ABSTRACT
Objectives To evaluate the parameter changes of posterior circulation blood flow and wall shear stress in patients with vertebral artery hypoplasia (VAH) and to understand the possible mechanisms of VAH-induced posterior circulation infarction (PCI). Methods A total of 261 consecutive patients with suspected vascular vertigo admitted to the Department of Neurology, People's Hospital of Zhengzhou from October 2014 to January 2016 were enrolled. The vertigo symptom scale (VSS) was used to evaluate the severity of vertigo. All patients completed TCD and high field strength MR examination within 3 d of admission (Tl ,T2 weighted imaging,fluid attenuation inversion recovery [FLAIR] ,diffusion-weighted imaging [DWI],MR angiography [MRA], contrast-enhanced MRA [CEMRA]),and according to the diameter of the vertebral artery combined with the diagnostic criteria of VAH, they were divided into VAH group and non-VAH group, Posterior circulation blood flow velocity (systolic velocity [V,], diastolic velocity [Vd] , mean velocity [V]) , pulsatility index (PI) , resistance index (RI) , mean flow velocity (MFV) ,and wall shear stress (WSS) between the two group were analyzed. The paired or independent sample t test, Mann-Whitney U test and the 2 test were conducted with SPSS19.0 for intra-group or inter-group comparisons. Results Of 261 patients,78 (29.9%) had VAH,26 were complicated with basilar artery hypoplasia,37 were complicated with fetal type posterior circle of Willis,and posterior circulation infarction occurred in 48 (18. 4%). Compared with the non-VAH group, the degree of vertigo of patients was more severe in the VAH group(3[2,4] vs. 3[1,3] ,Z = 2. 29) ,and the incidence of posterior circulation infarction was significantly increased (25. 6% [20/78] vs. 13. 5% (28/183) ,x =5- 34)- The differences were statistically significant (all P 0. 05). Conclusions The incidence of VAH was higher in patients with vertigo and vascular risk factors. VAH affected the posterior circulation hemodynamics, which might be associated with the occurrence of PCI.
ABSTRACT
Objective To summarize the clinical features and vascular lesions in patients who suffered from cerebellar infarction with vertebral artery hypoplasia(VAH). Methods Retrospective analysis was used in the research. The selected patients suffered from cerebellar infarction with VAH or stenosis (stenosis rate≥50%). Seventy-one patients with cerebellar infarction were enrolled. There were 34 patients in VAH group and 37 patients in vertebral artery stenosis group. The age, sex, risk factors, clinical manifestations and characteristics of vascular examination were compared. Results The age, sex, risk factors between two groups had no significant differences (P>0.05). The scores of National Institutes of Health Stroke Scale (NIHSS) between two groups had no significant difference (P>0.05). The proportion of early neurological deterioration in VAH group (41.2%, 14/34) was higher than that in vertebral artery stenosis group (18.9%, 7/37), χ2=4.21, P<0.05. There were more patients with anterior circulation artery stenosis in the VAH group (35.3%, 12/34), compared with that in artery stenosis group (13.5%, 5/37),χ2=4.62, P<0.05. Except the ipsilateral vertebral artery, other arteries stenosis in VAH group (44.1%, 15/34) was significantly higher than that in vertebral artery stenosis group (13.5%, 5/37),χ2=8.20, P<0.05. Conclusions Cerebellar infarction with vertebral artery hypoplasia is more likely to have multiple cerebral arterial stenosis (stenosis rate ≥50%). The patients who suffered from cerebellar infarction with vertebral artery hypoplasia might be prone to early neurological deterioration.
ABSTRACT
Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.
Subject(s)
Humans , Angioplasty , Arteries , Compensation and Redress , Constriction, Pathologic , Embolism , Follow-Up Studies , Hemodynamics , Ischemia , Risk Factors , Stroke , Vertebral ArteryABSTRACT
BACKGROUND: Vestibular neuritis (VN) is one of the most common causes of acute vertigo. Viral infection is regarded to be the most common etiology of VN, but other various causes including labyrinthine ischemia have not yet been fully elucidated. We assumed that labyrinthine ischemia can develop from various disorders in the posterior circulation including vertebral artery hypoplasia and vertebrobasilar dolichoectasia. METHODS: Fifty-six patients with acute VN and 56 healthy controls were enrolled. Two neurologists independently used magnetic resonance angiography (MRA) to retrospectively investigate the posterior circulation in VN patients. The relation between the presence of VN and abnormalities of posterior circulation vascularity was analyzed. RESULTS: MRA findings of vertebral artery hypoplasia and vertebrobasilar dolichoectasia were present in 15 (27%) and 14 (25%) of the VN patients. However, the frequencies of these findings did not differ significantly from those in the healthy controls (p=0.16). CONCLUSIONS: The frequencies of vertebral artery hypoplasia and vertebrobasilar dolichoectasia did not differ significantly between VN patients and healthy subjects. We suggest that brain MRI and MRA are not essential in acute VN patients without central signs. Large prospective studies are needed to characterize the vascular etiology of vestibular neuritis.
Subject(s)
Humans , Brain , Ischemia , Magnetic Resonance Angiography , Prospective Studies , Vertebral Artery , Vertebrobasilar Insufficiency , Vertigo , Vestibular NeuronitisABSTRACT
Background. Disease of vertebralis and insufficiency of blood supply occur not a few, it decreases lab our ability much, complaints such as: headache, to feel giddy, to blur eyes, fatigue heartache, neck becomes stiff and unbalance reveal. By some researches study 25-30% of blood supply insufficiency of cranium occupies artery disease 65% of vertebral artery insufficiency occupies disease of external part of cranium we have introduced duplex sonography method by using medison Pico-ACE apparatus since 2006 and it gave possibility of revealing artery disease of external cranium. The most causes of artery disease occupy congenital and acquired deficiency such as: aplasia, hypoplasia and vertebra skin. Revealing and diagnosing these disease early is the confronted problem of society and health and it attracts attention of doctors and specialists of angioneurological branch. Aim of research work: We aimed at the study of diagnosing disease of artery of vertebral of external part of cranium by the method of duplex-sonography and studying dependence of type, size, form, case, age and sex. Materials and Methods. We did the study on 100 people who was done duplexsonographic diagnose because of blood supply insufficiency of cranium in the centre of diagnose of private structure Best Ema. We did analyse of DSG by using MedisonPicoACE apparatus by the stand and method, divided them into 6 groups in 10 age and studied type, size, location speed of stream, age and sex. Conclusion: 1. By duplex-sonography, in 18% hypoplasia of vertebral artery revealed, in 88.8% of it hemo-dynastic change revealed. 2. In 24% of patients involved in the study artery fold revealed, in 62.5 hemo-dynastic change revealed. 3. The main method of analyze which reveals location, size and dynamic and diagnosis vertebral artery of external part of cranium is DSG.