眩晕宁对颈性眩晕患者血浆内皮素水平的影响及其意义

目的观察眩晕宁对颈性眩晕患者血浆内皮素水平的影响,并探讨其作用机制。方法将93例颈性眩晕患者分为眩晕宁治疗组52例和非眩晕宁治疗组(对照组)41例,分别检测两组研究对象治疗前后血浆内皮素值,并对其眩晕症状改善程度进行评价。结果眩晕宁治疗组治疗后血浆内皮素水平较治疗前明显下降(P<0.05),且明显低于对照组(P<0.05);眩晕宁治疗组的总有效率为90.4%,高于对照组的73.2%(P<0.05)。结论眩晕宁可明显降低颈性眩晕患者的血浆内皮素水平,改善其临床症状。     

磁共振血管成像诊断脑血管疾病

本组５０例脑血管疾病患者（ＣＶＤ）的ＭＲＩ和ＭＲＡ检查结果说明，ＭＲＡ能检出颅内动脉瘤、动静脉畸形、脑动脉闭塞和狭窄病变。ＭＲ检查联合应用能显著提高单项ＭＲＩ对ＣＶＤ的诊断价值。ＭＲＡ有可能成为颅内血管疾病有效、常用的诊断手段。     

磁共振血管成像诊断脑血管疾病

本组５０例脑血管疾病患者的ＭＲＩ和ＭＲＡ检查说明，ＭＲＡ能检出颅内动脉瘤，动静脉畸形，脑动脉塞和狭窄病变。ＭＲ检查联合应用能显著提高单项ＭＲＩ对ＣＶＤ的诊断价值。ＭＡＲ有可能成为颅内血管疾病有效，常用的诊断手段。     

急性脑梗死患者临床表现与磁共振扩散加权成像和磁共振血管成像的相关性分析

目的：分析急性脑梗死患者的临床表现与磁共振扩散加权成像（DWI）和磁共振血管成像（M RA ）的相关性。方法回顾性分析51例急性脑梗死患者行DWI和M RA检查的临床资料,分析影像学特征。结果 DWI检查显示51例急性脑梗死患者均为高信号,而M RA检查显示阳性患者38例。结论对于急性脑梗死患者,DWI能够早期定位病灶及其性质, M RA能够显示颅内大血管狭窄或闭塞位置与程度,动态检测溶栓治疗效果,二者结合在指导临床和判定预后方面具有重要的作用。     

脑静脉窦血栓形成患者磁共振成像与磁共振静脉血管成像联合诊断的价值

目的：探讨脑静脉窦血栓（cerebral venous sinus thrombosis ,CVST ）形成患者磁共振成像与磁共振静脉血管成像联合诊断的价值。方法选取脑静脉窦血栓患者40例进行分析。诊断过程中,全体患者均接受磁共振（magnetic resonance venography ,MR）平扫,数字减影血管造影（digital subtraction angiography ,DSA）检查12例,MRV检测6例,增强扫描22例。结果单一横窦受累6例,上矢状窦、乙状窦及横窦受累8例,单一乙状窦受累16例,横窦和上矢状窦联合受累10例。所有患者磁共振成像（magnetic resonance venography ,MRI）及磁共振静脉成像（magnetic resonance venography ,MRV）均表现出信号改变。22例患者增强扫描显示脑静脉非正常强化,但静脉窦内部血栓未强化。M RV检查6例患者及DSA 12例患者的结果显示其受累静脉窦不明显、狭小、不规则,且出现侧支血管形成现象。结论 M RI与M RV联合诊断对于脑静脉窦血栓形成的诊断具有较好效果。     

血管源性眩晕

血管源性眩晕是指主要由脑血管疾病引发的一类眩晕,占各种眩晕的50％以上。血管源性眩晕可来自前循环,但大多数来自于后循环即椎基底动脉系统㈦。椎基底动脉系统的主要分支有：①大脑后动脉;②小脑上动脉;     

颅脑外伤中颈性眩晕的早期治疗研究

目的 探讨轻、中型颅脑外伤中颈性眩晕患者的早期治疗方案.方法 将轻、中型颅脑外伤中颈性眩晕患者84例按随机数字表法分成治疗组(38例)与对照组(46例),治疗组采用颈椎牵引、星状神经节封闭、早期颈部理疗等方法 并结合药物治疗,对照组采用单纯药物治疗,对其疗效进行非参数秩和检验分析.结果 治疗组治愈29例,好转8例,无效1例,平均治疗时间20d;对照组治愈26例,好转15例,无效5例,平均治疗时间30 d;治疗组疗效优于对照组,差异有统计学意义(P＜0.05).结论对颅脑外伤中颈性眩晕患者早期采用针对性治疗,其疗效好于单纯药物治疗,且治疗时间缩短.     

