溶血磷脂酸在后循环缺血所致眩晕诊断和治疗中的价值

目的探讨溶血磷脂酸（LPA）在后循环缺血所致眩晕诊断和治疗中的价值。方法对103例后循环缺血眩晕患者，128例其他病因眩晕患者，50例健康对照人群血浆LPA测定。后循环缺血眩晕患者分为脑梗死组、短暂脑缺血发作组（TIA组）。脑梗死组随机分为脑梗死试验组、脑梗死对照组。脑梗死试验组加用氯吡格雷0．75gqd。结果脑梗死组、TIA组发病3d内血浆LPA水平明显高于其他病因眩晕组及健康对照组，差异有非常显著意义（P〈0．01）。脑梗死2组发病4周时血浆LPA水平与健康对照组比较均无显著意义（P〉0．05），但发病2周时脑梗死试验组LPA水平较脑梗死对照组下降更明显，差异有非常显著意义（P〈0．01）。结论血浆LPA水平是后循环缺血所致眩晕敏感指标，可作为眩晕患者病因筛查常规检查项目，并为临床应用抗血小板聚集治疗和疗效判断提供客观依据。     

溶血磷脂酸在后循环缺血所致眩晕诊断和治疗中的价值

目的探讨溶血磷脂酸(LPA)在后循环缺血所致眩晕诊断和治疗中的价值。方法对103例后循环缺血眩晕患者,128例其他病因眩晕患者,50例健康对照人群血浆LPA测定。后循环缺血眩晕患者分为脑梗死组、短暂脑缺血发作组(TIA组)。脑梗死组随机分为脑梗死试验组、脑梗死对照组。脑梗死试验组加用氯吡格雷0.75gqd。结果脑梗死组、TIA组发病3d内血浆LPA水平明显高于其他病因眩晕组及健康对照组,差异有非常显著意义(P<0.01)。脑梗死2组发病4周时血浆LPA水平与健康对照组比较均无显著意义(P>0.05),但发病2周时脑梗死试验组LPA水平较脑梗死对照组下降更明显,差异有非常显著意义(P<0.01)。结论血浆LPA水平是后循环缺血所致眩晕敏感指标,可作为眩晕患者病因筛查常规检查项目,并为临床应用抗血小板聚集治疗和疗效判断提供客观依据。     

视频眼震电图在后循环缺血性眩晕诊断中的应用

目的探讨视频眼震电图（VNG）在以眩晕为主诉的后循环缺血患者诊断中应用价值。方法运用VNG技术检查68例以眩晕为主诉的后循环缺血患者，观察视眼动系统反应、自发性眼震、冷热试验、位置性眼震，并以40例正常健康老年人为对照。结果后循环缺血性眩晕组中有自发性眼震18例（26．5％），位置性眼震31例（45，6％），显著高于对照组（P〈0.05）。视眼动系统检查共56例（82．3％）出现1项或多项异常，表现为扫视试验32例（47.1％）异常，视跟踪试验Ⅲ型改变24例、Ⅳ型改变5例共29例（42．6％）异常，均显著高于对照组（P〈0．01）。视动试验有8例（11．8％）出现视动性眼震或视动眼震减弱。温度试验单侧减弱异常28例（41．2％），优势偏向异常16例（23.5％），总慢相角速度降低7例（10.3％），均显著高于对照组（P〈0.05）。结论VNG在后循环缺血性眩晕诊断中有重要意义。     

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。     

3D-ASL对表现为孤立性眩晕的后循环缺血的诊断价值

目的探讨磁共振三维动脉自旋标记成像(3D-ASL)在DWI阴性的临床表现为孤立性眩晕的后循环缺血中的诊断价值。方法回顾性分析DWI阴性的临床表现为孤立性眩晕后循环缺血的46例患者,均在发病48 h内行3D-ASL扫描,行双时相扫描(PLD:l.5 s,2.5 s)ASL检查,评估不同时相双侧小脑CBF的差异,并计算双侧不对称指数(AI)。结果标记后延迟时间(PLD)为1.5 s时,小脑区低灌注检出42例,PLD为2.5 s时,低灌注检出为40例,其中32例行MRA分析时相应供血区的椎动脉或基底动脉有病变,不对称指数均在10%以上(P0.05)。结论对疑似后循环缺血的患者,推荐早期常规行3D-ASL序列检查,为临床治疗方案的选择提供依据。     

多模式CT在后循环缺血性孤立性眩晕中的应用价值

目的 探讨多模式计算机断层扫描（computed tomography,CT）在后循环缺血性孤立性眩晕中的应用价值。      

血清IL-6联合ABCD2评分对孤立性眩晕患者并发脑梗死的诊断价值

目的 讨血清白介素-6(IL-6)联合ABCD2评分诊断孤立性眩晕患者并发脑梗死的价值.方法 选择2019年1月至2019年12月郴州市第一人民医院神经内科住院部和门诊收治的120例孤立性眩晕患者,根据头颅磁共振弥散加权成像检查诊断脑梗死25例(梗死组),未发生脑梗死95例(对照组).检测血清IL-6水平,采集临床资料...     

