TCD、BAEP对椎—基底动脉供血不足的诊断价值

本文对110例椎基底动脉供血不足患者进行了TCD、BAEP的双重检测研究，结果显示在缺血发作期，两者的异常率分别是97．1％和90％（P＞0．05）;缓解期两者的异常率分别为88．2％和63．1％。本研究证实TCD、BAEP能准确、快捷的对椎基底动脉供血不足诊断，阳性率高，有极高的诊断价值。     

BAEP转颈试验对VBI诊断价值的研究

目的：研究脑干听觉诱发电位（BAEP）转颈试验对椎基底动脉供血不足（VBI）的诊断价值。方法：对临床诊断为VBI而普通BAEP，TCD检查阴性的32例病人，作BAEP转颈试验。结果：？BAEP阳性率为37．5％，结论：BAEP转颈试验可提高VBI病人的阳性检出率。     

SPECT、MRA、TCD、颈部血管彩超对椎基底动脉供血不足的诊断价值

目的 探讨椎基底动脉供血不足（VBI）的客观可靠的辅助诊断方法。方法 对临床确诊VBI患者40例，进行SPECT，颈部血管彩超、TCD检查，并对SPECT结果正常的部分患者进行了乙酰唑胺（Diamox)介入SPECT检查，对26例患者进行颅脑MRA检测。结果 VBI患者普通SPECT阳性率为52.5%,Diamox介入SPECT后阳性率提高至79.4%，ＴＣＤ阳性率为６２.5%，CDFI阳性率为42.5%，MRA阳怀率为7.69%。结论 TCD、颈部血管彩超可作为简单筛选VBI的检查手段。MRA可能对VBI诊断帮助不大，SPECT及Diamox介入SPECT可能是目前VＢＩ诊断较实用的客观可靠的检查手段。值得临床推广。     

SPECT脑灌注显像在椎基底动脉供血不足的临床研究

目的 探讨单光子发射计算机断层扫描(SPECT)脑灌注显像在椎基底动脉供血不足(vertebrobasilar insuf-ficiency,VBI)的临床应用价值,并与其他对VBI的研究方法相比较,力图找出一个研究VBI较客观理想的临床方法。方法 将临床确诊VBI的患者50例,全部进行了经颅多普勒超声(TCD)、颈部血管彩色超声多普勒(CDFI)、SPECT检查,将其中普通SPECT显示正常的19例患者,48 h后予以口服乙酰唑胺2 g,2 h后再行SPECT检查。50例患者中26例进行了核磁共振血管成像(MRA)检查,其中1例还进行了正电子发射计算机断层扫描(PET)检查。结果50例患者TCD阳性率为66％,CDFI阳性率为56％,普通SPECT阳性率为62％。三种方法阳性率无明显差异,加用乙酰唑胺后的SPECT检查阳性率提高到86％,与TCD和CDFI比较有显著性差异。SPECT显示缺血部分多在枕颞叶等椎基底动脉(VBA)系统供血区域。26例患者MRA显示有2例椎动脉狭窄。其中1例患者MRA、SPECT显示正常,口服乙酰唑胺后SPECT检查及PET检查显示有颞枕叶缺血。结论 TCD和CDFI在VBI的诊断上可作为粗略的筛选手段,MRA在VBI的诊断价值可能不大,加用乙酰唑胺后SPECT阳性率明显提高,我们认为其对VBI的诊断具有重要价值,值得临床推广。     

TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中的对比研究

目的探讨彩色经颅多普勒（TCD）、脑电图（EEG）、脑干听觉诱发电位（BAEP）、CT在小儿脑性瘫痪诊断中各自的作用及与临床的关系。方法对2001～2006年采用TCD、EEG、BAEP、CT检查的资料数据完整的40例小儿脑性瘫痪病例,进行统计学处理及分析。结果TCD阳性率为72.5%、EEG为75.0%、BAEP为80.0%、CT为57.5%。TCD、EEG、BAEP之间相比无统计学意义P〉0.05。TCD、EEG、CT亦无统计学意义P〉0.05。仅BAEP阳性率与CT阳性率有统计学意义χ^2=4.1,P〈0.5。结论TCD、EEG、BAEP、CT在小儿脑性瘫痪诊断中各自均有一定的价值,对脑性瘫痪的诊断如采用多种检查,将起到相辅相成的作用,综合分析意义更大。     

