癫痫发作间期脑动脉血流速度的改变

采用经颅超声多普勒（ＴＣＤ），对３８例癫痫病患者发作间期的脑动脉平均血流速度（Ｖｍ）进行了观察。结果３８例中６例正常，４例Ｖｍ增快，３例Ｖｍ减慢，２２例表现为双侧血流速度不对称（ＢＡＶ），３例ＢＡＶ并Ｖｍ增快或减慢，脑动脉Ｖｍ异常发生率为８４．２１％（３２／３８）。说明癫痫发作间期脑动脉血流速度可有一定程度的异常改变，其异常改变的主要形式为ＢＡＶ。     

妊高征患者脑血流变化观察

应用经颅多普勒超声（ＴＣＤ）检测３５例妊高征患者（观察组）及３０例正常孕妇（对照组）的大脑中动脉（ＭＣＡ）、大脑前动脉（ＡＣＡ）、大脑后动脉（ＰＣＡ）、椎动脉（ＶＡ）、基底动脉（ＢＡ）收缩期血流速度（Ｖｓ）舒张末期血流速度（Ｖｄ）、平均血流速度（Ｖｍ）及搏动指数（ＰＩ）。结果显示：观察组中的中、重度妊高征患者脑动脉Ｖｓ、Ｖｄ均高于对照组（Ｐ＜０．０１），并随病情加重逐渐升高。观察组各条脑动脉的Ｖｍ均显著高于对照组（Ｐ＜０．０１）。观察组各条动脉ＰＩ值均显著低于对照组（Ｐ＜０．００１）。同时观察３６例妊高征患者眼底，仅３例中度及６例重度妊高征患者眼底血管有痉挛表现。说明：ＴＣＤ能检测妊高征患者脑血管痉挛所致血流速度改变，表现为血流速度加快，脑血管舒缩功能降低。ＴＣＤ能早期提供妊高征患者脑血流动力学资料，避免脑血管病危及孕妇安全。因而可作为妊高征患者预防脑血管并发症的监测手段之一。     

彩色多普勒血流显像对青光眼血流动力学研究

本文用美国Ａｃｕｓｏｎ－１２８ＸＰ彩色多普勒检测２４例原发开角青光眼（ＰＯＡＧ）、２７例低压青光眼（ＬＴＧ）及２０例正常人的眼动脉、视网膜中央动脉及睫状后短动脉的血流参数，测定收缩期血流峰值速度（Ｖｍａｘ）、舒张末期血流速度（Ｖｍｉｎ）平均血流速度（Ｖｍｅａｎ）及阻力指数（ＲＩ）、同时测血压及眼压。结果显示，ＰＯＡＧ和ＬＴＧ患者视网膜中央动脉的Ｖｍａｘ、Ｖｍｅａｎ及睫状后短动脉的Ｖｍａｘ、Ｖｍｉｎ、Ｖｍｅａｎ均显著降低，与对照组有显著差异（Ｐ＜０．０５）；而ＰＯＡＧ与ＬＴＧ两组间差异无显著性（Ｐ＞０．０５）。眼动脉的４个血流参数，ＰＯＡＧ、ＬＴＧ与对照组均无显著差异（Ｐ＞０．０５）；收缩压、舒张压三组间亦无显著差异（Ｐ＞０．０５）；而ＰＯＡＧ患者的眼压均值显著高于ＬＴＧ及对照组（Ｐ＜０．０１）。本文结果提示，ＰＯＡＧ和ＬＴＧ患者视网膜中央动脉、睫状后短动脉均存在血流动力学异常。使视盘的血液供应不良，从而导致结构和功能改变。     

