SP03-3
Vascular Vertigo
AUDIOVESTIBULAR LOSS IN AICA TERRITORY INFARCTION: PATTERN AND CLINICAL
IMPLICATION
Hyung LEE1, Hyun-Ah KIM1
1Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
Acute audiovestibular loss is a common neurotological condition that is characterized by sudden onset of severe prolonged vertigo and hearing loss. Acute ischemic stroke in the distribution of the AICA is known to be associated with vertigo, hearing loss, nystagmus, facial weakness, gait ataxia, and hypalgesia. To date, at least eight subgroups of AICA infarction have been identified according to the pattern of neurotological presentations, among which the most common pattern of audiovestibular dysfunction is the combined loss of auditory and vestibular functions. Unlike inner ear dysfunction of a viral cause, which can commonly present as an isolated vestibular (i.e., vestibular neuritis) or cochlear loss (i.e., sudden deafness), labyrinthine dysfunction of a vascular cause rarely results in isolated loss of vestibular or auditory function. Because audiovestibular loss may occur in isolation before ponto-cerebellar infarction involving AICA distribution, audiovestibular loss may serve as a window to prevent the progression of acute audiovestibular loss into more widespread areas of infarction in posterior circulation (mainly in the AICA territory). Clinician should keep in mind that acute audiovestibular loss may herald impending AICA territory infarction, especially when patients had basilar artery occlusive disease presumably close to the origin of the AICA on brain MRA, even if other central signs are absent and MRI does not demonstrate acute infarction. This review aims to highlight recent advances on audiovestibular loss in the AICA territory infarction and to address their clinical significance.
SP03-3
血管性眩晕
小脑前下动脉区域梗塞后听觉前庭功能受损的表现形式和临床意义
Hyung LEE1, Hyun-Ah KIM1
韩国，启明大学医学院，神经内科
急性的听觉前庭功能受损是一种常见的神经耳科学表现，通常会突发严重的持续性眩晕和听力下降。急性的小脑前下动脉缺血性脑卒中通常与眩晕、听力下降、眼球震颤、面部神经衰弱、共济失调和痛觉减退相联系。至今为止，依据神经耳科表现已确定至少八个小脑前下动脉梗死模式，其中最常见的听、前庭功能障碍模式是听觉功能和前庭功能的同时减退。不同于病毒性内耳功能障碍，这通常表现为单独的前庭（例如前庭神经炎）或耳蜗（突发性聋）受损，迷路血管功能障碍很少会导致孤立的听觉和前庭机能障碍。因为听觉前庭功能受损也可能在小脑前下动脉分区区域脑桥－小脑梗死发生之前发生，所以已知的听觉前庭受损可以作为防止其发展为更大范围的后循环系统梗死（主要在小脑前下动脉区域）的窗口。临床医生需要牢记的是，急性的听觉前庭功能受损预警即将来临的小脑前下动脉区域梗死，特别是如果在脑部磁共振血管成像中发现病人有靠近小脑前下动脉起点区域的基底动脉闭塞性疾病时，甚至缺乏其他中枢症状和核磁共振成像没有显示出急性梗死的情况下。这一回顾分析在于强调研究小脑前下动脉梗死后，急性听觉前庭功能受损方面的最新进展及其临床意义。
Vascular Vertigo
CILOSTAZOL VERSUS ASPIRIN THERAPY IN PATIENTS WITH CHRONIC DIZZINESS AFTER
ISCHEMIC STROKE
Ken JOHKURA
Department of Neurology, Yokohama Brain And Spine Center, Japan
Background: Chronic dizziness is frequently reported by patients in the chronic stage after ischemic stroke. The aim of this study was to determine the efficacy of cilostazol versus that of aspirin for the chronic dizziness that follows ischemic stroke.
Methods: We performed a prospective, randomized, open-label, blinded endpoint trial. One hundred six patients who suffered supratentorial ischemic stroke within the previous 1–6 months and subsequently complained of persistent dizziness without other obvious sequelae were enrolled. Patients were randomly given cilostazol (200 mg/day) or aspirin (100 mg/day) for 6 months. Rates of improvement in the dizziness were then evaluated. Changes in fixation suppression of the vestibulo ocular reflex (an indicator of cerebral control over the brainstem reflex related to balance), regional cerebral blood flow (CBF) in the cerebrum, cerebellum, and brainstem; and the Zung Self-Rating Depression Scale (SDS) were also evaluated.
Results: Dizziness was significantly improved in the cilostazol group vs. the aspirin group (P <0.0001) after the 6- month therapy. The capacity for fixation suppression of the vestibulo-ocular reflex was improved (P <0.0001), and regional CBF in the cerebrum (relative to that in the brainstem [P = 0.003] and to that in the cerebello-brainstem [P = 0.012]) was increased only in the cilostazol group. There was no statistical difference in the change in SDS scores between the two groups.
Conclusion: Cilostazol improves the chronic dizziness that follows ischemic stroke and increases supratentorial CBF and cerebral function for adaptation of the brainstem reflex related to the sense of balance.
SP03-4
血管性眩晕
西洛他唑和阿司匹林治疗缺血性脑卒中伴慢性眩晕病人的疗效比较
Ken JOHKURA
日本，横滨大脑和脊柱中心，神经内科
背景：慢性眩晕经常在慢性期的缺血性脑卒中患者中被报道。本研究的目的是比较西洛他唑和阿司匹林在治疗缺血性脑卒中后发生的慢性眩晕的治疗效果。
方法：我们开展了一项前瞻性、随机、开放性、盲终点的研究。共有106位在前1-6个月发作幕上缺血性卒中且随后除了眩晕外没有其他后遗症的患者入组。随机给予患者西洛他唑（200mg/每天）或阿司匹林（100mg/每天）治疗6个月。评估了药物改善患者眩晕症状的有效率，同时也评估了前庭眼反射（与平衡相关的大脑对脑干反射控制的指标）的固视抑制变化，还有评估了大脑、小脑、脑干的局部血流情况以及郑氏自我评估抑郁量表的结果。
结果：通过6个月的治疗，西洛他唑组较阿司匹林组更能有效改善患者的眩晕情况 (P < 0.0001)。仅仅在西洛他唑组发现前庭眼反射的固视抑制能力有所提高(P< 0.0001)、大脑的局部血流有所增加（相对于脑干[P = 0.003]和相对于小脑-脑干区域[P = 0.012]）。两组的郑氏自我评估抑郁量表结果没有统计学的差异。
结论：西洛他唑可以改善缺血性脑卒中患者随后发生的慢性眩晕情况，以及提高大脑慕上的局部血流量和改善大脑适应平衡相关的脑干反射的功能。
（王豪 译，广东省惠州市第三人民医院耳鼻咽喉头颈外科）
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