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cervical vertebral artery disease clinical manifestations and diagnosis of

Read in CN

2011-11-12 20:38| publisher: admin| Views: 771| Comment: 0


   

cervical vertebral artery disease age of onset higher than in the 50-80 years of age, symptoms increased with increasing age. Often in patients with positional vertigo, or postural fall, headache, nausea, vomiting, or tinnitus, deafness, blurred vision, tongue movement disorder, abnormal blood pressure, numbness, paresthesia, symptoms such as holding objects fall treatment. Often accompanied by clinical neurological symptoms of cervical spondylosis. The incidence rate of approximately 9.44% of cervical spondylosis.

, clinical manifestations

headache: is due to vertebrobasilar insufficiency resulting in vasodilation collateral circulation caused by a vascular headache. Often episodic emergence of sustainable minutes, hours or longer, paroxysmal increase in the attack. Early morning, when the car turning head and neck and symptoms. Pain mostly on one side, in the right occipital or pillow top, was throbbing, burning or acid pain, often starting from the back of the neck to the ear and the pillow top of the expansion, or bridge of the nose to the eyes and the Department of Radiology, may have a transient black eyes, flash as the other sign. Often accompanied by nausea, vomiting, sweating, birthday flow and palpitation, suffocation, blood pressure abnormalities, or facial, palate, tongue, throat pain, numbness, itching, and foreign body sensation.

occipital neuropathy is caused by a common cause of headache. Dominant vertebral artery occipital artery occipital nerve, clinical vertebral artery spasm caused by the greater occipital nerve ischemia and ischemia, there may be greater occipital nerve area of ​​the headache symptoms, the nature of intermittent throbbing pain; from the side of the neck radiation to the occipital and hemi-head, may be associated with burning sensation, hyperalgesia small number of patients showing the affected area, pain when touching the affected area scalp, hair and even touch that sense of pain. Trapezius branch dominated by the peripheral nerve, the nerve from 5 to 6 in the neck section, the root disease or trauma can cause trapezius muscle spasm, from Reattachment in the occipital squama to wear the trapezius aponeurosis out of the occipital nerve branch, due to the squeezing of symptoms. Ring or axial vertebral rotation displacement occurs between the piercing when the can from its arch occipital nerve damage or irritation, headache, local tenderness of the nerve.

vertigo: The most common symptoms of disease-oriented. Vertigo are: ① the surrounding landscape with its own direction of rotation or the illusion; ② body standing firm, self-inductance of the ground shaking move; ③ object tilt, subsidence, etc. Often change position, rotation or flexion over the head when induced or aggravated. Episodes of varying duration, can be very short, but also sustainable for several hours or longer. May be associated with tinnitus, hearing loss or progressive deafness. Rare nystagmus. Some patients in the rotation when the neck suddenly feeling weak and lower limbs suddenly fall, when the disease is more unconscious barriers to their stand in a short time patients can walk, which is the clinical vertebral artery type of cervical spondylosis at onset of a characteristic, and other cerebrovascular disease can be identified in disguise.

visual symptoms: mainly the posterior cerebral artery ischemia. Because cervical lesions caused by vertebral artery in spasm, secondary to occipital visual center of the brain damage caused by ischemia and sexually transmitted diseases, visual impairments, the light blurred vision or diplopia unclear symptoms, often for the onset of vision loss, eyes flash, scotoma, visual field defects or blindness, visual hallucination and so on. Because the vertebral artery through the posterior communicating artery and the carotid artery system is connected, there can also be reflective retinal artery spasm, causing eye pain, retinal vascular changes in tension, such as the retinal veins, and arteries become thin, especially when cervical hyperextension, or vascular retinitis and other spasms. Some cervical spondylosis, may be associated with blepharospasm, conjunctival hyperemia, corneal hypoesthesia or even the formation of ulcers, lacrimal gland disorder, retrobulbar optic neuritis, proptosis and glaucoma.

nerve root symptoms: As the local anatomy, common clinical vertebral artery in patients with cervical spondylosis, cervical radiculopathy can be combined with the symptoms of disease, or sympathetic cervical lesions symptoms, there are more complex pathological changes should be careful differential diagnosis.

other symptoms: a small number of patients may have symptoms of episodic disturbance of consciousness, such as excessive in a particular rotation or flexion neck when he suddenly felt dizziness and severe headache, and Soon syncope and even coma. Minutes that is better, the attack may have lethargy and mental changes. A few patients may suddenly numbness, weakness and fall, but sane, fell soon after getting up to walk, or excessive rotation, so there suddenly fell back. Occasional episodes of throat pain, and with ant line, tearing and foreign body sensation, or even dry cough, hoarseness, difficulty swallowing, choking, and gag reflex weakened hair and other symptoms.

in signs, the onset of neck activity for neck rotation or extension activities can cause dizziness, nausea, vomiting, palpitation and other symptoms. Some patients in the ipsilateral supraclavicular auscultation examination can be heard as distorted vertebral artery, blood flow obstruction caused by noise. Neck palpation thumb often found the risk of vertebral rotation to the side of the shift, the shift of the spinous process and facet joint tenderness.

Second, the diagnosis is based on

1, the neck have chronic fatigue or a history of trauma, in patients with neck palpation, can be found in some patients suffering from upper cervical vertebral displacement or other, the corresponding joint capsule swelling, tenderness. Some patients can be heard in the upper part of the ipsilateral clavicle blocked vertebral artery blood flow noise. Functional activities of the neck when the disease is limited.

2, middle-aged patients, often due to changes in head and neck postural dizziness, nausea, headache, or vision loss, tinnitus, deafness, tongue movement disorder, abnormal blood pressure . Such as long-term insufficiency, can occur cerebellum and occipital lobe brain damage symptoms (cerebral paresis, ataxia, nystagmus and other complex symptoms of central nervous system damage).

3, positional vertigo, or orthostatic fall patients to a significant reduction in neck rotation, extension activities, can cause dizziness or orthostatic fall; pressure head test was positive.

4, cervical spine is skewed X-ray film showed pathologic changes may be the risk of vertebral or rotational displacement. Rule out fracture, dislocation, tuberculosis, cancer and other diseases.

5. Other tests, such as cerebral blood flow map, EMG, ECG, blood, eyes, urine and other tests, if necessary, for the vertebral artery angiography.

Third, the differential diagnosis

(a) of the inner ear syndrome (Meniere's syndrome) ① often sudden onset, for four weeks at the scene or its illusion of rotation or shaking, seizures irritant (such as light, emotional waves, moving, etc.) to increase; ② often accompanied by severe nausea and vomiting, pale, sweating and other symptoms of the vagus nerve; ③ attack lasted, in l ~ 3 days and more gradually eased, as the repeated attacks, intermittent normally asymptomatic.

(b) of the benign paroxysmal vertigo often trauma, ear disease, old age, use of noise-induced injury and streptomycin allergy, so that the inner ear utricular otolith degeneration , shift (gravity effect) due. Identification: ① common 50 to 60 year-old woman; ② eyes open for the location of the detected position (3 to 6 seconds after) nystagmus; ③ pathologic examination as benign, may have recurrence.

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