彩色多普勒血流显像对青光眼血流动力学研究

目的：应用彩色多普勒血流显像研究开角型青光眼眼部血流动力学变化，方法：对原发性开角型青光眼（ＰＯＡＧ）１４例，低眼压性青光眼（ＬＴＧ）１１例及正常对照组１５例测量眼动脉、视网膜中央动脉、睫状后动脉的收缩期峰值流速（ＰＳＶ）、舒张末期血流速度（ＥＤＶ）、阻力指数（ＲＩ），结果①和正常组比较，ＰＯＡＧ组和ＬＴＧ组双眼视网膜中央动脉ＰＳＶ、ＥＤＶ均值减低，ＲＩ均值升高，Ｐ＜０．０５；②ＰＯＡＧ组双眼睫状后动脉ＥＤＶ均值减低，ＲＩ较正常组升高（Ｐ＜０．０５），ＬＴＧ组双眼ＥＤＶ均值减低，左眼ＰＳＶ减低（Ｐ＜０．０５）；③ＰＯＡＧ组、ＬＴＧ组眼动脉血流参数与正常组比较无差异（Ｐ＞０．０５）；④ＰＯＡＧ组与ＬＴＧ组间无显著性差异。结论，开角型青光眼视盘血流速度减低，支持血管学说     

彩色三维经颅多普勒对飞行员脑血流状态的研究

目的　为探讨飞行员的脑血流变化及影响因素寻找一条途径。方法　应用彩色三维经颅多普勒对２３例飞行员颅内血流状态进行了检测。结果　飞行员组与对照组比较,其各动脉各期血流速度均有显著差异（ Ｐ＜００５） 。飞行员组大脑中动脉（ ＭＣＡ） 、大脑前动脉（ＡＣＡ） 、大脑后动脉（ＰＣＡ） 、椎动脉（ＶＡ） 及基底动脉（ＢＡ） 的收缩峰值流速（Ｖｓ） 、平均流速（Ｖｍ）、舒张末期流速（Ｖｄ） 均明显增高。脉动指数（ＰＩ） 虽有差异,但无统计学意义。结论　彩色三维经颅多普勒对飞行员脑血流变化的检测很有价值。     

经颅多普勒超声评价外伤性脑血管痉挛

应用经颅多普勒超声（ＴＣＤ）检测３２例急性颅脑损伤病人颅内动脉的血流速度，并与ＣＴ扫描相对照。结果表明，如果大脑中动脉血流速度（ＶＭＣＡ）大于１２０ｃｍ／ｓ，大脑中动脉血流速度与同侧颈内动脉血流速度之比（ＶＭＣＡ／ＶＩＣＡ）大于３时，则提示伴有脑血管痉挛（ＣＶＳ），外伤性蛛网膜下腔出血量的多少与ＣＶＳ的发生有密切关系。     

血液流变学对腔隙性脑梗塞脑血流的影响

研究血液流变学对腔隙性脑梗塞脑血流动力学及脑血流量（ＣＢＦ）的影响；随机选择５８例患者同时检查血液流变学、ＴＣＤ及１３３Ｘｅ吸入法测定ＣＢＦ；结果血液流变学异常２４例，正常２４例，异常组脑动脉平均血流速度（Ｖｍ）及ＣＢＦ显著低于正常组，Ｐ＜０．０５～０．０１；切变率分别为２００ｓ－１、１０ｓ－１时全血比粘度及血浆比粘度与大脑中动脉平均血流速度呈负相关，ｒ＝－０．８７、－０．９２、－０．８３，Ｐ＜０，０１。相应局部脑血流量（ｒＣＢＦ）与Ｖｍ呈良好的一致性。故认为高粘血症使腔隙性脑梗塞患者脑血流速度下降，脑血流量减少。     

视网膜静脉阻塞患者视网膜中央动脉血流动力学研究

目的：研究视网膜静脉阻塞（ＲＶＯ）患者的视网膜中央动脉血流动力学改变，并探讨该动脉血流动力学变化在静脉阻塞分型中的应用价值。方法：对７９例ＲＶＯ患者男性３４例，女性４５例，视网膜中央静脉阻塞２０例，分支静脉阻塞５９例，根据眼底荧光血管造影分为缺血型及非缺血型组，同时对患眼和对侧健眼的球后视网膜中央动脉行彩色超声多普勒检测。结果：患眼的视网膜中央动脉收缩期峰值血流速度、平均血流速度均低于对侧眼（Ｐ＜０．０００１）。缺血型与非缺血型患眼之间其血流速度无显著差异。结论：ＲＶＯ对患眼的视网膜中央动脉收缩期峰值血流速度、平均血流速度明显低于对侧健眼，其间有极显著差异，说明ＲＶＯ时ＣＲＡ有血流动力学异常。缺血型与非缺血型组间其患眼血流速度差异无统计学意义，此项检测在ＲＶＯ分型不是可应用的参考指标     

