颈动脉狭窄与眩晕症状的初步分析

A preliminary analysis of carotid stenosis and vertigo

目的 探讨眩晕与颈动脉狭窄之间的联系。 方法 17例经手术或DSA证实的颈动脉重度狭窄病例。临床表现为大脑半球供血不足症状 10例 ,反复发作性眩晕 7例 ,其中 4例眩晕为惟一或主要临床症状 ,手术解除狭窄后症状消失或减轻。 17例均首先行颈部血管多普勒超声 (DUS) ,然后行颈部血管磁共振血流成像 (MRA)及头部CT或MRI检查 ,其中 10例同时行头部血管MRA ,5例行DSA检查。测量颈动脉狭窄程度 ,评价颅内动脉及Willis环。 结果 临床表现为大脑半球供血不足症状者 ,狭窄同侧腔隙性脑梗死 3例 ,同侧多发性脑梗死 2例 ,两侧多发梗死灶 3例 ,狭窄对侧皮层梗死 1例 ,未见异常1例。狭窄侧后交通动脉 (PCOA)未见显示 5例 ,显示细小 1例。反复发作性眩晕者 ,狭窄同侧腔隙性脑梗死 2例 ,对侧皮层梗死 1例 ,未见异常 4例。狭窄侧PCOA显示 2例 ,PCOA粗大 1例 ;狭窄侧未显示PCOA ,而大脑后动脉增粗 1例。 结论 对以眩晕为惟一或主要症状的颈动脉重度狭窄者 ,应重视同时行头部血管MRA以评价Willis环及颅内动脉 ,并测量流速 。

Objective To assess the relationship between carotid stenosis and the symptom of vertigo Methods 17 patients with severe carotid stenosis confirmed by endarterectomy or DSA were examined with Doppler US and MRA CT or MRI of the brain was also done in all patients MRA of the brain was performed in 10 and DSA in 5 The degree of carotid stenosis was evaluated Meanwhile, the circles of Willis and intracranial arteries were analyzed on MRA of the brain Among them, the symptoms associated with carotid insufficiency were in 10, and the vertigo was only complaining in 7, of which, the feeling of vertigo was disappeared or improved after endartectomy in 4 Results Of the 10 carotid stenosis with carotid insufficiency, there were lacuna infarct on the ipsilateral cerebral hemisphere in 3, multiple infarcts in 2; multiple infarcts bilaterally in 3, cortical infarcts on the contrary side in 1, and normal in 1 Posterior communicating arteries (PCOA) were not displayed in 5, and a tiny configuration in 1 Of the 7 cases with vertigo, there were lacuna infarcts on the ipsilateral cerebral hemisphere in 2, cortical infarct on the contrary side in 1, and normal in 4 The circles of Willis were entire in 2 PCOA was relative large on the ipsilateral carotid stenosis in 1, and PCOA was not well visualized while posterior cerebral artery was large on the same side in 1 Conclusion In cases of severe carotid stenosis with an only symptom of the vertigo, MRA of the brain and measurement of the velocity besides the examination of carotid artery are worthy of doing to evaluate the circle of Willis and the intracranial arteries as a while, because the patients could be beneficial from the treatment of release of carotid stenosis