椎基底动脉供血不足性眩晕与血管结构异常

背景：近年来国外有研究报道称血管结构异常是椎基底动脉供血不足眩晕发病的主要形态学基础。但国内极少有关于椎基底动脉供血不足的血管结构异常的报道。目的：观察椎基底动脉供血不足性眩晕患者血管结构异常的数字减影血管造影表现及临床意义。设计：病例分析。单位：南京医科大学附属无锡第二医院（无锡市第二人民医院）神经内科及南华大学附属怀化医院神经内科。对象：2003—08／2004—05在南华大学附属怀化医院神经内科就诊及2004—10／2005—05在南京医科大学附属无锡第二医院（无锡市第二人民医院）神经内科就诊、以发作性眩晕，恶心或呕吐症状的门诊及住院患者57例。方法：对两年来收治的57例椎基底动脉供血不足性眩晕患者行数字减影主动脉弓及全脑血管造影：采用股动脉穿刺逆行血管造影法，以预灌装针筒形式供应的Optiray（安射力）非离子型造影剂行主动脉弓造影。数字减影机从多角度显示双侧颈动脉、椎动脉，范围包括颈总动脉起始至颈内动脉虹吸弯，由2位神经科医生分别进行测量和评价。主要观察指标：主动脉弓、颈内动脉及椎基底动脉系统血管结构异常的类型、分布及比例。结果：参加实验57例患者。1例患者因左椎动脉不能进入而放弃。1例在行主动脉弓造影时并发大面积脑梗死手术中止。进入结果分析55例。经检查发现共有71％（39／55）患者存在颈及颅内血管结构异常。单纯前循环病变占11％（6／55）；后循环病变占60％（33／55），其中合并有前循环异常的复合病变9例（16％），累及两条或两条以上血管的共24例（24／55，44％），以椎动脉合并其他血管狭窄最为常见；其余16例（16／55，29％）造影未见血管结构异常。结论：各种类型的血管结构异常是椎基底动脉供血不足性眩晕的主要病因，诊断椎基底动脉供血不足眩晕的金标准应为数字减影血管造影。     

数字减影血管造影评估椎基底动脉供血不足性眩晕患者的血管结构

目的：应用数字减影主动脉弓及全脑血管造影方法观察椎基底动脉供血不足性眩晕患的血管结构异常类型、好发部位，探讨其对血管病变的评估价值。方法：选择2003-01／2004-12在解放军第三军医大学第一附属医院神经内科临床拟诊为椎基底动脉供血不足性眩晕的住院患86例，全部进行数字减影主动脉弓及全脑血管造影检查，分析血管结构异常的类型、好发部位以及受累血管数目。结果：按意向处理分析，86例患全部进入结果分析。①49例患存在颈及颅内血管结构异常：单纯前循环病变10例；后循环病变39例，累及两条或两条以上血管的共20例，以椎动脉合并其他血管狭窄最为常见；其余37例造影未见血管结构异常。②不同血管受累分布情况：颈内动脉受累21例，锁骨下动脉6例，椎动脉31例，基底动脉1例，大脑后动脉4例。结论：各种类型的血管形态异常是导致椎基底动脉供血不足患前庭功能障碍的主要原因，以椎动脉合并其他血管狭窄的复合病变发生率最高，单纯颈内动脉狭窄也比较常见。     

数字减影血管造影评估椎基底动脉供血不足性眩晕患者的血管结构

目的:应用数字减影主动脉弓及全脑血管造影方法观察椎基底动脉供血不足性眩晕患者的血管结构异常类型、好发部位,探讨其对血管病变的评估价值。方法:选择2003-01/2004-12在解放军第三军医大学第一附属医院神经内科临床拟诊为椎基底动脉供血不足性眩晕的住院患者86例,全部进行数字减影主动脉弓及全脑血管造影检查,分析血管结构异常的类型、好发部位以及受累血管数目。结果:按意向处理分析,86例患者全部进入结果分析。①49例患者存在颈及颅内血管结构异常:单纯前循环病变10例;后循环病变39例,累及两条或两条以上血管的共20例,以椎动脉合并其他血管狭窄最为常见;其余37例造影未见血管结构异常。②不同血管受累分布情况:颈内动脉受累21例,锁骨下动脉6例,椎动脉31例,基底动脉1例,大脑后动脉4例。结论:各种类型的血管形态异常是导致椎基底动脉供血不足患者前庭功能障碍的主要原因,以椎动脉合并其他血管狭窄的复合病变发生率最高,单纯颈内动脉狭窄也比较常见。     

