经颅多普勒超声转颈试验阳性9例临床分析并文献复习

doi:10.3969/j.issn.1004-583X.2025.04.010

摘要/Abstract

摘要：

目的探讨经颅多普勒超声(transcranial doppler ultrasound,TCD)转颈试验阳性的血流频谱特点,旨在提高TCD操作医师对旋转性椎动脉闭塞的认识。方法回顾性分析于2023年8月-2024年8月在河北省人民医院神经内科门诊或病房就诊的头晕患者9例,主诉中均提及与头颈部活动相关的头晕症状。分析其临床资料及TCD转颈试验表现。结果 9例患者中,双侧椎动脉受累2例,单侧椎动脉受累7例。共涉及11条椎动脉,左侧受累7条,右侧受累4条,其中3条椎动脉在转颈后血流速度显著增快,其余受累椎动脉在转颈后血流速度明显减低甚至降至基线。其中3例在左侧椎动脉受累的同时,均合并右侧椎动脉纤细或未汇入基底动脉等情况。结论主诉头颈部活动相关的头晕患者,可利用TCD转颈试验进行筛查,能实时观察椎动脉血流动力学改变,为头晕病因的诊断提供线索。

关键词: 椎底动脉供血不足, 旋转性椎动脉闭塞, 经颅多普勒超声, 猎人弓综合征, 转颈试验

Abstract:

Objective To investigate the flow spectral characteristics of a positive transcranial Doppler ultrasound (TCD) neck rotation test, thus improving the understanding of rotational vertebral artery occlusion detected by TCD. Methods Nine patients with dizziness who attended outpatient clinics or admitted in the Department of Neurology in Hebei General Hospital from August 2023 to August 2024 were retrospectively analyzed. Dizziness symptoms related to head and neck movements were described in their chief complaints. Their clinical data and the performance of TCD neck rotation test were analyzed. Results Among the nine patients, two patients had bilateral vertebral artery involvement and seven patients had unilateral vertebral artery involvement. A total of eleven vertebral arteries were involved, including seven on the left side and four on the right side. Three of the vertebral arteries showed a significant increase in blood flow velocity after neck rotation, while the remaining showed a significant decrease in blood flow velocity or even to the baseline after turning the neck. In three cases, the left vertebral artery was involved and the right vertebral artery was thin or did not converge to the basilar artery. Conclusion Patients complaining of dizziness related to head and neck activity can be screened using the TCD neck rotation test, which enables real-time observation of vertebral artery hemodynamic changes and provides clues to the diagnosis of dizziness etiology.

Key words: vertebrobasilar insufficiency, rotational vertebral artery occlusion, transcranial doppler ultrasound, bow hunter's syndrome, neck rotation test

中图分类号:

R743.9

贾砚秋, 霍甜甜, 范鸣玥, 何莎莎, 靳玮, 吕佩源. 经颅多普勒超声转颈试验阳性9例临床分析并文献复习[J]. 临床荟萃, 2025, 40(4): 349-354.

Jia Yanqiu, Huo Tiantian, Fan Mingyue, He Shasha, Jin Wei, Lyu Peiyuan. Clinical analysis of nine cases with positive transcranial Doppler ultrasound neck rotation test and literature review[J]. Clinical Focus, 2025, 40(4): 349-354.

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https://lchc.magtechjournal.com/CN/Y2025/V40/I4/349

图/表 3

表1 9例TCD转颈试验阳性临床资料

Tab. 1 Clinical data of nine patients with positive TCD neck rotation test

例序	性别	年龄 (岁)	病例来源	主诉	颈部血管超声	MRA	累及动脉
1	女	44	门诊	间断头晕1周,以转头时明显	未见异常	-	R/LVA
2	男	34	门诊	间断头晕1月,与头部活动有关	-	-	R/LVA
3	女	58	门诊	发作性头晕2月余,与头部活动有关	RVA纤细	BA起源于LICA	LVA
4	男	46	住院	头部活动时头晕1月余	未见异常	RVA纤细,未汇入BA	LVA
5	女	59	门诊	头晕20余天,与头部活动有关	-	-	LVA
6	男	41	门诊	头晕恶心10余天,与头部活动有关	-	-	LVA
7	女	60	住院	头晕耳鸣20余天,头晕似乎与头部活动相关	未见异常	未见异常	RVA
8	男	22	门诊	间断头晕4年,向右侧转头时明显	-	RVA纤细,颅内段未见明确显示	LVA
9	男	30	门诊	转头时头晕1年,加重1周	-	-	RVA

图1 9例TCD转颈试验阳性患者VA频谱 a.病例1:向左侧转颈,RVA3血流速度降至基线; c. 病例1:向右侧转颈,LVA3血流速度明显减低; e. 病例2:向左侧转颈,RVA3血流速度降至基线; f. 病例2:向右侧转颈,LVA3血流速度明显升高; g. 病例3:向右侧转颈,LVA3血流速度明显减低; h. 病例4:向右侧转颈,LVA3血流速度降至基线; j. 病例5:向右侧转颈,LVA3血流速度明显减低; l. 病例6:向右侧转颈,LVA3血流速度明显减低; n. 病例7:向左侧转颈,RVA3血流速度明显减低; p. 病例8:向右侧转颈,LVA3血流速度明显升高; q. 病例9:向左侧转颈,RVA3血流速度明显升高; b、d、e、g、i、k、m、o.体位恢复后血流恢复。

Fig. 1 VA spectra of nine patients with positive TCD neck rotation test a. Case 1: Turning the neck to the left side, RVA3 blood flow velocity decreased to baseline; c. Case 1: Turning the neck to the right, the LVA3 blood flow velocity decreased significantly; e. Case 2: Turning the neck to the left, RVA3 blood flow velocity decreased to baseline; f. Case 2: Turning the neck to the right, the LVA3 blood velocity was significantly elevated; g. Case 3: Turning the neck to the right side, the LVA3 blood flow velocity was significantly reduced; h. Case 4: Turning the neck to the right side, LVA3 blood flow velocity decreased to baseline; j. Case 5: Turning the neck to the right side, LVA3 blood flow velocity was significantly reduced; l. Case 6: Turning the neck to the right side, LVA3 blood flow velocity was significantly reduced; n. Case 7: Turning the neck to the left side, RVA3 blood flow velocity was significantly reduced; p. Case 8: Turning the neck to the right side, the LVA3 blood flow rate was significantly elevated; q. Case 9: Turning the neck to the left side, the RVA3 blood flow rate was significantly elevated; b, d, e, g, i, k, m, o. Blood flow resumed after postural recovery.

表2 9例TCD转颈试验血流速度

Tab. 2 TCD neck rotation test blood flow velocity in nine patients

例序	LVA3转颈试验向右(cm/s)	RVA3转颈试验向左(cm/s)
1	30→10	34→0
2	32→91	46→0
3	29→5	10,探查欠满意
4	44→0	16,转颈无变化
5	22→10	53,转颈无变化
6	45→11	41,转颈无变化
7	40,转颈无变化	37→8
8	42→83	探查不满意
9	34,转颈无变化	29→110

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