超短波治疗颈性眩晕临床疗效分析

目的探讨超短波治疗颈性眩晕的效果。方法37例颈性眩晕超短波治疗。结果超短波治疗颈性眩晕总有效率为97.2%。结论超短波治疗颈性眩晕能使局部水肿、炎症吸收,缓解脊髓、神经根或椎动脉受压的症状。超短波治疗颈性眩晕是比较有效的疗法之一。     

颈性眩晕的病因及其发病机制

颈性眩晕是指椎基底动脉(VA)颅外段受颈部病变的影响导致血流障碍引起以眩晕为主的临床综合征。其病因及发病机制为:颈交感神经受激惹,钩椎关节增生、椎间盘突出、横突孔狭窄、寰椎VA沟挤压VA、VA硬化、VA发良不良、椎间不稳和神经鞘瘤等使VA受压,颈部纤维结构炎症反应使颈交感神经受激惹,血浆内皮素使VA收缩,导致VA供血不足,以致脑干、小脑及前庭系统缺血而引起眩晕。     

颈性眩晕——神经科医师的旧识新知

起源于颈椎的、以头晕为主诉的综合征统称为颈性眩晕。它通常与颈椎病有关，但不一定完全由颈椎病所致。     

Clinical findings of intracranial vertebral artery disease using magnetic resonance angiography

The vertebral artery lesion has a variety of clinical characteristics. We sought to clarify the clinical patterns and the location of the intracranial vertebral artery (ICVA) diseases according to analyses of images obtained using magnetic resonance angiography (MRA). We studied vascular lesions, risk factors, symptoms, signs, and outcomes in 35 patients with ICVA disease (3 had bilateral occlusion; 9, unilateral occlusion; 6, bilateral stenosis; and 17, unilateral stenosis). The most common site of unilateral and bilateral lesions was the distal ICVA after the origin of posterior inferior cerebellar artery (PICA). We found accompanying basilar artery disease in 28.6% of patients with unilateral and bilateral ICVA disease. The majority of the ICVA lesions were associated with internal carotid arteries disease (48.8%). The common vascular risk factors were hypertension (71%), diabetes mellitus (34%), hyperlipidemia (31%), smoking (29%), and coronary artery disease (23%). Eighteen patients (51.4%) had transient ischemic attacks (TIAs) only, 10 patients (28.6%) had TIAs before stroke, and 5 patients (14.3%) had strokes without TIAs. Most patients (80%) with TIAs, with or without stroke, had multiple episodes. Vertigo or dizziness, ataxia, limbs weakness and abnormal gait were the common symptoms and signs. At 6 months follow-up, 66.7% patients had no symptoms or only slight symptoms that caused no disability. Our data showed (1) the usual location of ICVA disease (occlusion or severe stenosis) was distal to PICA, especially near the vertebrobasilar junction; (2) the risk factors were hypertension, diabetes mellitus, hyperlipidemia, smoking, and coronary artery disease; (3) patients with ICVA disease had a high frequency of accompanying internal carotid, middle cerebral, or basilar artery disease; (4) vertigo or dizziness, and ataxia were the common symptoms and signs; (5) TIA was the most common clinical pattern; (6) the outcome was favorable, except in cases with bilateral ICVA occlusion.     

椎动脉扭曲与颈源性眩晕的关系

目的 探讨椎动脉扭曲与颈源性眩晕的关系.方法 对31例拟诊为颈源性眩晕(眩晕组)及80例无眩晕(对照组)的患者进行颅颈动态增强磁共振血管成像(DCE-MRA)检查,测量其颈段直线距离及颈段椎动脉长度,计算其延长值,评价椎动脉扭曲程度.结果 经DCE-MRA检查排除椎-基底动脉有明显狭窄闭塞性改变的患者27例,其中眩晕组9例,对照组18例.眩晕组两侧椎动脉延长值均显著长于对照组(P＜0.05 ～0.01).相关分析显示,左右两侧椎动脉延长值与颈源性眩晕相关(r=0.275,r=0.255;均P＜0.05),左侧椎动脉延长值与年龄呈正相关(r=0.216,P=0.027),颈段直线距离与年龄呈负相关(r=-0.219,P=0.025).结论 椎动脉扭曲源于其颈段缩短,与颈源性眩晕发作有关.     

