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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。
BACKGROUND: In recent years, foreign studies have reported that vascular structural abnormalities are the main morphological basis of vertebrobasilar insufficiency vertigo. However, there are few reports on abnormal vascular structures in vertebrobasilar artery in China. Objective: To observe the clinical manifestations and digital subtraction angiography of vascular structural abnormalities in vertebrobasilar insufficiency vertigo patients. Design: Case Analysis. SETTING: Department of Neurology, Wuxi Second Hospital Affiliated to Nanjing Medical University (Wuxi Second People’s Hospital) and Department of Neurology, Huaihua Hospital Affiliated to Nanhua University. PARTICIPANTS: Department of Neurology, Huaihua Hospital Affiliated to Nanhua University, 2003-08 / 2004-05 Department of Neurology, Wuxi Second Hospital Affiliated to Nanjing Medical University (Wuxi Second People ’s Hospital) from October 2004 to May 2005 with episodes 57 cases of outpatients and inpatients with dizziness, nausea or vomiting. Methods: Digital subtraction aortic arch and whole cerebrovascular angiography were performed in 57 patients with vertebrobasilar insufficiency vertigo treated in two years: retrograde angiography with femoral artery puncture and Optiray Force) nonionic contrast agent line aortic arch angiography. Digital subtraction cameras showed bilateral carotid and vertebral arteries from multiple perspectives, ranging from the beginning of the common carotid artery to the siphon of the internal carotid artery, and were measured and evaluated by two neurologists. MAIN OUTCOME MEASURES: Types, distributions and proportions of vascular structural abnormalities in the aortic arch, internal carotid artery and vertebrobasilar artery system. Results: 57 patients participated in the experiment, 1 patient left the left vertebral artery can not enter and give up. 1 case of aortic arch angiography complicated by large-area cerebral infarction surgery. Enter the result analysis of 55 cases. A total of 71% (39/55) of the patients had abnormal cervical and intracranial vascular structures. The anterior circulation lesions accounted for 11% (6/55) and the posterior circulation lesions (60%, 33/55) 9 cases (16%) had abnormal compound circulation, 24 cases (24/55, 44%) involved two or more vessels, vertebral artery and other vascular stenosis were the most common. The other 16 cases (16/55 , 29%) angiography no vascular structural abnormalities. CONCLUSION: Various types of vascular structural abnormalities are the main causes of vertigo in vertebrobasilar insufficiency. The gold standard for vertigo diagnosis of vertebrobasilar insufficiency should be digital subtraction angiography.