无先兆型偏头痛患者间隙期脑血流检测

采用经颅多普勒超声（ＴＣＤ），脑血管血液动力学分析仪（ＣＢＡ）和磁共振成像（ＭＲＩ）等多种先进检查手段对无先兆型偏头痛患者头前间歇期进行检测。４０例患者进行了ＴＣＡ检查，结果示患者双组侧大脑中动脉平均血流速度增高，有９例患者颅内动脉平均流速不对称。４４例患者的ＣＢＡ检查显示，患者组脑血管外周阻力ＲＶ，动态阻力ＤＲ和临界压力ＣＰ增高。这些结果提示患者间歇期颅内血管紧张性增高，血流状态仍呈现不稳定性，     

典型和普通型偏头痛患者间歇期脑血管机能状态的经颅多普勒…

我们采用经颅多普勒超声（ＴＣＤ）技术。对２５０例典型和普通型偏头痛患者头痛间歇期的超声表现进行对照研究。结果示：典型和普通型偏头痛的ＴＣＤ改变无显著性差异，提示两种类型偏头痛于头痛间歇期血管机能的改变相同；偏头痛患者的颅内动脉的平均血流速度（ＭＦＶ）均明显高于正常对照组。反映出头痛间歇期患者的颅内动脉处于广泛的收缩状态。     

经颅多普勒超声与磁共振血管造影的比较研究

目的 本研究利用经颅多普勒超声（ＴＣＤ）仪及磁共振血管造影（ＭＲＡ）技术,无创伤性地探查颅内大动脉的管腔情况及血流动力学情况,了解ＴＣＤ与ＭＲＡ探查脑血管狭窄性病变的可能性及相关性,探讨ＴＣＤ在临床上的应用价值,以便能利用ＴＣＤ仪观察脑血管疾病演变过程中,脑血管本身的病变过程。方法 对门诊就诊及住院的９１例患者,同时行ＴＣＤ、ＭＲＡ及磁共振成像（ＭＲＩ）检查,分析ＴＣＤ、ＭＲＡ的结果及两者的相符性     

彩色多普勒能量图在烟雾病诊断中的价值

目的　探讨彩色多普勒能量图（ＣＤＥ） 对烟雾病的诊断价值。方法　对１７例经ＤＳＡ确诊的烟雾病患者及２５例健康对照者大脑前、中、后动脉（ＡＣＡ、ＭＣＡ、ＰＣＡ）、颈总、颈内、颈外动脉（ＣＣＡ、ＩＣＡ、ＥＣＡ）以及颞浅动脉（ＴＳＡ）的阻力指数（ＲＩ）、搏动指数（ＰＩ）及平均血流速度（Ｖｍ ）进行检测分析。结果　①ＣＤＥ对颅内血管狭窄及闭塞的正确诊断率为８７．２５％ ; ②烟雾病患者颅外血管ＣＣＡ、ＩＣＡ表现为流速下降, 阻力升高, 而ＴＳＡ恰恰相反; ③ＣＤＥ显示１０例患者颅底异常血管网, 即对５８．８２％ 的患者做出烟雾病诊断。结论　ＣＤＥ可将烟雾血管显示为星星点点的血流信号, 在烟雾病的诊断中具有较高的临床应用价值。     

彩色多普勒血流显像对Ⅱ型糖尿病患者肾内动脉血流的研究

应用彩色多普勒血流显像（ＣＤＦＩ）检查５９例Ⅱ型糖尿病（ＤＭ－Ⅱ）患者的肾内动脉血流动力学参数，并以４０名正常人为对照。结果提示：ＲＩ是反映肾内动脉血流阻力大小的客观指标之一。ＤＭ－Ⅱ组肾功能在正常范围者，已有部分病例ＲＩ增高，表明肾内动脉血流阻力异常较肾功能异常出现为早。     

腔隙性脑梗塞的TCD变化

目的　测定腔隙性脑梗塞颅内血管血流动力学的参数。方法　采用经颅多普勒超声（ＴＣＤ） 对５００ 例经ＣＴ 或ＭＲＩ确诊为腔隙性脑梗塞患者的颅内各主要动脉进行检测。结果　５００ 例腔隙性脑梗塞ＴＣＤ 表现：血速缓慢供血不足３２９ 例（６６ ％ ） ,血速异常增高９６ 例（１９ ％ ） ,血速正常７５ 例（１５ ％ ） 。结论　双侧多发腔隙性脑梗塞以双侧血速峰值对称性下降为主（６６ ％ ） ,Ｐ＜ ００５ ;单发腔隙性脑梗塞由于侧支循环的建立,血速峰值多正常（ Ｐ＞００５） ;腔隙性脑梗塞引起血速异常增高的病因多为高血压。ＴＣＤ 可做为腔隙性脑梗塞患者必要的检测手段之一。     

