Rheoencephalographic studies in patients with vertebrobasilar insufficiency

Rheoencephalographic investigations in different head positions were carried out in 62 subjects, including 22 healthy ones and 40 patients with vertebrobasilar arterial failure comparing the results with degenerative changes in the cervical spine. In patients with advanced changes in this spine the blood flow in the cerebral vessels was lower and their tonus was greater than in the remaining patients. Rheoencephalographic investigations may be particularly useful in patients in whom vertebral angiography is contraindicated.     

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。     

重心动摇平衡仪治疗急性椎-基底动脉供血不足性眩晕的临床观察

目的探讨人体重心动摇平衡仪在椎-基底动脉供血不足性眩晕患者治疗中的应用价值.方法将2004年8月～2005年1月西京医院神经内科病房住院的椎-基底动脉供血不足性眩晕患者80例随机分为治疗组和对照组,2组药物治疗相同,治疗组同时接受日本Anima公司生产的EAB-100型重心动摇平衡仪康复治疗,每周训练3次,每次为15～30 min,共2周.结果治疗至第1,2周时2组重心动摇面积均在减小,治疗组重心动摇面积显著小于对照组(P＜0.05),1、2周时治疗组症状改善有效率分别为88.3%、96.5%,显著高于对照组67.6%、75.7%(P＜0.05).结论给椎-基底动脉供血不足性眩晕患者服用药物治疗的同时,给予重心动摇平衡仪康复训练,能促进患者平衡功能障碍的恢复和显著改善患者急性期的眩晕症状.     

Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion

PurposeTo evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion.MethodsFrom April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed.ResultsAll three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0–2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment.ConclusionEndovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.     

A case of basilar artery fenestration with recurrent attacks of vertebrobasilar insufficiency

Fenestration of basilar artery is an uncommon vascular anomaly that is usually an incidental product on autopsy or angiography. None of the cases in the literature had clinical symptoms associated with this anomaly except for subarachnoid hemorrhage when accompanied with saccular aneurysm. We report a rare case of the basilar artery fenestration associated with clinical symptoms without any aneurysm. A 71-years-old male, who had been treated for labile hypertension and had had recurrent attacks of vertigo, nausea, sometimes diplopia or unsteady gait, for 5 years, was referred to our hospital on Sept. 13, 1985. One day prior to admission, he suddenly felt diplopia and vertigo and unsteady gait. His family noticed he was dysarthric. On admission, he was alert and normotensive. He complained of dysesthesia on the right half of the perioral region and his right fingers. A neurological examination showed a mild weakness and hyperactive deep tendon reflexes on his right leg. His motor coordination was almost normal, but he was unsteady when he stood on one foot with his eyes closed. Laboratory examinations were normal except for an elevated serum uric acid level. A chest x-ray film showed a sclerotic change of aorta and mild cardiomegaly. Left ventricular hypertrophy was observed on his ECG. His CT scans showed multiple lacunae and mild brain atrophy. On cerebral angiography, his basilar artery (BA) had a fenestration almost in its total length that divided the BA, like a duplication, into two components with a smaller diameter than normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Initial symptoms of vertebrobasilar artery occlusions and the outcomes after endovascular treatment

Journal of Neurology - Acute vertebrobasilar artery occlusion (VBAO) is a devastating disease in stroke patients. This study was aimed to identify the initial symptoms of patients with acute VBAO...     

Deafness associated with vertebrobasilar insufficiency.

The incidence of auditory disturbances in vertebrobasilar insufficiency (VBI) is considered much rarer than vestibular disturbances, but no routine audiometric test results for VBI patients have been published. To determine the incidence of deafness associated with VBI and the sites predominantly involved in deafness, we studied 70 vertiginous patients with VBI using a routine audiological examination and magnetic resonance imaging (MRI). MRI detected a lacunar infarct involving the cochlear nuclei in one patient, but lacunae did not involve central auditory structures in the other patients. Twenty-five patients experienced tinnitus, deafness, or both, during vertigo episodes. Audiological examinations confirmed the development of unilateral deafness in 15 (21%) patients, involving the cochlea in 14 and cochlear nuclei in one. These findings indicate that hearing loss occurs in approximately one-fifth of VBI patients, much less frequently than vestibular disturbances, and that deafness associated with VBI mainly involves the cochlea.     

