Evaluating The Morphological Changes Of Intracranial Arteries And Whole-brain Perfusion In Undetermined Isolated Vertigo

Background:Vertigo is a common public heath care issue with a broad differential diagnosis. Generally speaking, vertigo originates from peripheral vestibular disorders are associated with inner ear symptoms, vertigo originates from central neurologic diseases are associated with nervous system defect symptoms. It often results from peripheral vestibular diseases such as benign paroxysmal positional vertigo(BPPV)[1,2]. Isolated vertigo(IV), a clinical symptomatology conception, indicates vertigo as the main syndrome in the absence of other focal central neurological or/and inner ear deficits. When there are negative neurologic examinations and normal results of brain magnetic resonance imaging(MRI) or noncontrast computed tomography(CT), recurrent undetermined IV(UIV) remains undetermined and is also more complicated.Purpose: To observe, evaluate and disscuss the relationship among vascular risk factors(VRFs), the morphological changes of intracranial arteries and whole-brain perfusion in recurrent UIV patients.Methods: This study was approved by the Medical Ethics Committee, the First Affiliated Hospital of Jinan University, China. And registered in the WHO clinical trial registry(registration number: Chi CTR-DCD-15006540). This was a prospective and observational study. A total of 150 patients who are underwent whole-brain computed tomography perfusion(CTP) imaging in 2 days of the onset of symptoms were divided into UIV group(76 individuals) and BPPV group(74 individuals). Sixty individuals with sex- and agematched without vertigo and cerebral diseases served as the control. Vascular risk factors(VRFs) including age ≥ 60 y, male, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease(CHD), smoking or drinking history and NO.s of VRFs≥3, body mass index(BMI) were analyzed. The morphological changes of intracranial arteries including the stenosis or occlusion of arteries, anterior cerebral artery(ACA) hypoplasia, posterior cerebral artery(PCA) hypoplasia, vertebral artery dominance(VAD)or vertebral artery hypoplasia(VAH)、basilar artery hypoplasia(BAH), basilar artery curvature(BAC) were also analyzed by computed tomography angiography(CTA) among three groups. To determine the risk predictors for vascular morphological changes, the correlation between the VRFs with the shapes were assessed using non-conditional logistic regression analysis. Relative values of perfusion parameters and the correlation in the corresponding territory of abnormal arteries with regional perfusion were analyzed, calculated and compared by using CTP.Results: In UIV patients, hypertension, hyperlipidemia and VRF s ≥ 3 occurred more commonly(P < 0.0125, respectively). The incidence of abnormal VBA including VAD, vertebral artery stenosis(VAS) or vertebral artery occlusion(VAO) and BAC were significantly higher(P < 0.0125, respectively). Hypertension was an independent risk predictor of non-VAD(OR: 5.411, 95%CI:1.401; 20.900, P = 0.014). Hypertension and VAD associated with BAC served as risk predictors(OR: 4.081, 95%CI:1.056;15.775, P = 0.041 and OR: 6.284, 95%CI: 1.848; 21.365, P = 0.003, respectively). In UIV patients, statistically significant differences were found in r CBV, r CBF, MTT, TTP of brainstem ROIs(P < 0.05, respectively). Similar results were shown in r CBV, r CBF, MTT of cerebellum ROIs(P < 0.05, respectively). No significant differences were found in the CTP parameters of any other regional ROIs in BPPV and control patients(P >0.05). Hypoperfusion was found in the territories of the non-VAD side and the BAC cohort in UIV patients(P < 0.05, respectively).Conclusions: On the basis of multiple VRFs, intracranial morphological changes of vertebrobasilar artery(VBA) and the unilateral hypoperfusion of the cerebellum and brainstem, that acts as a herald for UIV occurrence, which should be paid cautious attention to undetermined UIV patients.