双功能经颅彩色多普勒超声对冠心病患者脑血流动力学的研究

本文应用双功能经颅彩色多普勒超声（ＴＣＣＤ）对３４例冠心病患者进行了脑血流动力学的检测，结果表明，冠心病患者频谱形态，第二峰高于第一峰２０例，第一峰高于第二峰６例。大脑中动脉（ＭＣＡ）血流速度低于正常对照组，搏动指数（ＰＩ）、阻力指数（ＲＩ）均增高Ｐ＜０．００１。椎动脉（ＶＡ）的ＰＩ升高Ｐ＜０．００１。而基底动脉（ＢＡ）Ｖｓ、Ｖｄ、Ｖｍ及ＰＩ、ＲＩ均有显著差异Ｐ＜０．０５和Ｐ＜０．００１。我们认为ＴＣＣＤ可以反映冠心病患者脑血流动力学变化及血管病变的程度，也可对冠心病患者并存脑动脉硬化的诊断具有一定临床应用价值     

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。     

胎儿脐动脉及大脑中动脉血流监测对胎儿预后的作用

目的 评价超声监测胎儿脐动脉及大脑中动脉血流对胎儿预后的作用。方法 应用彩色多普勒监测６９例中晚期正常妊娠及１６例宫内缺氧（窘迫）组及５例围产儿死亡组胎儿大脑中翅膀（ＭＡＣ）、脐动脉（ＵＡ）收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ）及阻力指数（ＲＩ）并与妊娠结局相对照。结果 正常妊娠时随孕周增加ＵＡ、ＭＣＡ的Ｓ／Ｄ及ＲＩ值逐渐下降;异常组ＵＡ的Ｓ／Ｄ、ＲＩ值均明显高于正常组,     

高血压无症状性脑血管病的经颅多普勒与B型超声的对比分析

应用经颅多普勒（ＴＣＤ）对６２例高血压病人的颅底血管进行检测，并与颅外颈动脉的Ｂ型超声检查结果进行对比。结果：老年和中年高血压组ＴＣＤ检测ＭＣＡ峰值速度增高，符合颅内血管狭窄诊断标准各为２４例和１１例，占６０％和５２％。颅外颈动脉的Ｂ型超声检查发现老年组颈内动脉狭窄５例（占１２％），中年组未见颈动脉狭窄，显示颅内血管狭窄明显高于颅外血管。结论：ＴＣＤ和颈动脉Ｂ超的双重检测显示我国高血压病人颅内血管     

典型和普通型偏头痛患者间歇期脑血管机能状态的经颅多普勒超声对照研究

我们采用经颅多普勒超声（TCD）技术。对250例典型和普通型偏头痛患者头痛间歇期的超声表现进行对照研究。结果示：典型和普通型偏头痛的TCD改变无显著性差异，提示两种类型偏头痛于头痛间歇期血管机能的改变相同；偏头痛患者的颅内动脉的平均血流速度（MFV）均明显高于正常对照组。反映出头痛间歇期患者的颅内动脉处于广泛的收缩状态。     

Transcranial Doppler evaluation of common and classic migraine. Part I. Ultrasonic features during the headache-free period

To study vascular abnormalities in migraine, transcranial Doppler (TCD) was used for evaluation of 100 consecutive patients with either common or classic migraine during the headache-free period. We insonated the basal cerebral arteries and the internal carotid artery (ICA) in the neck. Particular ultrasonic features in migraineurs included intracranial elevations of mean flow velocity (MFV) above 3 standard deviations of normal values in 16%, probably reflecting increased vasotonus. Marked asymmetry of MFV in corresponding intracranial arteries was found in 12%, and could represent "asymmetrical" vascular tone. Characteristic vascular bruits of low frequency and sometimes harmonic quality were detected in 56%. When compared to TCD findings in 40 young controls, MFV were significantly higher in all intracranial arteries in migraineurs, but not in the cervical ICA. Marked differences were also found for incidence of MFV elevations and vascular bruits (p less than 0.0001). Vascular reactivity in response to eye closing as measured by flow changes in the posterior cerebral artery (visually evoked flow) was significantly greater in migraineurs than in controls (%MFV change, 14.1 +/- 5.4 vs 11.4 +/- 4.8; p = 0.004). TCD features did not discriminate common from classic migraine. Taken together, our results support the view of intracranial vascular abnormality in migraineurs reflecting, in particular, a narrower and more reactive arterial tree. The value of TCD in the differential diagnosis of "vascular headache" and in the study of migraine pathophysiology will have to be determined in the future.     