脑干听觉诱发电位和经颅多普勒超声联合应用对后循环缺血的诊断价值

目的研究脑干听觉诱发电位(BAEP)和经颅多普勒(TCD)对后循环缺血(PCI)的联合诊断价值。方法对209例临床诊断为PCI患者进行脑干听觉诱发电位的检测;同时采用经颅多普勒探测基底动脉(BA)、椎动脉(VA)、大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)的血供情况、血管壁的弹性和顺应性。结果209例患者中BAEP异常和TCD异常共189例,总阳性率为90.43%。其中BAEP异常179例(85.65%);TCD阳性检出率169例(80.86%)。结论BAEP和TCD互为补充,可以分别从神经电生理方面和血流动力学来为PCI的诊断和定位提供有价值的客观依据。     

TCD、BAEP、MRI对椎基底动脉供血不足的诊断价值

目的　探讨椎基底动脉供血不足 (VBI)可靠的辅助诊断方法。方法　对临床确诊的VBI 115例患者同时进行了经颅多普勒 (TCD)、脑干听觉诱发电位 (BAEP)、脑颅核磁共振 (MRI)检查。结果　TCD异常率为 82 2 %,BAEP异常率为 72 1%,MRI异常率为 2 6 1%。结论　TCD、BAEP异常率高可为VBI早期诊断提供客观依据 ,TCD应作为首选的监测手段 ,也证明了VBI患者在形态学无明显改变时MRI除与VBI的鉴别诊断外 ,不应作为VBI的常规检查。     

TCD、BAEP、MRI对椎基底动脉供血不足的诊断价值

目的 探讨椎基底动脉供血不足(VBI)可靠的辅助诊断方法．方法 对临床确诊的VBI 115例患者同时进行了经颅多普勒(TCD),脑干听觉诱发电位(BAEP),脑颅核磁共振(MRI)检查.结果:TCD异常率为82.2%,BAEP异常率为72.1%,MRI异常率为26.1%,结论:TCD,BAEP异常率高可为VBI早期诊断提供客观依据,TCD应作为首选的监测手段,也证明了VBI患者在形态学无明显改变时MRI除与VBI的鉴别诊断外,不应作为VBI的常规检查.     

经颅多普勒、MRI和磁共振血管成像对椎-基底动脉供血不足的诊断价值

目的探讨经颅多普勒(TCD)、MRI和磁共振血管成像(MRA)对椎-基底动脉供血不足(VBI)的诊断价值。方法对60例临床诊断为VBI的患者分别进行TCD、MRI和MRA检查．并对检查结果进行分析。结果TCD检查异常53例(88．3％)，其中椎动脉血流速度减慢15例，脑血管硬化6例，脑血管痉挛23例，血管狭窄9例?MRI显示脑干缺血性改变(灌注不足)12例(20．0％)，脑干腔隙性梗死3例(5．0％)：MRA发现椎动脉异常32例(53．3％)。结论TCD检查对VBI诊断的敏感性高，MRA的特异性高：TCD、MRI和MRA联合检查对VBI的病因、病变部位、病理改变有诊断价值。     

脑干听觉诱发电位对脑干缺血诊断价值的探讨

目的：探讨脑干听觉诱发电位对脑干缺血诊断价值。方法：对44例经颅多普勒检查（TCD）确定为椎基底动脉供血不足的眩晕患者（VBI组）进行脑干听觉诱发电位（BAEP）检查,并与52例经颅多普勒检查确定为脑血管痉挛的眩晕患者（对照组）脑干听觉诱发电位检查结果进行对照分析。结果：椎基底动脉供血不足的眩晕组BAEP异常率为52．27％,明显高于对照组（3．85％,P＜0．001）。VBI组BAEP各波潜伏期均长于对照组（P＜0．05）,BAEP的I波及V波波幅低于对照组（P＜0．05）。结论：脑干听觉诱发电位可作为评价脑干缺血及其程度的一个客观指标。     

经颅多普勒在后循环缺血性眩晕疗效评估中的应用价值

目的探索经颅多普勒技术在后循环缺血性眩晕疗效评估中的临床价值,为后循环缺血性眩晕疾病诊断、治疗提供参考依据。方法收集后循环缺血性眩晕患者86例,给予常规治疗,并根据患者情况加服中药治疗,治疗前后行经颅多普勒检查,比较TCD参数变化情况。结果 64例(74.42%)椎基底动脉的终末支大脑后动脉血流异常以血流速度减慢为主,椎基底动脉和大脑后动脉血流速减慢分别是67.44%和51.16%,少数出现动脉硬化症,分别是40.70%和29.07%。多数患者同时出现颈内动脉血流异常,大脑中动脉和大脑前动脉发生率较为接近,分别为86.04%和86.05%,以血流减慢为主。入选患者治疗后,有效74例,总有效率为86.05%,无效12例。有效与无效病例的各指标进行比较,前者VA和BA的Vs、Vm均较后者显著升高,差异具有统计学意义(P0.05)。结论 TCD具有无创性,可作为后循环缺血性眩晕患者颅底大动脉血流动力学的有效观察指标,显示不同时期病理变化,为后循环缺血性眩晕疾病诊断、治疗提供参考依据。     

