焦信忠;刘廷敏;孔秀燕;

• 1:茌平县人民医院

摘要(Abstract)：

目的分析椎基底动脉缺血性眩晕老年患者颅脑多普勒超声(TCD)检查的血流动力学指标以及异常情况。方法选取2014—2016年茌平县人民医院收治的90例椎基底动脉缺血性眩晕患者90例为观察组,选取同期健康体检的老年人为对照组,对比2组TCD检测指标及检查结果异常率。结果 90例椎基底动脉缺血性眩晕患者中TCD检查存在异常的患者73例(81.11%),其中60例为椎基底动脉血流异常(82.19%)。观察组大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)以及基底动脉(BA)与椎动脉(VA)的Vm均明显低于对照组(P<0.05),ACA、VA、BA的PI指数明显高于对照组(P<0.05)。结论椎基底动脉缺血性眩晕老年患者TCD检查可见颅内血流指标改变明显,椎基底动脉改变较为明显。

关键词(KeyWords)： 缺血性眩晕;椎基底动脉;经颅多普勒超声;血流动力学;颈椎病变;椎动脉粥样硬化

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 焦信忠;刘廷敏;孔秀燕;

参考文献(References)：

• [1] PFADENHAUER K,ESSER M,BERGER K,et al.Vertebrobasilar ischemia and structural abnormalities of the vertebral arteries in active temporal arteritis and polymyalgia rheumatica--an ultrasonographic case-control study[J].J Rheumatol,2005,32(12):2 356-2 360.
• [2] 吴正福.经颅多普勒超声在椎基底动脉缺血性眩晕中的应用价值[J].实用心脑肺血管病杂志,2014,33(10):77-78.
• [3] 孙国兵,许康,余丹芳,等.经颅多普勒超声屏气试验评价重度颈动脉狭窄脑血管储备功能[J].神经损伤与功能重建,2014,24(6):475-477.
• [4] ZHONG N.The correlation of auditory brainstem response and transcranial Doppler on the vertebrobasilar transient ischemic vertigo[J].Zhonghua Er Bi Yan Hou Ke Za Zhi,1996,31(2):86-88.
• [5] PENG Y F,ZHANG H L,ZHANG D P,et al.Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo[J].Ann Clin Transl Neurol,2018,5(12):1 562-1 573.DOI:10.1002/acn3.665.
• [6] LIMA NETO A C,BITTAR R,GATTAS G S,et al.Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency:A Review of the Literature[J].Int Arch Otorhinolaryngol,2017,21(3):302-307.DOI:10.1055/s-0036-1593448.
• [7] CHEN Y Y,CHEN W,ZHANG Q,et al.Puerarin and betahistine treatment of vertebrobasilar ischemia vertigo:A meta-analysis of randomized controlled trials[J].Exp Ther Med,2016,11(3):1 051-1 058.
• [8] ALNAAMI I,SIDDIQUI M,SAQQUR M.The diagnosis of vertebrobasilar insufficiency using transcranial Doppler ultrasound[J].Case Rep Med,2012:894 913.DOI:10.1155/2012/894913.
• [9] SCHNEIDER J I,OLSHAKER J S.Vertigo,vertebrobasilar disease,and posterior circulation ischemic stroke[J].Emerg Med Clin North Am,2012,30(3):681-693.DOI:10.1016/j.emc.2012.06.004.
• [10] DELLA-MORTE D,RUNDEK T.Dizziness and vertigo[J].Front Neurol Neurosci,2012,30:22-25.DOI:10.1159/000333379.
• [11] KARATAS M.Vascular vertigo:epidemiology and clinical syndromes[J].Neurologist,2011,17(1):1-10.DOI:10.1097/NRL.0b013e3181f09742.
• [12] HEIDENREICH K D,CARENDER W J,HEIDENREICH M J,et al.Strategies to distinguish benign paroxysmal positional vertigo from rotational vertebrobasilar ischemia[J].Ann Vasc Surg,2010,24(4):553.e1-e5.DOI:10.1016/j.avsg.2009.09.018.
• [13] MOUBAYED S P,SALIBA I.Vertebrobasilar insufficiency presenting as isolated positional vertigo or dizziness:a double-blind retrospective cohort study[J].Laryngoscope,2009,119(10):2 071-2 076.DOI:10.1002/lary.20597.
• [14] HUANG Q.Fifty cases of vertebrobasilar ischemic vertigo treated by acupuncture[J].J Tradit Chin Med,2009,29(2):87-89.
• [15] DENG Y,ZHU H Q,DENG G B,et al.A clinical study on the effect of Yinxing Damo combined with betahistine hydrochloride injection on vertebral basilar artery ischemic vertigo[J].Chin J Integr Med,2005,11(3):229-231.
• [16] 唐晓菊,蔡泽鹏,孙明亮,等.颈性眩晕诊断的研究进展[J].大众科技,2014,31(7):125-127.
• [17] DODT C,ZELIHIC E.Vertigo and dizziness.Diagnostic algorithm from the perspective of emergency medicine[J].Med Klin Intensivmed Notfmed,2013,108(1):41-46.DOI:10.1007/s00063-012-0173-3.
• [18] PAKSOY Y,VATANSEV H,SEKER M,et al.Congenital morphological abnormalities of the distal vertebral arteries (CMADVA) and their relationship with vertigo and dizziness[J].Med Sci Monit,2004,10(7):CR316-CR323.