典型偏头痛和普通型偏头痛TCD检查对照研究

对２０例典型偏头痛和４０例普通型偏头痛的ＴＣＤ进行对照研究，发现典型偏头痛发作期ＭＣＡ和ＰＣＡ在头痛侧平均血流速度明显加快，存在血管痉挛，普通型偏头痛发作期头痛侧与无症状侧平均血流速度无显著差异，提示典型与普通型偏头痛的发病机理可能存在本质区别，前者多数由血管因素所致。     

Transcranial Doppler evaluation of common and classic migraine. Part II. Ultrasonic features during attacks

Transcranial Doppler (TCD) examinations were performed in 13 patients with common and 5 patients with classic migraine during attacks and compared to TCD findings during the headache-free period. Two distinct patterns of flow changes were detected to distinguish common from classic migraine on the basis of TCD findings. During attacks, patients with common migraine exhibited reduction of flow velocities associated with an increase of pulse wave amplitudes. Vascular bruits that were heard during the headache-free interval often disappeared. Opposite changes were found in attacks of classic migraine during the headache phase with increase of flow velocities, decrease of pulsatility and more prominent or newly appearing bruits. These findings were often diffuse and did not appear to correlate with side of headache or side of neurological aura. Uniform changes occurred in the cervical internal carotid artery and the basal cerebral arteries in either form of migraine. We propose that these changes represent caliber fluctuations of the large arteries, suggesting vasodilatation during attacks of common migraine and vasoconstriction during attacks of classic migraine. We do not intend to imply a casual role of these preliminary findings in migraine pathogenesis, but we suggest that TCD be used in combination with other methods to study vascular changes in migrainous disorders.     

Hemodynamic findings in migraine patients on transcranial Doppler sonography.

Forty migraine patients were examined by means of 3D-transcranial Doppler scanning (TCD). The complete circle of Willis was investigated in all patients during headache-free intervals. TCD investigations were repeated in 10 patients during a migraine attack, in one patient twice. Based on the diagnostic criteria of the "headache classification committee of the international headache society" 23 patients were assigned to a "migraine without aura" group and 17 to a "migraine with aura" group. Twenty age-matched volunteers, not suffering from headache or any vascular disease, served as a control group. No significant differences were detected between the hemodynamic data of the control group and the migraine groups both with respect to the headache-free interval and the attack. No hemodynamic changes in keeping with the pathophysiologic hypothesis of vasospasm were found in the proximal segments of the basal cerebral arteries.     

Blood flow velocity and pulsatility index differences in patients with unilateral migraine

OBJECTIVE: To evaluate blood flow velocity and pulsatility in unilateral migraine without aura during the headache-free period using transcranial Doppler (TCD) sonography. METHODS: Patients with unilateral headache were recruited during the headache-free period. Maximum mean flow velocity (MFV) and pulsatility index (PI) were measured in the middle cerebral (MCA) and basilar arteries. Controls were headache-free individuals without cerebrovascular disease. RESULTS: Twenty-five patients with right-sided migraine, 25 patients with left-sided migraine, and 19 controls were studied. The MCA PI was higher on the right headache side versus the left headache side (0.97 +/- 0.2 versus 0.86 +/- 0.1 cm/s, P =.02) and versus controls (0.9 +/- 0.2 cm/s, NS). The basilar artery MFV was higher in patients with right-sided headache versus left-sided headache (39.5 +/- 5.6 versus 34.7 +/- 8.2 cm/s, P =.02) and versus controls (38.2 +/- 8 cm/s, NS). No decrease in MFV with age was observed in patients with migraine. CONCLUSIONS: Middle cerebral artery flow pulsatility and basilar artery velocity are higher in patients with right-sided migraine compared with left-sided migraineurs, during the headache-free period. Although these parameters were similar to controls, the differences found during the headache-free period in migraineurs may indicate vascular involvement predisposing to the unilateral headache recurrence.     

