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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,适时解除颈动脉狭窄有利于消除或减轻此类病人的眩晕。
Objective To investigate the relationship between vertigo and carotid artery stenosis. Methods 17 cases of severe carotid stenosis confirmed by surgery or DSA. Clinical manifestations of cerebral hemisphere insufficiency symptoms in 10 cases, recurrent dizziness in 7 cases, 4 cases of vertigo as the only or the main clinical symptoms, surgery to relieve the symptoms disappear or reduce stenosis. Seventeen patients underwent DUS of the neck and MRA of the neck and CT or MRI of the head. Among them, 10 had MRA of the head and 5 had the MRA DSA check. The degree of carotid stenosis was measured and the intracranial arteries and Willis rings were evaluated. Results The clinical manifestations were cerebral hemisphere insufficiency symptoms, 3 cases of stenosis ipsilateral lacunar infarction, 2 cases of ipsilateral multiple cerebral infarction, 3 cases of multiple infarcts on both sides and 1 case of contralateral cortical infarction without abnormalities 1 case. 5 cases were not seen in the narrow lateral communicating artery (PCOA) and 1 was small. Recurrent episodes of vertigo, stenosis ipsilateral cerebral infarction in 2 cases, contralateral cortical infarction in 1 case, no abnormalities in 4 cases. Two cases of narrow PCOA and one case of PCOA were found in the stenotic side. PCOA was not found in the stenotic side, but thicker in the posterior cerebral artery. Conclusion Severe carotid stenosis with dizziness as the only or main symptom should pay attention to the MRA of the head vessel to evaluate the Willis ring and intracranial artery and to measure the velocity of flow and relieve the stenosis of the carotid artery timely to eliminate or relieve such patients Dizziness