the right ICA stenosis to 85%, chronic occlusion of the left vertebral artery, and mild stenosis of the right vertebral artery, and brain MRI subsequently confirmed a small acute ischaemic lesion in the left cerebellar hemisphere. Management combined carotid artery stenting with a personalised, multidisciplinary secondary prevention plan addressing his full cardiometabolic risk profile. At three months, he remained asymptomatic, with NIHSS and modified Rankin Scale scores of 0. A targeted, CABARET-guided literature review of six comparable case reports showed that our patient carried the most extensive cardiometabolic burden yet had the mildest and most transient presentation, in contrast to the recurrent or progressive symptoms typical of the comparator reports; Conclusions: A single brief episode of isolated vertigo may be the only manifestation of acute posterior circulation ischaemia, even when bedside findings are normal. In patients with an adverse cardiometabolic and vascular risk profile, a reassuring examination should not preclude further neurovascular investigation, and early, risk-guided recognition-supported by personalised, multidisciplinary care-may provide an important opportunity for stroke prevention.