非创伤性椎基底动脉供血不足的DSA分类及其临床意义

[目的]探讨椎基底动脉供血不足(VBI)的数字减影血管成像(DSA)分类及其临床意义.[方法]对102例经DSA检查与临床表现诊断为VBI的患者的临床资料进行分析,了解DSA的情况并对本组病例分类及进行相关的治疗选择,通过临床效果的分析评价分类方法的意义.[结果]本组102例VBI根据DSA分为四型:Ⅰ,椎动脉局部受压...     

椎基底动脉供血不足性眩晕TCD和DSA的对比分析

目的探讨经颅多普勒超声（Transcranial Doppler TCD）与数字减影血管造影（digital sub-straction angiography DSA）在椎基底动脉供血不足（vertebrobasilar Insufficiency VBI）性眩晕中的应用价值,从而对眩晕的血管原因进行分析。方法共33例患者,男23例,女10例,年龄29—75岁,平均（56．2±6．7）岁,符合椎基底动脉供血不足诊断标准,所有患者于1周内行TCD和DSA检查。结果33例患者中TCD显示椎基底动脉系统异常29例（87．88％）,DSA显示椎基底动脉异常12例（36．7％）,颈内动脉系统异常14例（42．4％）,无血管异常7例（21．2％）。结论椎基底动脉供血不足的原因可能是椎基底动脉系统病变,也可能是前循环缺血的表现或功能性因素,TCD对椎基底动脉供血不足具有重要诊断意义,DSA是诊断椎基底动脉供血不足的金标准。     

椎基底动脉供血不足患者的血管异常分析

背景:椎基底动脉供血不足的血管结构异常有助于对病因的认知和理解,对血管结构异常的分型可以使诊断规范化、系统化。目的:探讨椎基底动脉供血不足患者血管异常的影像学特点、分型及临床意义。设计:以诊断为依据的非对照研究。地点和对象:1999-01/2002-12青岛市市立医院门诊及病房椎基底动脉缺血患者33例,男23例,女10例。干预:椎基底动脉供血不足患者进行数字减影血管造影(DSA)或磁共振血管造影(MRA)检查,对发现的33例血管异常者进行系统分析,并将其尝试性地进行分型。主要观察指标:椎基底动脉系统血管结构异常分型。结果:将椎基底动脉结构异常分为锁骨下动脉型、椎动脉型、基底动脉型和大脑后动脉型4个类型,每型又分为2～5个亚型。椎动脉型是椎基底动脉供血不足患者血管结构异常的主要类型,占61%,其次为基底动脉型、锁骨下动脉型和大脑后动脉型。结论:椎动脉血管结构异常是最常见的导致椎基底动脉缺血的血管性病因。血管结构异常因其成因、年龄等因素影响表现出不同的病变类型。     

纳洛酮治疗椎基底动脉供血不足性眩晕临床疗效观察

纳洛酮为阿片受体拮抗剂 ,近年来广泛应用于治疗缺血性脑血管病 ,但对于椎基底动脉供血不足 (Ｖｅｒｔｅｂｒｏ ｂａｓｉｃａｒｔｅｒｉａｌｉｓｃｈｅｍｉａ,ＶＢＩ)的疗效目前少见报道。本文收集了我院收治的 6 0例椎基底动脉供血不足患者 ,应用纳洛酮治疗。现报告如下。1　临床资料1.1　病例选择　从我院 1999年 5月至 2 0 0 1年 3月神经内科住院患者中随机选择 6 0例 ,所有病例均以眩晕为初始症状及主要症状符合 1989年ＷＨＯ对短暂性ＶＢＩ制定的诊断标准[1] ,全部患者行头颅ＣＴ检查排除脑干、小脑、枕叶出血或梗死 ,。并排除心、肝、…     