不同眼动特征在中枢性孤立性眩晕中的诊断价值

目前研究认为,孤立性眩晕是后循环TIA或脑梗死的常见表现形式,而且当中枢病变患者以前庭症状发病时,初始的临床表现中,孤立性眩晕较非孤立性眩晕更为常见.长期以来,临床医师对中枢性眩晕的诊断多基于临床体征的定位诊断,事实上,在脑干和小脑中包含诸多调控眼动的中枢前庭结构,这些结构受损会导致相应的异常眼动模式.本文综述了中枢性...     

眩晕症临床表现多样化的诊断分析

1临床资料 1．1一般资料选择我科1999—02—2004—02共82例住院眩晕症患者并随访半年以上,其中男30例,女52例,年龄14．86岁,平均43．2岁。病程2h-3年,平均1．2周。（1）有明确相关基础疾病者30例,包括高血压病、低血压、心衰、高血脂症、糖尿病、贫血、血液病、血流变异常、颈椎及颈肌异常、颅底畸形、脑动脉盗血综合征、上呼吸道感染、中耳炎、变态反应、药物中毒、头颈外伤、晕动病史、精神障碍、睡眠障碍、人格障碍。（2）与基础疾病有一定相关性者44例。（3）无明确相关性者8例。     

天麻素治疗后循环缺血性眩晕的临床观察

目的 观察天麻素治疗后循环缺血性眩晕的疗效.方法 选择以眩晕为初始症状及主要症状的本院住院及门诊患者共68例.随机分为治疗组和对照组各34例,对照组采用常规治疗,治疗组在此基础上加用天麻素治疗.结果 治疗组总有效率为94.12%,对照组为76.47%,2组相比差异有统计学意义(P＜0.05).且治疗组完全缓解及显效时间亦明显短于对照组.结论 天麻素治疗后循环缺血性眩晕有良好的疗效,且不良反应少,值得临床推广应用.     

眩晕并椎动脉发育不良患者后循环梗死的规律及危险性分析

目的探讨椎动脉发育不良(vertebralartery dysplasia,VAH)在眩晕患者中的发生率及其相关后循环梗死的规律和危险性。方法连续入组245例眩晕患者(可疑为血管性),采用磁共振血管成像检查合并VAH情况,根据磁共振弥散加权成像是否出现后循环新鲜梗死灶分为梗死组和非梗死组,对相关血管危险因素进行单因素和多因素分析;并分析VAH合并后循环梗死的特点和规律。结果 VAH发生率26.1%(64/245);多因素分析显示VAH(OR=2.59,95%CI:1.07~6.27,P=0.035)、后循环血管狭窄(OR=6.04,95%CI=1.94~17.07,P=0.002)和糖尿病(OR=3.21,95%CI:1.36~7.57,P=0.008)是后循环梗死独立危险因素。VAH合并后循环梗死患者中,TOAST分型多为小动脉病变型(10/18);8例桥脑、丘脑和颞枕叶梗死发生在VAH对侧(8/11),4例小脑和延髓梗死发生在VAH同侧(4/6)。结论 VAH在可疑的血管性眩晕病人中较常见;VAH为后循环梗死的独立危险因素,其相关的梗死分布存在一定的规律性。     

盐酸丁咯地尔联合舒血宁治疗后循环缺血性眩晕的疗效观察

目的观察丁咯地尔联合舒血宁注射液治疗后循环缺血性眩晕的疗效。方法将86名后循环缺血性眩晕病例随机分为治疗组(46例)和对照组(40例)。治疗组给予丁咯地尔注射液200mg和舒血宁注射液20ml静滴,对照组给予曲克芦丁0.8g+血塞通0.4g静滴,1次/d,14d为1疗程。监测患者血液流变学和后循环血流动力学指标。结果治疗组显效42例,总有效率91.30%。对照组显效32例,总有效率80.00%,治疗组优于对照组(P0.05),2组患者均未出现不良反应。治疗组后循环血流速度、搏动指数以及患者全血高切、低切还原黏度,血浆黏度指标的改善均优于对照组(P0.05)。结论丁咯地尔联合舒血宁注射液治疗后循环缺血性眩晕疗效显著,且无明显不良反应。     

Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo

Acupuncture at Fengchi(GB20) in the posterior neck improves vertigo.However,subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck.Therefore,in the present study,we assessed the safety of acupuncture at Fengchi.Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo.A total of 136 patients were randomly assigned to four groups.Verum acupuncture was conducted with different needle insertion directions(contralateral paropia or prominentia laryngea) and different needle twisting frequencies(60 or 120 times/minute) at Fengchi and matching acupoints(for example,Zhongwan [CV12],Qihai [CV6],Zusanli [ST36],and Fenglong [ST40]).The patients received 14 treatments over 3–4 weeks.Routine blood analysis,hepatic and renal function tests,urine and feces tests and electrocardiography were performed before the first treatment session and after the final session.Adverse events were recorded after every session.Of the 136 patients,120 completed the study.There were no significant differences between pretreatment and posttreatment test results in any of the groups.Only five patients suffered from minor adverse events(needling pain,slight hematoma and transient chest tightness).No serious adverse events were found.Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.     