椎动脉优势与后循环缺血性眩晕的关系

目的 探讨椎动脉优势在后循环缺血性眩晕(VAIV)中的临床意义.方法 前瞻性收集经头颅MRA检查发现的椎动脉优势的VAIV患者41例为研究对象,以非椎动脉优势的患者36例为对照,比较两组患者的基底动脉情况及眩晕严重程度.将椎动脉优势组患者根据椎动脉直径差异分为轻度变异组(0.04～0.70mm)、中度变异组(0.70～1.17 mm)、重度变异组(≥1.17 mm)3组,比较3组患者的眩晕严重程度差异.所有患者均随访1年,观察椎动脉优势与阳性事件发生(眩晕反复发作或发生后循环脑梗死)的关系.结果 (1)椎动脉优势组基底动脉形状异常率为70.73％(29/41),明显高于非椎动脉优势组33.33％(12/36)(x2=10.77,P＜0.01);(2)椎动脉优势组眩晕严重程度(3.3±1.2)高于非椎动脉优势组(2.3±0.6)(t=1.99,P＜0.01);不同变异3组间两两比较,椎动脉优势重度变异组眩晕严重程度(4.0±1.1)大于轻度变异组(2.9±0.9)(t=2.07,P＜0.05);(3)随访1年后,椎动脉优势组阳性事件发生率(65.85％)高于非优势组(30.56％)(x2=9.56,P＜0.01).结论 椎动脉优势的VAIV患者基底动脉异常率高,眩晕程度更严重,更容易反复发作眩晕或发生后循环脑梗死.     

Transient achromatopsia in vertebrobasilar insufficiency

Zusammenfassung Es wird ein 54j?hriger Mann beschrieben, bei welchem Attacken von Achromatopsie, zeitweise mit und zeitweise ohne gleichzeitige „drop attacks“ auftraten. Bei der Untersuchung konnte kein eigentlicher Visusausfall nachgewiesen werden und Hilfsuntersuchungen waren negativ. Es wird angenommen, da? eine Durchblutungsinsuffizienz im vertebrobasil?ren Gebiete mit vorübergehender Isch?mie der entsprechenden Sehrinde für die vorübergehende St?rung der Farbwahrnehmung verantwortlich sei.      

症状性椎基底动脉狭窄患者支架置入术后再狭窄相关因素分析

目的 探讨症状性椎基底动脉(VBA)狭窄患者支架置入术后再狭窄与临床因素的关系. 方法收集我院36例症状性VBA狭窄且行支架置入术患者的临床资料,以经颅多普勒(TCD)、彩色多普勒超声(CDI)、数字减影血管造影(DSA)随访支架置入术后的再狭窄率.选择了脑梗死易患因素、靶病变长度、靶病变部位等11项观察指标,分析上述各种临床因素与再狭窄的相关性,对有、无相关危险因素再狭窄率采用卡方检验. 结果 36例患者有40处狭窄,置入支架40枚,平均随访时间为(16.5±15.4)个月(3个月～3年),TCD、CDI随访30例,DSA随访6例,8例(8/36,22.2%)出现＞50%的再狭窄.再狭窄组病人合并有糖尿病史比例较无再狭窄组明显增多(分别为62.5%、32.1%,P＜0.05);再狭窄组椎动脉开口病变比例明显高于无再狭窄组(分别为62.5%、39.3%,P＜0.05);再狭窄组的靶病变≥10mm明显高于无再狭窄组(分别为50.0%、28.6%,P＜0.05).结论 症状性椎基底动脉狭窄支架置入术患者合并糖尿病、椎动脉开口病变及靶病变长度可能是术后再狭窄的预测因素.     

椎-基底动脉重度狭窄的血管内治疗

目的回顾性分析椎-基底动脉重度狭窄患者临床诊断与治疗经过,以评价血管内支架成形术的可行性和临床疗效。方法16例椎-基底动脉重度狭窄患者均施行血管内支架成形术,观察其技术成功率、围手术期并发症发生率及远期疗效。结果16例患者经脑血管造影检查共发现27个狭窄病变,共成功植入36枚球囊扩张式支架,技术成功率达100%(16/16)。1例于手术后24h发生支架内急性血栓形成,围手术期并发症发生率为6.25%(1/16)。随访期间,3例(18.75%)发生支架内再狭窄而致卒中再发。结论血管内支架成形术治疗椎-基底动脉重度狭窄,在技术上可行,远期疗效良好。     

Cervical spondylosis causing vertebrobasilar insufficiency: a surgical treatment

Although the most common aetiology of transient vertebrobasilar insufficiency is atherosclerosis, a similar syndrome may occasionally be produced by cervical osteophytes. The possibility of such a remedial lesion makes further investigation mandatory in such patients—especially if symptoms are associated with sudden movements of the head or neck. When vertebral compression results from osteophytes, it can be easily relieved by a minor modification of the usual anterior cervical fusion technique. This method has proved to be quite efficacious in two patients whose case histories are reported.     

