Comparison of neck rolling-flexion and head hypsokinesis test with transcranial Doppler and nuclear magnetic resonance angiography in appraising vertigo caused by vertebral artery stenosis

Zeyu LI; Lin BO; Zhiguang WANG; Guohua ZHANG

ABSTRACT

BACKGROUND:

Vertigo caused by vertebral artery stenosis accounts for a corresponding large percent in vertigo patients. There is not a unified criterion in diagnostic method, which affects accuracy of diagnosis. Application of simply check such as neck rolling-flexion and head hypsokinesis test can give first diagnosis to patients with vertebral artery stenosis in clinic. Then examination of transcranial Doppler(TCD) and nuclear magnetic resonance angiography (MRA) can be given to increase accuracy of clinical diagnosis.

OBJECTIVE:

To appraise diagnostic value of vertebral artery stenosis by neck rolling-flexion test, TCD and MRA examination.

DESIGN:

Cases analysis based on patients.

SETTING:

Department of Neurology, Affiliated Hospital of Inner Mongolia Medical College.

PARTICIPANTS:

Totally 41 patients with diagnosis of vertigo were chosen in Clinic of Neurological Department in Affiliated Hospital of Inter Mongolia Medical College from February to April 2004. The cases with vertigo that were not caused by vertebral artery stenosis were excluded.

METHODS:

Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were given later examination of TCD and MRA to vertebral arteries and basilar artery.MAIN OUTCOME

MEASURES:

Three checking results of 41 patients.

RESULTS:

Totally 41 patients with vertigo whose symptoms were induced by neck rolling-flexion and head hypsokinesis test were chosen. Vertigo occurred after left-right neck rolling in 32 cases, which accounted for 78% in detectable rate, and vertigo occurred after neck flexion and head hypsokinesis in 25 cases, which accounted for 61% in detectable rate. Thirty cases were found dissymmetry of blood flow in vertebral arteries on two sides and diameter differences of vertebral arteries on two sides between 0.5-2.0 mm by examination of TCD, which accounted for 73% in detection rate. Thity-nine cases were found dissymmetry in inner diameter of vertebral arteries and the differences in diameter were between 0. 5-2.6 mm, which accounted for 95% in detection rate. The other two cases were detected vertebral artery stenosis.

CONCLUSION:

Neck rolling-flexion and head hypsokinesis test can induce vertigo symptom, which helps to give final diagnosis whether it is caused by vertebral artery stenosis. TCD examination has a corresponding higher accuracy in diagnosis of vertebral artery stenosis. MRA examination has the highest accuracy in diagnosis of vertebral artery stenosis.