椎-基底动脉供血不足性眩晕与颈椎不稳

目的:探讨椎-基底动脉供血不足(VBI)眩晕与颈椎不稳之间的关系方法:对2000/2002门诊和住院的84例VBI患者和30例健康志愿进行颈椎X线检查,在过伸过屈位X片上测量椎体间角度位移和水位移,在自然侧位X片上记录颈椎曲线。结果:VBI组有68例(81%)共74个节段有颈椎不稳,其中C5～619C3～416例,C2～3,C6～7各1例;正常对照组有4例(13%)共4个节段颈椎不稳,其中C4～52例,C3～4,C5～6各1例。两组颈椎不稳例数比较检验差异存在非常显著性意义(χ2=43.44,P<0.01)。VBI组颈椎线异常39例(46%),正常对照组颈椎曲线异常4例(13%),两组比χ2检验差异有非常显著性意义(χ2=10.31,P<0.01)。结论:VBI眩晕与颈椎不稳密切相关,颈椎不稳很可能是导致临床眩晕反复发作的原因之一。     

椎基底动脉供血不足性眩晕BAEP检查结果分析

椎基底动脉供血不足 (VBI)性眩晕在临床上十分常见 ,且多发于中老年人 ,所表现的临床征象常在短时间内消失。患者主观症状多 ,而客观依据少 ,且常在间歇期就诊 ,所以给临床诊断带来一定的困难。较多研究认为脑干听觉诱发电位 (BAEP)对VBI的诊断有一定的参考价值 [1,2 ] 。我室于 1 999年1 0月 - 2 0 0 0年 1 0月对 62例临床诊断的 VBI患者进行 BAEP检查 ,并对结果进行了分析。1　资料与方法1 .1　一般资料　VBI患者 62例 ,男 2 4例 ,女 38例 ;年龄 2 2 - 70岁 ,平均 43岁 ;病程 7d- 2 0年。临床诊断标准 [3 ] :1眩晕为旋转感或表现…     

葛根素治疗椎-基底动脉供血不足性眩晕

目的探讨葛根素治疗椎-基底动脉供血不足的临床疗效。方法将80例患者随机分为治疗组和对照组,分别采用葛根素注射液和复方丹参注射液进行治疗,均以1周为1个疗程。观察其疗效及经颅多普勒超声（TCD）变化。结果治疗组总有效率97.6%,对照组总有效率84.2%,治疗组疗效明显优于对照组（P〈0.05）,两组椎-基底动脉血流速度比较有统计学意义（P〈0.01）。结论葛根素是治疗椎-基底动脉供血不足有效的药物。     

Transcranial sonography and vertebrobasilar insufficiency

OBJECTIVE: The objective was to discuss a case illustrating the role of transcranial Doppler sonography in the screening and treatment of a patient with intermittent vertebral artery brainstem ischemia. CLINICAL FEATURES: A 28-year-old woman had neck pain, arm pain, headaches, and dizziness. Her symptoms occurred intermittently over several years. Past care had provided little relief. De Kleyn's test, transcranial Doppler sonography, and magnetic resonance imaging/magnetic resonance angiography helped establish a diagnosis of vertebrobasilar syndrome. INTERVENTION AND OUTCOME: The patient was referred for neurosurgical evaluation. She subsequently chose to be treated with spinal manipulative therapy. Her neck pain, headaches, and radicular symptoms resolved. The dizzy spells abated to a tolerable level. The neurosurgeon subsequently re-evaluated the patient and recommended that surgery not be performed. CONCLUSIONS: This illustrates a case of extra-arterial mechanical compression of the vertebral arteries documented by transcranial Doppler sonography procedures. Brainstem symptoms were correlated with a documented perfusion deficit during cervical positional testing. This case also demonstrated that spinal manipulative therapy may be safely used on patients with vertebrobasilar insufficiency when the biomechanics and related flow studies are elucidated.     