Long-term follow-up of patients after intraarterial thrombolytic therapy of acute vertebrobasilar artery occlusion

Local thrombolysis may reduce mortality after acute vertebrobasilar artery occlusion. We focused on variables affecting recanalization, outcome and long-term prognosis. Thirty-six patients with vertebrobasilar artery occlusion were treated with local intraarterial thrombolytic therapy. Four of the survivors were among the 16 patients without recanalization. Recanalization was associated with a higher survival rate. Top-of-the-basilar-type occlusions have the highest recanalization rate. The thrombolytic medication used did not influence the recanalization frequency. One patient died due to an intracerebral bleed after thrombolysis. There was no association between the time interval (greater or less than 6 h) between the onset of symptoms and therapy initiation and survival. Relapses during follow-up (mean follow-up 3.7 years) did not occur. MRI/MRA and ultrasound studies during follow-up showed unchanged results in these patients. All survivors at the time of follow-up lived at home.     

动脉溶栓治疗37例椎-基底动脉闭塞患者临床分析

目的 分析急性椎-基底动脉闭塞(VBAO)患者选择性动脉溶栓治疗(IAT)的血管再通效果、预后及其影响因素.方法 37例VBAO患者行选择性IAT,VA系统11例、BA系统26例,通过分析IAT时间、术前ESS、GCS评分等,并分析术后90d mRS评分结果.结果 血管总的再通率为64.86%,椎动脉闭塞(VAO)组再通率为27.27%,基底动脉闭塞(BAO)组为80.77%;开始行IAT的时间≤6h组血管再通率为85.71%,存活率为52.38%;＞6h组分别为37.5%和8.75%.术前GCS评分为12～15分组存活率为72.22%,3～11分组为5.26%;术前ESS评分＞35分组存活率为71.43%,0～35分组为17.39%;血管再通组存活率为50%,血管未通组为15.38%.死亡23例,其中1例死于脑出血.结论 选择性IAT治疗急性VBAO,血管再通生存率较高;IAT治疗的时间、血管闭塞的部位、术前ESS、GCS评分及血管是否再通与IAT疗效密切相关.     

Extra-intracranial bypass surgery for vertebrobasilar insufficiency due to obstructive vertebral artery and vertebral-basilar artery junction disease

This report is on 19 patients with vertebrobasilar insufficiency in whom direct extra-intracranial arterial bypass surgery to the posterior circulation was performed. In all patients preoperative angiography had demonstrated vascular lesions of haemodynamic significance of either one or both vertebral arteries (VA) or within the vertebral-basilar artery junction (VABAJ). The bypass procedure was performed between the occipital artery (OA) and - depending on the localization of the obstructive vascular lesion - the posterior inferior cerebellar artery (PICA), the VA or the anterior inferior cerebellar artery (AICA). A modification of the operative technique is presented with using a paramedian approach. The clinical results of this series support the concept that a patent extra-intracranial graft to the posterior circulation may have a protective effect by preventing further ischaemic events.     

头CTA对椎基底动脉供血不足的诊断意义

目的探讨多层螺旋CT血管成像(CTA)对椎基底动脉供血不足病因诊断的价值。方法对46例确诊为椎基底动脉供血不足的患者进行CTA和数字减影血管成像(DSA)检查,比较阳性率。结果 DSA显示的40例血管狭窄除1例CTA未检出外,余在CTA上均显示为同样程度的狭窄,CTA未出现假阳性。结论CTA作为椎基底动脉供血不足的辅助检查手段安全、方便、快速且准确,可作为椎基底动脉供血不足的首选检查方法。     

3D-CTA在老年患者椎-基底动脉供血不足诊断中的应用

椎-基底动脉供血不足（vertebrobasilar insufficiency VBI）是神经科常见病、多发病，但诊断多依赖主观症状，尚缺乏特异诊断标准。多层螺旋CT三维血管成像（three-dimensional computer angiography,3D-CTA）是近年发展起来的快速无创性血管显示技术，有许多报道证明其在诊断脑血管病中有很大应用价值，但其在诊断VBI中的应用目前报道尚少。     

丁咯地尔联合金纳多治疗椎基底动脉供血不足

目的观察丁咯地尔联合金纳多治疗椎基底动脉供血不足的疗效。方法将108例椎基底动脉供血不足患者随机分成2组各54例,治疗组给予丁咯地尔和金纳多,对照组给予金纳多,1次/d。结果治疗组和对照组总有效率比较,5d后差异有统计学意义(P<0.01),10d后差异无统计学意义(P>0.05)。结论丁咯地尔联合金纳多治疗椎基底动脉供血不足显效快,疗效明显。