• [19] TANG K,CHEN R,CAL R,et al.The relationship of brainstem auditory evoked potential to cerebral blood flow volume in with vertebrobasilar transient ischemic vertigo[J].Hua Xi Yi Ke Da Xue Xue Bao,2000,31(1):80-81;85.
• [20] LI H,ZHONG N.Analysis of spectral history of distort-product otoacoustic emissions in subjects of transient vertebrobasilar ischemic vertigo[J].Lin Chuang Er Bi Yan Hou Ke Za Zhi,1998,12(5):217-220.
• [21] HAUBRICH C,KOHNKE A,KLOETZSCH C,et al.Bilateral vertebral artery disease:transcranial Doppler assessment of the hemodynamic vulnerability to changes in posture[J].Ultrasound Med Biol,2006,32(10):1 485-1 491.
• [22] GUO Y,ZHOU H.Value of visual nystagmography in diagnosis of the patients with vertebrobasilar transient ischemic vertigo[J].Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2007,21(14):639-642.
• [23] GEKHT A B,VIALKOVA A B,GALANOV D V.Clinico-neurological and stabilometric analysis of betahistine (betaserc) efficacy in the patients with vertigo in the rehabilitation period of ischemic stroke[J].Zh Nevrol Psikhiatr Im S S Korsakova,2005,Suppl 15:32-38.
• [24] FAZEKAS A.Dizziness-vertigo.Alarming symptoms in vertebrobasilar ischemia.Part II[J].Ideggyogy Sz,2005,58(1/2):4-8.
• [25] RIBO M,GARAMI Z,UCHINO K,et al.Detection of reversed basilar flow with power-motion Doppler after acute occlusion predicts favorable outcome[J].Stroke,2004,35(1):79-82.
• [26] 贾国伟,徐卓.2D-CDFI与TCD检测双侧椎动脉对椎基底动脉系缺血性眩晕临床诊断的意义[J].中国医药导报,2010,7(26):160-161.
• [27] LI Q,ZHONG N,XUE X.TCD functional test for vertigo induced by ischemic cerebrovascular disorders[J].Lin Chuang Er Bi Yan Hou Ke Za Zhi,1999,13(4):159-160.
• [28] NAZERIAN P,BIGIARINI S,PECCI R,et al.Duplex Sonography of Vertebral Arteries for Evaluation of Patients with Acute Vertigo[J].Ultrasound Med Biol,2018,44(3):584-592.DOI:10.1016/j.ultrasmedbio.2017.11.002.
• [29] CHOI K D,LEE H,KIM J S.Ischemic syndromes causing dizziness and vertigo[J].Handb Clin Neurol,2016,137:317-340.DOI:10.1016/B978-0-444-63437-5.00023-6.
• [30] BLUM C A,KASNER S E.Transient Ischemic Attacks Presenting with Dizziness or Vertigo[J].Neurol Clin,2015,33(3):629-642,ix.DOI:10.1016/j.ncl.2015.04.005.
• [31] NEWMAN-TOKER D E,SABER TEHRANI A S,MANTOKOUDIS G,et al.Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness:toward an ECG for the eyes[J].Stroke,2013,44(4):1 158-1 161.DOI:10.1161/STROKEAHA.111.000033.
• [32] SCHNEIDER J I,OLSHAKER J S.Vertigo,vertebrobasilar disease,and posterior circulation ischemic stroke[J].Emerg Med Clin North Am,2012,30(3):681-693.DOI:10.1016/j.emc.2012.06.004.
• [33] ALEKSEEVA N S,KIRICHENKO I M.Vertigo and peripheral ischemic cochleovestibular syndrome caused by circulatory insufficiency in the vertebrobasilar system[J].Vestn Otorinolaringol,2006(2):15-19.
• [34] KERBER K A,RASMUSSEN P A,MASARYK T J,et al.Recurrent vertigo attacks cured by stenting a basilar artery stenosis[J].Neurology,2005,65(6):962.
• [35] KUMAR A,MAFEE M,DOBBEN G,et al.Diagnosis of vertebrobasilar insufficiency:time to rethink established dogma?[J].Ear Nose Throat J,1998,77(12):966-969;972-974.
• [26] ALEMDAR M.Vertebrobasilar artery dolichoectesia and pain;coincidence oretiology?[J].Agri,2017,29(3):141-146.DOI:10.5505/agri.2016.29200.
• [27] WILKINSON D A,PANDEY A S,GARTON H J,et al.Late recanalization of basilar artery occlusion in a previouslyhealthy 17-month-old child[J].BMJ Case Rep,2017:pii:bcr-2017-013277.DOI:10.1136/neurintsurg-2017-013277.
• [28] WANG M Y,LIU Y S,LI K,et al.Protective effect of the microcatheter placed at the normal vertebral artery in intracranial stent-assisted angioplasty for vertebral artery stenosis:A case report[J].Medicine (Baltimore),2017,96(29):e7569.DOI:10.1097/MD.0000000000007569.