以双耳听力下降为首发症状的脑梗死临床观察

目的观察以双耳听力下降为首发症状的脑梗死患者,探讨其病灶分布特点及血管形态异常之间的关系。方法对3例以双耳听力下降为首发症状的脑梗死患者行头MR(包括T1WI、T2WI、DWI、MRA)、TCD、BAEP检查。结果 3例患者均为后循环多灶性梗死,最常累及的部位是小脑、脑桥,均有双侧椎动脉或基底动脉起始段严重狭窄或闭塞,双侧内听动脉均受累。结论以双耳听力下降为首发症状的脑梗死均符合多灶性后循环缺血的特点,血管形态异常是其重要病理基础和致病因素,预后差。     

Accuracy and Criteria for Localizing Arterial Occlusion With Transcranial Doppler

The authors determined transcranial Doppler (TCD) accuracy for the proximal internal carotid artery (ICA), distal ICA, proximal middle cerebral artery (MCA), distal MCA, anterior cerebral artery (ACA), posterior cerebral artery (PCA), terminal vertebral artery (tVA), and basilar artery (BA) occlusion in cerebral ischemia patients. Detailed diagnostic criteria were prospectively applied for TCD interpretation independent of angiographic findings. Of 320 consecutive patients referred to the neurosonology service with symptoms of cerebral ischemia, 190 (59%) patients also underwent angiography (MRA or DSA). 48 of those 190 patients had angiographic occlusion and 12 of those 48 patients had involvement of multiple vessels. Median time from TCD until angiography was performed was 1 hour (41 patients had angiography before TCD). TCD showed 40 true positive, 8 false negative, 8 false positive, and 134 true negative studies with sensitivity 83.0%, specificity 94.4%, positive predictive value 83.0%, negative predictive value 94.4%, and accuracy 91.6% to determine all sites of occlusion. Sensitivity for each individual occlusion site was: proximal ICA 94%, distaiiCA 81%, MCA 93%, tVA 56%, BA 60%. Specificity ranged from 96% to 98%. TCD is sensitive and specific in determining the site of the arterial occlusion using detailed diagnostic criteria, including proximal ICA and distal MCA lesions. TCD has the highest accuracy for ICA and MCA occlusions. If the results of TCD are normal, there is at least a 94% chance that angiographic studies will be negative. Key words: ultrasound, transcranial Doppler sonography, stroke, occlusion, angiography.     

转颈对眩晕患者基底动脉流速的影响

目的　采用TCD观测转颈对正常人及眩晕患者基底动脉流速的影响。方法　正常对照组 3 6例 ,眩晕患者 3 1例 ,TCD常规检查椎 -基底动脉及转颈时基底动脉流速的变化。结果　正常人随年龄增大 ,椎 -基底动脉流速下降 ,转颈前后基底动脉流速差异无显著性 ;眩晕患者椎 -基底动脉流速下降 ,转颈后基底动脉流速明显下降 ,较转颈前差异有显著性 (P <0 .0 5 )。结论　转颈后基底动脉流速下降≥ 2 0 % ,即为转颈试验阳性 ,提示患者椎—基底动脉系统代偿能力差 ,存在椎动脉狭窄等病变的可能 ,需进一步检查     

椎基底动脉供血不足与椎动脉MRA

目的:分析、探讨椎动脉核磁共振血管造影(MRA)对椎基底动脉供血不足(VBI)的诊断价值和意义。方法:共65患者,男33例,女32例,年龄40～78岁,平均年龄56.85+11.07岁。符合椎基底动脉供血不足诊断标准,分别进行椎动脉MRA、TCD、BAEP及椎动脉超声等检查。结果:65例患者中椎动脉MRA异常35例(53.8％),TCD异常53例(81.5％),椎动脉B超异常33例(50.8％),BAEP异常30例(46.2％)。椎动脉MRA能清楚的显示血管病理形态,主要表现为单侧或双侧椎动脉变细、粗细不均及血流信号降低。MRA异常率与病人的病程长短有关。结论:椎动脉MRA、TCD、BAEP、椎动脉超声4种方法合用,有助于全面客观诊断椎基动脉供血不足。     

Rotational vertebral artery syndrome due to compression of nondominant vertebral artery terminating in posterior inferior cerebellar artery

