转颈屈颈及仰头试验与经颅多普勒和核磁共振血管成像评估椎动脉狭窄性眩晕的效应比较

背景眩晕患者中椎动脉狭窄性眩晕占相当比例,其诊断方法没有统一的标准,影响其诊断的准确性.用转颈、屈颈、头后仰法试验,简单的检查做到对椎动脉狭窄患者临床初诊,再进行经颅多普勒(TCD)和核磁共振血管成像(MRA)检查,可提高临床诊断准确率.目的评估转颈屈颈及仰头试验与TCD和MRA检查对椎动脉狭窄性眩晕诊断价值.设计以患者为研究对象,病例分析.单位内蒙古医学院附属医院神经科.对象2004-02/04内蒙古医学院附属医院神经科门诊眩晕的患者41例,排除非椎动脉狭窄的其他病因所致的眩晕.方法用转颈、屈颈及头后仰法诱发出眩晕症状的41例患者,然后用TCD和MRA分别进行椎动脉和基底动脉检查.主要观察指标41例患者三项检查结果.结果41例患者经转颈试验屈颈和头后仰诱发眩晕症状,其中左右转颈出现眩晕者32例,检出率为78%,屈颈和头后仰出现眩晕者25例,检出率为61%.TCD检查发现双侧椎动脉血流不对称,双侧椎动脉直径相差在0.5～2.0 mm者30例,检出率为73%.MRA检查发现血管内径双侧椎动脉不对称,相差在0.5～2.6mm者39例,其余2例患者双侧椎动脉狭窄,检出率为95%.结论转颈、屈颈和头向后仰试验,对诱发患者出现眩晕症状,是否为椎动脉狭窄性眩晕进行确诊,TCD检查对诊断椎动脉狭窄的准确率相对较高,MRA检查确定椎动脉狭窄的准确率最高.

Comparison of neck rolling-flexion and head hypsokinesis test with transcranial Doppler and nuclear magnetic resonance angiography in appraising vertigo caused by vertebral artery stenosis

BACKGROUND: Vertigo caused by vertebral artery stenosis accounts for a corresponding large percent in vertigo patients. There is not a unified criterion in diagnostic method, which affects accuracy of diagnosis. Application of simply check such as neck rolling-flexion and head hypsokinesis test can give first diagnosis to patients with vertebral artery stenosis in clinic. Then examination of transcranial Doppler(TCD) and nuclear magnetic resonance angiography (MRA) can be given to increase accuracy of clinical diagnosis.OBJECTIVE: To appraise diagnostic value of vertebral artery stenosis by neck rolling-flexion test, TCD and MRA examination.DESIGN: Cases analysis based on patients.SETTING: Department of Neurology, Affiliated Hospital of Inner Mongolia Medical College.PARTICIPANTS: Totally 41 patients with diagnosis of vertigo were chosen in Clinic of Neurological Department in Affiliated Hospital of Inter Mongolia Medical College from February to April 2004. The cases with vertigo that were not caused by vertebral artery stenosis were excluded.METHODS: Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were given later examination of TCD and MRA to vertebral arteries and basilar artery.MAIN OUTCOME MEASURES: Three checking results of 41 patients.RESULTS: Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were chosen. Vertigo occurred after left-right neck rolling in 32 cases, which accounted for 78% in detectable rate, and vertigo occurred after neck flexion and head hypsokinesis in 25 cases, which accounted for 61% in detectable rate. Thirty cases were found dissymmetry of blood flow in vertebral arteries on two sides and diameter differences of vertebral arteries on two sides between 0.5-2.0 mm by examination of TCD, which accounted for 73% in detection rate. Thity-nine cases were found dissymmetry in inner diameter of vertebral arteries and the differences in diameter were between 0. 5-2.6 mm, which accounted for 95% in detection rate. The other two cases were detected vertebral artery stenosis.CONCLUSION: Neck rolling-flexion and head hypsokinesis test can induce vertigo symptom, which helps to give final diagnosis whether it is caused by vertebral artery stenosis. TCD examination has a corresponding higher accuracy in diagnosis of vertebral artery stenosis. MRA examination has the highest accuracy in diagnosis of vertebral artery stenosis.