Noninvasive evaluation of vertebrobasilar insufficiency

The diagnosis of vertebrobasilar insufficiency (VBI) is a clinical challenge because its manifestations are subjective and difficult to quantify. We evaluate 61 patients with the clinical diagnosis of VBI and 30 control patients with other medical problems. We used duplex scanning to study the extracranial carotid, vertebral, and subclavian arteries, and a 2-MHz transcranial Doppler (TCD) to examine the intracranial vertebral and basilar arteries. Extracranial lesions were more common in VBI patients than among controls, including stenosis of the subclavian artery with and without subclavian-vertebral steal and stenosis of the vertebral artery. Intracranial abnormalities identified in the vertebrobasilar circulation included stenosis and occlusion of the intracranial vertebral artery and basilar artery steal. Overall, significant lesions were detected in 32.8% of VBI patients and 3.0% of controls (P less than 0.05). Systolic artery velocity (cm/sec) in the extracranial vertebral artery was higher in controls (65.9 +/- 23.3) than in VBI patients who had no evidence of vertebrobasilar steal (43.0 +/- 17.4, P less than 0.05). Patients with a steal mechanism had an intracranial vertebral artery systolic velocity of 90.0 +/- 38.9, compared with 53.0 +/- 15.0 in controls (2P less than 0.050). Intracranial vertebral artery systolic velocity was higher among VBI patients with significant carotid artery disease (greater than 50%, 76.7 +/- 28.8) than in those with less severe disease (less than 50%, 47.3 +/- 13.8, P less than 0.05). Evaluation and quantitation of the vertebrobasilar circulation using both intra- and extracranial noninvasive studies may afford further insight as to the pathophysiology of vertebrobasilar insufficiency and provide a readily available, direct, and simple method of initial and serial assessment of VBI patients.     

Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke

Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. Isolated vertigo can be the only initial symptom of a posterior circulation stroke. The sensation of imbalance especially raises this possibility. Research involving strokes of the posterior circulation has lagged behind that of the anterior cerebral circulation. Investigations of the last 20 years, using new technologies in brain imaging in combination with detailed clinical studies, have revolutionized our understanding of the clinical presentation, causes, treatments, and prognosis of posterior circulation ischemia.     

椎-基底动脉供血不足患者椎动脉颅外段及颅内段超声对比观察

目的探讨椎-基底动脉供血不足(VBI)患者椎动脉颅外段和颅内段检测结果的相关性.方法对210例VBI患者,采用CDFI和TCCD检查,并对两种检查结果作对比分析.结果 CDFI诊断VBI的敏感性为80.95%,TCCD为89.05%,二者结合的敏感性为92.86%.两种检查结果一致者为77.14%(162例);结果不一致者48例,占22.86%.结论多数VBI患者椎动脉颅外段和颅内段的检测结果明显相关,但也存在部分患者两种结果不一致,采用CDFI与TCCD联合检测可提高超声对VBI诊断的准确率.     

椎基底动脉供血不足患者的血小板变化

目的：对椎基底动脉供血不足患者血小板的数量、平均血小板体积、血小板压积、血小板宽度进行分析，探讨椎基底动脉供血不足患者血液参数改变及其意义。 方法：选择2001-01／2004-03中南大学湘雅医院和白云区中医院收治住院患者127例，其中椎基底动脉供血不足组45例，男25例．女20例，年龄33-82岁；脑梗死组42例，男22例，女20例，年龄33～87岁；脑出血组40例，男20例。女20例，年龄32-81岁，以上患者发病均在3d内。健康对照组30例，男16例，女14例。年龄30-80岁。对椎基底动脉供血不足患者血小板的血小板体积、血小板压积、血小板宽度值进行统计分析。 结果：157例被测试者均进入结果分析。①椎基底动脉供血不足组、脑梗死组、脑出血与对照组相比，血小板的数量下降、平均血小板体积增大，统计学上差异均有显著性俨〈0．01）。②脑梗死、脑出血组间血小板的数量、平均血小板体积统计学上差异无显著性俨〉0．05），但椎基底动脉供血不足组较脑梗死、脑出血组有统计学上差异[血小板数量：（151．12&;#177;70．85）&;#215;10^9,（210．07&;#177;70．45）&;#215;10^9（201．53&;#177;96．76）&;#215;10^9 P〈0．01；平均血小板体积：（13．07&;#177;1．82）fl，（9．40&;#177;1．76）fl，（9．51&;#177;1．35）fl，P〈0．01]。③椎基底动脉供血不足组与脑梗死、脑出血组相比，血红蛋白、红细胞数、血小板压积、血小板宽度统计学上差异均无显著性（P〉0．05）。④椎基底动脉供血不足、脑梗死与脑出血“血小板团块”比较，差别无显著性（P〉0．05）。 结论：心脑血管供血发生改变的疾病发病后早期均可出现平均血小板体积增大、血小板的数量下降现象，血小板自身外的某种因素，可能参与了平均血小板体积的增加与血小板的下降。     