• [29] DMITRIEV O V,VACHEV A N,STEPANOV M I,et al.Treatment of vertebrobasilar insufficiency due to stenosis and aneurysm of the vertebral artery[J].Angiol Sosud Khir,2017,23(2):108-117.
• [30] VURU?KAN E,SARA?OGLU E,POLAT M,et al.Case images:Treatment of thrombotic subclavian artery stenosis involving vertebral artery ostium with maxi-mum protection[J].Turk Kardiyol Dern Ars,2017,45(2):207.DOI:10.5543/tkda.2016.93727.
• [31] JENKINS J S,STEWART M.Endovascular Treatment of Vertebral Artery Stenosis[J].Prog Cardiovasc Dis,2017,59(6):619-625.DOI:10.1016/j.pcad.2017.02.005.
• [32] RENFROW J J,FRENKEL M B,EDWARDS M S,et al.Evaluation of a Traumatic Vertebral Artery Occlusion[J].World Neurosurg,2017,101:815.e13-815.e17.
• [33] YAGI K,NAKAGAWA H,MURE H,et al.Cryptic Recanalization of Chronic Vertebral Artery Occlusion by Head Rotation[J].J Stroke Cerebrovasc Dis,2017,26(4):e60-e61.DOI:10.1016/j.jstrokecerebrovasdis.2016.12.034.
• [34] BUCH V P,MADSEN P J,VAUGHAN K A,et al.Rotational vertebrobasilar insufficiency due to compression of a persistent first inter segmental vertebral artery variant:case report[J].J Neurosurg Spine,2017,26(2):199-202.DOI:10.3171/2016.7.SPINE163.
• [35] FELBAUM D R,RYAN J E,STEMER A B,et al.Bilateral Subaxial Rotational Vertebral Artery Occlusion in a Setting of a Prior Cervical Construct[J].WorldNeurosurg,2017,97:762.e5-762.e10.DOI:10.1016/j.wneu.2016.08.120.
• [36] GROSS B A,ALBUQUERQUE F C.Stenting Versus Aggressive Medical Management for Symptomatic Vertebral Artery Stenosis[J].World Neurosurg,2015,84(3):613-615.DOI:10.1016/j.wneu.2015.07.064.
• [37] MORALES A,PARRY P V,JADHAV A,et al.A novel route of revascularization inbasilar artery occlusion and review of the literature[J].J Neurointerv Surg,2016,8(7):e25.DOI:10.1136/neurintsurg-2015-011723.rep.
• [38] MORALES A,PARRY P V,JADHAV A,et al.A novel route of revascularization inbasilar artery occlusion and review of the literature[J].BMJ Case Rep,2015:pii:bcr2015011723.DOI:10.1136/bcr-2015-011723.
• [39] HAUSSEN D C,DHARMADHIKARI S S,SNELLING B,et al.Posterior communicating and vertebralartery configuration and outcome in endovascular treatment of acute basilarartery occlusion[J].J Neurointerv Surg,2015,7(12):864-867.DOI:10.1136/neurintsurg-2014-011327.
• [40] HEALY A T,LEE B S,WALSH K,et al.Bow hunter's syndrome secondary to bilateral dynamic vertebral artery compression[J].J Clin Neurosci,2015,22(1):209-212.DOI:10.1016/j.jocn.2014.05.027.
• [41] ABE A,OKUBO S,ONOZAWA S,et al.Acute vertebral artery origin occlusion leading to basilar artery thrombosis successfully treated by angioplasty with stenting and thrombectomy[J].Interv Neuroradiol,2014,20(3):325-328.DOI:10.15274/NRJ-2014-10022.
• [42] SAFAIN M G,TALAN J,MALEK A M,et al.Spontaneous atraumatic vertebral artery occlusion due to physiological cervical extension:case report[J].J Neurosurg Spine,2014,20(3):278-282.DOI:10.3171/2013.12.SPINE13653.
• [43] SHUTZE W,GIERMAN J,MCQUADE K,et al.Treatment of proximal vertebral artery disease[J].Vascular,2014,22(2):85-92.DOI:10.1177/1708538112473966.
• [44] DARGON P T,LIANG C W,KOHAL A,et al.Bilateral mechanical rotational vertebral artery occlusion[J].J Vasc Surg,2013,58(4):1 076-1 079.DOI:10.1016/j.jvs.2012.12.044.
• [45] SCHELFAUT S,VERHASSELT S,CARPENTIEr K,et al.Subaxial rotational vertebral artery syndrome:resection of the uncinate process and anterior fusion can be sufficient!:case report and review of the literature[J].J Spinal Disord Tech,2015,28(2):66-70.DOI:10.1097/BSD.0b013e3182886fbf.
• [46] SCHUETTE A J,BARROW D L.Rotational vertebral artery syndrome[J].World Neurosurg,2013,79(5/6):680-681.DOI:10.1016/j.wneu.2012.07.023.