经颅多普勒超声对新生儿缺氧缺血性脑病脑血流速度检测的临床意义

目的：探讨新生儿缺氧缺血性脑病（ＨＩＥ）的脑血流速度（ＣＢＦＶ） 的变化及临床意义。方法：全部患儿在检测时均保持安静入睡状态, 经颞部透声窗探测双大脑中动脉、大脑前动脉、颈内动脉末端的ＣＢＦＶ。结果：５２ 例ＨＩＥ患儿的ＣＢＦＶ除７ 例正常外,４５ 例均显示出不同程度的异常。ＣＢＦＶ增高者３７ 例（７１．１５％） 。ＣＢＦＶ降低者８ 例（１５．３８％） 。４５ 例ＨＩＥ与正常新生儿组比较颅内动脉血流速度有显著差异, Ｐ＜ ０．０１。７ 例血流速度正常者与正常新生儿组比较无显著差异Ｐ＜ ０．０５。结论：利用经颅多普勒超声对ＨＩＥ脑血流速度的检测,对其患儿的治疗、康复提供可靠依据,颇具临床应用性,应予推广     

脑动脉收缩峰值流速异常增高判断脑梗塞部位的临床价值：102例…

本文１０２例按ＣＴ及ＭＲＩ检查结果分成脑梗塞组７３例，大脑梗塞组２９例。后才的颅内动脉ＴＣＤ测值与文献报道的国人同年龄组的正常值相近，而前者的颅内动脉血流速度多有增高，尤以收缩主平均速度增高明显。以ＶｓＡＣＡ≥９０ｃｍ／ｓ，ＭＣＡ≥１００ｃｍ／ｓ，ＰＣＡ≥９０ｃｍ／ｓ作为判断受检动脉有无狭窄的指标，脑梗塞组中５０例的脑动脉Ｖｓ异常增高，非脑梗塞组中仅５例的ＭＣＡＶｓ≥１００ｃｍ／ｓ。     

基底动脉的CT表现与眩晕或头晕的关系:151例常规CT与临床表现的对照研究

目的　探讨分析中老年人的头晕或眩晕与其常规头颅CT平扫所示基底动脉表现的关系。方法　收集 815例常规头颅CT平扫的影像 ,分析其中 15 1例 5 0或 5 0岁以上有眩晕或头晕症状患者的基底动脉的CT密度、直径、分叉高度和位置 ,并与非眩晕组对照。结果　中老年眩晕或头晕患者基底动脉的CT值及直径的平均值大于非眩晕组 ,P值分别为0 .0 0 3及 0 .0 3 6;非眩晕组 85 %的患者CT值范围为 2 0～ 44 .6Hu ,而眩晕组大于 44 .6Hu的占 3 0 .5 % ;位置及分叉高度两组没有差异。结论　常规头颅CT平扫基底动脉密度的增高、直径的增宽提示患者可能为血管性眩晕 ,应进一步检查除外基底动脉病变。     

Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study

In a single-subject experiment undertaken on 14 consecutive patients, the effects of acupuncture, cervical manipulation, no therapy, and NSAID-percutan application on kinesthetic sensibility, dizziness/vertigo and pain were studied in patients with dizziness/vertigo of suspected cervical origin. The ability to perceive position of the head with respect to the trunk was studied. The effects of different forms of therapy-and none-on dizziness and neck pain were compared, using a 100 mm visual analogue scale (VAS). Active head relocation by subjects with dizziness was significantly less precise than in the control group. Manipulation was the only treatment to diminish the duration of dizziness/vertigo complaints during the past 7 days and increased the cervical range of motion. Both acupuncture and manipulation reduced dizziness/vertigo on the VAS scale and had positive effects on active head repositioning. Ketoprofen percutan application and acupuncture both alleviated pain. The results of this study would suggest that spinal manipulation may impact most efficiently on the complex process of proprioception and dizziness of cervical origin.     