Recent advances in magnetic resonance angiography of carotid and vertebral arteries

New magnetic resonance angiographic sequences using gadolinium infusion allow high-quality images of supra-aortic vessels. Raw data may be obtained in a short scan time of less than 30 s, with a large acquisition volume from the aortic arch to the circle of Willis. After computed reconstruction of the vascular tree, angiograms appear similar to those obtained with conventional catheter angiography. Parameters of the sequence must be carefully chosen, however, with trade-offs between spatial resolution, scan time, acquisition volume and contrast of image. New developments have been proposed to improve the image quality with different acquisition strategies. These recent advances will probably be useful to assess the carotid and the vertebral arteries with more accuracy. They will require high-performance gradient systems and sophisticated software that is not yet available on all machines, however.     

Magnetic resonance angiography of spontaneous vertebral artery dissection suspected on Doppler ultrasonography

Spontaneous vertebral artery dissection (VAD) is a rare but well-known cause of cerebrovascular disease and is often difficult to diagnose even using conventional arteriography. While noninvasive tests such as Doppler ultrasonography and magnetic resonance imaging (MRI) have failed to provide reliable criteria for the diagnosis of VAD, the diagnostic value of magnetic resonance angiography (MRA) has not yet been undetermined. To establish the reliability of a combined noninvasive approach, 11 patients were prospectively examined for VAD by means of colour-coded duplex studies, MRI and three-dimensional time-of-flight MRA prior to conventional angiography. Among 11 patients with VAD suspected clinically as well as on Doppler ultrasonography, angiography confirmed the diagnosis in seven patients but found a vertebral artery occlusion in three and a vertebral artery stenosis in one. The combination of MRI and MRA findings led to the correct diagnosis of dissection in three patients, of vertebral artery occlusion in three patients, and of vertebral artery stenosis in one. VAD was misinterpreted as vertebral artery occlusion in four patients. Doppler ultrasonography is a valuable screening method for the detection of vertebral artery pathologies. The diagnosis of VAD can only be established if a typical intramural vessel wall haematoma is seen on T1-weighted MRI in combination with MRA findings of irregular artery stenosis or occlusion.     

Origin of isolated vertigo in rotational vertebral artery syndrome

Rotational vertebral artery syndrome (RVAS) is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, and ataxia induced by head rotation. Although recent report has described the RVAS as an important but unrecognized cause of isolated vascular vertigo, the locus of injury site responsible for isolated vertigo in RVAS is still unclear. We report here two patients with RVAS who had a stereotypic clinical presentation characterized by recurrent attacks of isolated vertigo induced by head rotation. The pattern of nystagmus observed in our patients with RVAS can be best explained by the stimulation of the vestibular labyrinth bilaterally or unilaterally. In RVAS, the isolated vertigo may occur due to transient ischemia of the superior vestibular labyrinth. RAVS should be considered in the differential diagnosis of positional vertigo, especially when vertigo is developed while sitting or standing position.     

Vertebral artery dissections: follow-up with magnetic resonance angiography and injection of gadolinium

Vertebral artery dissection is a frequent cause of ischemic stroke in young adults but time course of VA dissections remains poorly documented. Angiography was considered as the gold standard for the diagnosis. Recently, non-invasive methods have been developed such as helical CT and magnetic resonance angiography. The purpose of the study was to assess the reliability of a gadolinium-enhanced fast three dimensional (3D) magnetic resonance (MR) angiographic sequence to image vertebral arteries and to assess the long-term follow-up of vertebral artery (VA) dissections. Sixteen consecutive patients with 18 angiographically documented VA dissections were followed-up by gadolinium-enhanced 3D MR angiography and cervical T1-weighted MR imaging at a median delay of 22 months. Ten patients had MR imaging scan at the acute stage as well and nine had early follow-up angiography at a median delay of 3 months. MR angiography was evaluated in a consensus manner including image quality, presence of residual stenosis, luminal irregularities and occlusion. All patients clinically improved. Ten of 11 stenotic dissections returned to normality whereas one stenotic dissection progressed to occlusion. Two pseudoaneurysms detected on the initial angiography resolved spontaneously, one appeared only on a delayed MR angiographic scan and one was detected on early MR angiograms and finally resolved on a late one. Of the seven initially occluded VAs, five reopened with a hairline residual lumen in three. Contrast MR angiography is an interesting tool to assess the late course of VA dissections. Most lesions resolved spontaneously but persisting occlusion or pseudoaneurysm may be found in long term follow-up.     

Posterior cerebral artery dissection on a serial magnetic resonance angiography

Posterior cerebral artery (PCA) dissection in children seldom is reported in the literature. This is the second report of acute PCA dissection with infarct occurring in a young child. A serial magnetic resonance angiography demonstrated a delayed and transient narrowing of the arterial caliber, which was consistent with a focal PCA dissection with delayed vascular recanalization. PCA dissection should be included in the causes of infarct in children and a thorough and serial neurovascular imaging should be considered if no cause of stroke is found.