孤立性眩晕起病的后循环缺血性脑卒中患者临床分析

目的 探讨后循环缺血性脑卒中的患者中最初仅表现为孤立性眩晕的患者的临床特点.方法 回顾性分析阜新市中心医院2018-08—2019-08以孤立性眩晕起病的后循环缺血性脑卒中患者13例,对13例以孤立性眩晕起病的后循环缺血性脑卒中患者的危险因素、临床表现、磁共振特点及预后进行回顾性分析.结果 13例患者的发病危险因素主要...     

青年人后循环缺血的病因和危险因素

脑卒中是一种高发病率、高致残率的疾病,严重威胁着人类的生命与健康.在世界范围内我国属于脑卒中高发地区,而近年来临床上青年人卒中发病率呈明显上升趋势[1].在我国,青年卒中发病率占全年龄组卒中的2.5%～5.9%[2].青年人后循环缺血是指发生在15～45岁的后循环缺血性脑血管病,包括TIA和脑梗死,其中后循环又称为椎-基底动脉系统,由椎动脉、基底动脉、大脑后动脉及其各级分支组成,主要分支供应脑干、小脑、枕叶、颞叶后部和丘脑等.     

Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke

BACKGROUND: Randomized trials of thrombolytic stroke treatment have either excluded patients with posterior circulation ischemia or used inclusion criteria making enrollment of these patients less likely. Consequently, there is less published information on thrombolytic therapy for posterior circulation stroke. OBJECTIVE: To determine effective thrombolytic treatment times for posterior circulation stroke and factors that might help predict clinical outcome. DESIGN: We describe our experience treating 21 consecutive patients with either intravenous or intra-arterial thrombolytic therapy for posterior circulation ischemic stroke between October 9, 1993, and February 19, 2001. MAIN OUTCOME MEASURES: National Institutes of Health Stroke Scale, Glasgow Coma Scale, and modified Rankin Scale scores were evaluated at baseline, and the modified Rankin Scale was measured 3 months after stroke, with a good outcome being a modified Rankin Scale score of 2 or less. RESULTS: Nine patients received intravenous therapy; 12 patients received intra-arterial therapy. The median National Institutes of Health Stroke Scale score at onset was 20 (range, 2-39), and the median Glasgow Coma Scale score was 9 (range, 3-15). Twelve patients were treated within 8 hours of symptom onset (range, 1 1/2 hours to 16 days). Nine patients (43%) had a modified Rankin Scale score of 2 or less at 3 months. The initial Glasgow Coma Scale score and treatment within 8 hours of symptom onset were each associated with good outcome, but the initial National Institutes of Health Stroke Scale score was not predictive. CONCLUSIONS: Thrombolytic therapy for posterior circulation stroke may be beneficial even when initiated 8 hours after symptom onset. Level of consciousness, as measured by Glasgow Coma Scale score, seems to be a more important predictor of outcome than the initial National Institutes of Health Stroke Scale score.     

Dementia increases the risk of death in stroke patients: A retrospective cohort-based risk score model study

BackgroundThe relationship between dementia and the mortality of stroke is a significant concern for patients and careers. However, there are few research about it in China and a lack of reliable data on the risk of dementia. We aim to analyze and compare the risk of death in stroke patients with and without dementia. Further investigation into the predictive value of dementia for stroke death.MethodsAll patients with stroke who were identified among residents of Ningxia, between January 1, 2014 to December 31, 2021, set death or May 22, 2022 as the observation endpoint. All patients were screened by 1:4 propensity score matching (PSM). The association between dementia and all-cause mortality was evaluated using Cox regression with survival time. Evaluation of the predictive value of dementia using decision curve analysis (DCA) and clinical impact curve (CIC) curves.ResultMortality of stroke with dementia is 45.4% and without dementia is 13.8%, further calculated one-year mortality is higher in the patients with dementia than without dementia (17.3%vs. 5.4%, p < 0.001). Stroke patients with dementia had a 3.74 times higher risk of death (95% CI = 3.29,4.26) and had a shorter survival time than those without dementia. Dementia was an independent predictor of death in all models (hazard ratio [HR]=3.77,95%CI: 3.31-4.30, p < 0.001). DCA and CIC curves indicated that dementia has a high value in predicting the risk of death in stroke patients.ConclusionDementia is an independent risk factor for death and reduces survival time in stroke patients.