The treatment of dizziness by improving cervical lordosis: a Chiropractic BioPhysics® case report

[Purpose] To present the case of the relief of idiopathic dizziness and the reduction of neck pains and headache by the improvement in cervical alignment using Chiropractic BioPhysics^® technique. [Participant and Methods] A 57 year old female presented with 30 years of chronic dizziness, neck pains and headache. Multiple testing ruled out known causes of vertigo. The patient was diagnosed with idiopathic dizziness. The patient scored 56 points on the dizziness handicap inventory. The patient showed a cervical hypolordosis of −13.7° and anterior head translation of 27 mm. The patient underwent a multimodal treatment of spinal manipulation, cervical extension traction, neck exercises as well as initial electrical stimulation. Traction procedures were slowly progressive due to the severity of the dizziness symptoms. [Results] Over a period of 12-months and 115 treatments there was a 20° increase in cervical lordosis. The patient reported significant reduction in neck pains, headache and dizziness frequency and severity. The patient had a 44-point drop on the dizziness handicap inventory; dizziness symptoms were reported to be very rare. A 1.5 year follow-up showed stability of the symptom relief and a negligible score on the dizziness handicap inventory. [Conclusion] Cervical hypolordosis may be an under-diagnosed cause of idiopathic dizziness in some patients.Key words: Dizziness, Cervical lordosis, Cervical spine     

Chronic cervical myofascial pain syndrome: Improvement in dizziness and pain with a multidisciplinary rehabilitation program. A pilot study

Purpose: The purpose of this retrospective, pilot study was to assess changes in dizziness, pain and function in subjects undergoing an outpatient rehabilitation program focusing on cervical pain.Methods: Fifteen subjects with chronic cervical myofascial pain and concurrent dizziness of suspected cervical origin completed a retrospective questionnaire. Improvement in pain, dizziness and function were recorded on a visual analog scale (VAS) in response to a non-standardized rehabilitation program involving modalities, stretching, strengthening, trigger point injections and aerobic conditioning.Results: Subjects reported an average VAS improvement in dizziness of 59% (±29%), pain 69% (±21%) and function 71%(±19). Seven subjects experienced reproduction of their dizziness and pain during trigger point injections. Overall, twenty seven percent reported no further episodes of dizziness. All subjects experienced a decrease in the frequency of episodes of dizziness. There was a correlation between dizziness and pain (r = 0.58), dizziness and function (r = 0.60), and pain and function (r = 0.74).Conclusion: Subjects with dizziness and cervical myofascial pain of suspected cervical origin may experience symptomatic and functional improvement through a rehabilitative program addressing their cervical pain. Future prospective, randomized controlled studies are needed to address which intervention is the most effective.     

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness. Anterior cervical surgery can eliminate not only chronic neck pain, cervical radiculopathy or myelopathy, but also dizziness. Immunohistochemical studies show that a large number of mechanoreceptors, especially Ruffini corpuscles, are present in degenerated cervical discs. The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease (i.e. cervical discogenic dizziness). Disc degeneration is characterized by an elevation of inflammatory cytokines, which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization. Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system, resulting in sensory mismatches with vestibular and visual information and leads to dizziness. In addition, neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles. Like cervical discogenic pain, the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out. Conservative treatment is effective for the majority of patients. Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.     