Transcranial Doppler Monitoring of a Migraine with Aura Attack From the Prodromal Phase to the End

SYNOPSIS
Transcranial Doppler sonography (TCD) was performed in a case of migraine with aura during the different phases of the attack. In the prodromic period our patient showed a slight central deficit of the seventh right cranial nerve and hypesthesia in her right arm. TCD indicated a remarkable decrease of the mean flow velocity (MFV) of the left middle cerebral artery (MCA). During the headache phase and when the signs and symptoms subsided, TCD showed an increase in MFV of both middle cerebral arteries with normal symmetry. An electroencephalogram (EEG) demonstrated a left temporal disorder. A month later a cranial CT scan, an EEG, and TCD were normal. In our opinion all these findings suggest a focal reduction in cerebral blood flow in the prodromic phase.     

Blood flow velocity changes in migraine attacks-a transcranial Doppler study

A pulsed Doppler device was used to measure blood flow velocities in the common carotid artery, the extracranial part of the internal carotid artery, the external carotid artery, the middle cerebral artery, and the anterior cerebral artery in 31 migraineurs without aura (n = 27) and with aura (n = 4), both during and outside an attack. The aims were to compare blood flow velocity during and between migraine attacks and to study asymmetries of the blood flow velocity. Compared with blood flow velocity values obtained in the attack-free interval, blood flow velocity was lower during attacks without aura in both common carotid arteries, but not in the other extra- and intracranial vessels which were examined. However, during attacks of migraine with aura, blood flow velocity tended to be lower in all examined vessels. There were no asymmetries of the blood flow velocity. We suggest that during migraine attacks without aura there is a dissociation in blood flow regulation in the common carotid and middle cerebral arteries.     

Involvement of calcitonin gene-related peptide in migraine: regional cerebral blood flow and blood flow velocity in migraine patients

Calcitonin gene-related peptide (CGRP)-containing nerves are closely associated with cranial blood vessels. CGRP is the most potent vasodilator known in isolated cerebral blood vessels. CGRP can induce migraine attacks, and two selective CGRP receptor antagonists are effective in the treatment of migraine attacks. It is therefore important to investigate its mechanism of action in patients with migraine. We here investigate the effects of intravenous human alpha-CGRP (halphaCGRP) on intracranial hemodynamics. In a double-blind, cross-over study, the effect of intravenous infusion of halphaCGRP (2 mug/min) or placebo for 20 min was studied in 12 patients with migraine without aura outside attacks. Xenon-133 inhalation SPECT-determined regional cerebral blood flow (rCBF) and transcranial Doppler (TCD)-determined blood velocity (V (mean)) in the middle cerebral artery (MCA), as well as the heart rate and blood pressure, were the outcome parameters. No change of rCBF was observed at the end of infusion [1.2% +/- 1.7 with halphaCGRP, vs. -1.6% +/- 3.1 with placebo (mean +/- SD)] (P = 0.43). V (mean) in MCA decreased to 13.5% +/- 3.6 with halphaCGRP versus 0.6% +/- 1.8 with placebo (P < 0.005). Since rCBF was unchanged, this indicates a dilation of the MCA. halphaCGRP induced a decrease in MAP (12%) (P < 0.005) and an increase in heart rate (58%) (P < 0.0001). CGRP dilates cerebral arteries, but the effect is so small that it is unlikely to be the only mechanism of CGRP-induced migraine.     

Basilar and middle cerebral artery reactivity in patients with migraine

BACKGROUND: Migraine has been reported as a possible risk factor for ischemic stroke. The mechanisms underlying this association are unknown. OBJECTIVES: To evaluate cerebrovascular reactivity to hypercapnia in the anterior and posterior circulation of patients with migraine, as reduced cerebrovascular reactivity is associated with a predisposition to stroke in various clinical conditions. METHODS: Using transcranial Doppler ultrasonography, changes in flow velocity during apnea were measured in both middle cerebral arteries and in the basilar artery of 15 control subjects and 30 patients with migraine (15 with aura and 15 without aura) during an attack-free period. Cerebrovascular reactivity was evaluated using the breath-holding index, which is calculated by dividing the percent increase in mean flow velocity recorded during a breath-holding episode by its duration (in seconds) after a normal inspiration. RESULTS: Vascular reactivity in the middle cerebral arteries was similar in patients and controls and significantly lower in the basilar artery of patients with migraine with aura compared with the other 2 groups (P <.0001). CONCLUSIONS: These findings show that in patients with migraine with aura, there is an impairment in the adaptive cerebral hemodynamic mechanisms in the posterior circulation. This fact could have pathogenetic implications since the association between migraine and stroke frequently regards patients with migraine with aura, and cerebral infarcts occur more commonly in the vertebrobasilar district.