Rotational vertebral artery syndrome (RVAS) is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, and ataxia induced by head rotation. We report on a patient who developed atypical RVAS due to compression of the vertebral artery (VA) terminating in the posterior inferior cerebellar artery (PICA). A 59-year-old man suffered from vertigo and nystagmus induced by leftward head rotation and oculography showed right beating horizontal-torsional and downbeat nystagmus. Cerebral angiography showed hypoplastic right VA terminating in PICA without connection to the basilar artery. The basilar artery received its flow from the left VA only and branched out both anterior inferior cerebellar arteries. Cerebral angiography revealed a complete occlusion of the right distal VA at the level of the C1–2 junction when the head was rotated to a leftward position. In contrast, the blood flow through the left vertebral and basilar arteries remained intact while turning the head to either side. The hemodynamic compromise observed in our patient with RVAS indicates that isolated vertigo and nystagmus may occur due to transient ischemia of the inferior cerebellum or lateral medulla.     

轻微椎－基底动脉缺血性眩晕的rCBFM与BAEP对比观察

对３０例轻微椎—基底动脉（ＶＢＡ）缺血性眩晕患者进行了ｒＣＢＦＭ与ＢＡＥＰ检查的对比观察，认为前者在显示ＶＢＡ系统缺血方面可以直接明确诊断，阳性率高，可直观地显示缺血的部位和范围，且可了解颈动脉系统代偿供血情况，但不能完全取代ＢＡＥＰ。     

丁苯酞软胶囊治疗椎动脉优势型眩晕疗效观察

目的观察丁苯酞软胶囊治疗椎动脉优势型后循环缺血性眩晕的疗效及安全性。方法收集首次发作眩晕并行MRA检查证实一侧椎动脉优势的后循环缺血患者76例为研究对象,随机分为治疗组和对照组,对照组给予阿司匹林加阿托伐他汀钙片基础治疗,治疗组在对照组的基础上加用丁苯酞软胶囊,治疗14 d后观察眩晕缓解程度、TCD血流异常率变化。结果治疗组总有效率92.1%,对照组总有效率65.8%,两组比较差异有统计学意义P0.05)。两组经治疗后基底动脉TCD异常率均有下降,其中治疗组(47.4%)与对照组(57.9%)相比较下降更明显,差异有统计学意义(P0.05)。结论丁苯酞软胶囊治疗椎动脉优势型眩晕有显著疗效且安全。     

Basilar artery hypoplasia associated with changes of brainstem potential,transcranial Doppler and perfusion-weighted imaging

Objective: The aim of this study was to observe brainstem hemodynamic alterations associated with basilar artery hypoplasia (BAH). Methods: Nine hundred and fifty-two consecutive patients received emergency multimodal computed tomography; magnetic resonance imaging and magnetic resonance angiogram during the period of January 2011 to December 2014 were included. The vascular risk factors, brainstem auditory evoked potential (BAEP), blink reflex (BR), transcranial Doppler (TCD) and dynamic susceptibility contrast-enhanced perfusion-weighted imaging were completed. Results: There was significant difference in the abnormal rates of TCD and BAEP between BAH and non-BAH patients. A positive correlation between basilar artery diameter and systolic velocity among BAH patients was suggested. V-wave value was used to predict posterior circulation infarction (PCI) with the sensitivity of 0.933 and specificity of 0.50 with the cutoff value of 5.97 s. Abnormal BR rate was also significantly different in BAH and non-BAH patients. The latency of R2 was used to predict PCI with the sensitivity of 0.933 and specificity of 0.50 with the cutoff value of 46.4 ms. The incidence of hypoperfusion was higher in BAH than non-BAH group and it was significant difference. Conclusion: BAH is closely associated with hemodynamic alterations within the pons, which might contribute to vascular vertigo due to regional hypoperfusion.     

症状性椎基底动脉狭窄的血管内治疗(附95例报告)

目的 总结椎基底动脉系统症状性血管狭窄的血管内治疗的策略、方法 、术中风险及术后疗效.方法 回顾性分析2004年1月至2008年7月治疗的95例采用支架置入治疗的症状性椎基底动脉狭窄患者的临床资料.结果 采用支架置入治疗的患者中,椎动脉起始部狭窄者21例,椎动脉颈段狭窄者3例,椎动脉颅内段狭窄者16例,椎基底动脉交界处狭窄者15例,基底动脉段狭窄者36例,大脑后动脉P2段狭窄者4例.所有狭窄均>50%.手术的技术成功率为97%(92/95).术后平均狭窄率从76.1%(50%～95%)下降到9.2%(0～20%).所有患者均在术后6个月-2年内随访,其中88例患者效果良好.结论 脑血管狭窄处支架置入术是目前治疗该类疾病的有效方法 ,其长期疗效还有待进一步观察.