闭目原地踏步试验对头晕/眩晕患者病因筛查的诊断价值

目的：探讨闭目原地踏步试验对头晕/眩晕初步病因筛查的诊断价值。方法对564例头晕/眩晕患者采用原地闭目踏步试验、眼球震颤检测、Dix-Hallpike 试验,分析闭目原地踏步试验对头晕/眩晕病因初步筛查的诊断价值。结果本组患者闭目原地踏步试验发生倾倒72例(12.8%),其中合并眼球震颤68例(94.4%),诊断为：前庭周围病变59例,其他13例;偏向一侧310例(55.0%),其中合并眼球震颤43例,Dix-Hallpike 阳性102例,诊断为：位置性眩晕41例、前庭周围病变4例、复发性前庭病168例、椎基底动脉供血不足50例、精神性头晕26例、其他原因21例;踏步试验阴性182例(32.3%),Dix-Hallpike 阳性96例,诊断为：位置性眩晕94例、精神性头晕58例、椎基底动脉供血不足12例、复发性前庭病6例,其他12例。头晕/眩晕前庭周围病变、复发性前庭病、椎基底动脉供血不足患者闭目原地踏步试验多为阳性表现(χ2=34.97、58.18、16.20,P <0.01),而位置性眩晕、精神性头晕患者多为阴性表现(χ2=14.11、8.26,P<0.01)。结论闭目原地踏步试验结合眼球震颤、Dix-Hallpike 检查是快速筛查头晕/眩晕患者初步病因的有效方法。     

Use of Translatoric Mobilization in a Patient with Cervicogenic Dizziness and Motion Restriction: A Case Report

Abstract

Some physical therapists consider the report of dizziness at end-range cervical extension when coupled with side-bending and rotation to the same side (coupled lower cervical rotation in extension) to be a positive sign of vertebral artery compromise. However, degenerative changes and associated movement abnormalities in cervical motion segments may also produce dizziness. The use of mid-line translatoric joint mobilization in the presence of limited active cervical motion that is accompanied by dizziness during cervical extension, rotation, and coupled rotation in extension has not been addressed in the current literature. This case report describes the examination, evaluation, diagnosis, intervention, and outcomes for a 64-year-old woman who presented with limited cervical mobility and the complaint of dizziness during performance of these movements. Examination included a clinical differentiation process to determine the cause of the movement-related dizziness. Examination findings included increased translatoric joint play, tenderness, and reproduction of dizziness at the C4-C6 segments and decreased translatoric joint play at the C1-C4 and C7-T4 motion segments. Intervention included movement re-education and application of translatoric joint mobilization to the hypomobile segments. After 8 visits, there was complete resolution of dizziness during all active cervical movements and improved cervical mobility, as documented with the CROM. This case report demonstrates that clinical symptoms consistent with cervicogenic dizziness and limited cervical mobility may be treated safely and effectively using translatoric joint mobilization techniques. Confirmatory diagnostic ultrasound analysis of the vertebral artery revealed no compromise in flow velocity during the application of these translatoric mobilization techniques.     

Prostaglandins

Sorting out a patient's complaint of dizziness can be almost as disorienting to the physician as the dizziness is to the patient. Some of the confusion may be due to the variety of symptoms that often accompany dizziness and the hard-to-describe nature of the symptoms. But another factor may be that physicians lack a systematic approach to the problem. Dr Ruckenstein provides a stepwise method of evaluating dizziness built around a set of pertinent, progressive questions.     

Standing balance in persistent whiplash: a comparison between subjects with and without dizziness.

OBJECTIVE: Dizziness and unsteadiness, associated with altered balance, are frequent complaints in subjects suffering persistent whiplash associated disorders. Research has been inconclusive with respect to possible aetiology. This study assessed balance responses in subjects with whiplash associated disorders, taking into account several possible causes. DESIGN: A prospective, 3 group, observational design.Subjects: 100 subjects with persistent whiplash associated disorders, 50 complaining of dizziness, 50 not complaining of dizziness and 50 healthy controls. METHODS: The Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance. The sway trace was analysed using wavelet analysis. CONCLUSION: The results indicated that the energy of the sway signal for comfortable stance tests was significantly greater in the group with dizziness compared with the group without dizziness. In the group without dizziness the energy was greater than controls for all tests, but significantly different on selected tests. In selected tandem stance tests, subjects with dizziness were significantly less able to complete the test than subjects without dizziness and controls. These deficits could not be attributed to medications, compensation, anxiety or age and are likely to be due to disturbances to the postural control system possibly originating from abnormal cervical afferent input.