The significance of concurrent vertebrobasilar insufficiency in postanesthesia recovery

A study of 149 patients was carried out, who had cervical osteochondrosis, by using the stage-based narcosis and general intravenous anesthesia. The parameters of the peripheral velocity of the bloodstream in the direct brain venous sine were examined by transcranial dopplerography. Preoperatively, the patients were shared between 3 groups with due respect to clinical and neurological symptoms as well as to X-ray-registered changes in the cervical spine. While evaluating the intracranial pressure, the cerebral hemodynamics was examined by ophthalmodynamometry procedures (diastolic pressure in the retinal central vein). The anatomotopographic peculiarities of the cervical spine, and in particular, of the spinal artery, vein and sympathetic nerve passage, as observed in the lateral vertebral processes in cases of spine osteochondrosis, aggravate the strangulation and blood circulation disturbances in the basilar and vertebral regions with respect to changes of the head position. Trachea incubation (head extended with anesthetic management), made in patients with the pronounced cervical osteochondrosis (group III), slowed down the peripheral blood flow into the direct brain venous sine; it also caused a higher intracranial pressure versus the parameters observed in the basilar and vertebral deficiency, as well as hemodynamics instability resulting in a late awakening after anesthetic management.     

椎基底动脉供血不足患者的血小板变化

目的:对椎基底动脉供血不足患者血小板的数量、平均血小板体积、血小板压积、血小板宽度进行分析,探讨椎基底动脉供血不足患者血液参数改变及其意义。方法:选择2001-01/2004-03中南大学湘雅医院和白云区中医院收治住院患者127例,其中椎基底动脉供血不足组45例,男25例,女20例,年龄33～82岁;脑梗死组42例,男22例,女20例,年龄33～87岁;脑出血组40例,男20例,女20例,年龄32～81岁,以上患者发病均在3d内。健康对照组30例,男16例,女14例,年龄30～80岁。对椎基底动脉供血不足患者血小板的血小板体积、血小板压积、血小板宽度值进行统计分析。结果:157例被测试者均进入结果分析。①椎基底动脉供血不足组、脑梗死组、脑出血与对照组相比,血小板的数量下降、平均血小板体积增大,统计学上差异均有显著性(P<0.01)。②脑梗死、脑出血组间血小板的数量、平均血小板体积统计学上差异无显著性(P>0.05),但椎基底动脉供血不足组较脑梗死、脑出血组有统计学上差异[血小板数量:(151.12±70.85)×109,(210.07±70.45)×109,(201.53±96.76)×109,P<0.01;平均血小板体积:(13.07±1.82)fl,(9.40±1.76)fl,(9.51±1.35)fl,P<0.01]。③椎基底动脉供血不足组与脑梗死、脑出血组相比,血红蛋白、红细胞数、血小板压积、血小板宽度统计学上差异均无显著性(P>0.05)。④椎基底动脉供血不足、脑梗死与脑出血“血小板团块”比较,差别无显著性(P>0.05)。结论:心脑血管供血发生改变的疾病发病后早期均可出现平均血小板体积增大、血小板的数量下降现象,血小板自身外的某种因素,可能参与了平均血小板体积的增加与血小板的下降。