| Part one Preliminary Application of High Frequency Ultrasound in the Superficial Temporal Artery and Occipital Nerve of MigraineObjective To investigate the vessels arranged,lumen diameter, peak systolic velocity(PSV),end diastolic velocity(EDV),resistence index( RI) and pulse index( PI) of superficial temporal artery(STA) and its frontal branch,and the cross-sectional area(CSA) and the morphological characteristics of occipital nerve(GON) in the specific site in migraine by high-frequency ultrasound. Methods Divided all the subjects into normal control group and study group diagnosed as migraine, the two groups were reassigned to 3 subgroups based on the age division standard formulated by the United Nations WHO : young group( n=47), aulte group(n=38) and elderly group(n=39);using high frequency ultrasound, observating the morphological characteristics of GON in the specific site and vessels arranged of STA on both sides of all subjects one by one,also the CSA value of GON and the numerical of lumen diameter,PSV,EDV and RI were measuremented, and statistics of those were analyzed among the subgroups between the normal control group and the study group. Results: 1.Ultrasound could show the normal and abnormal ultrasonograms of GON, and could clearly display the relationship between the GON and the surrounding muscles, fascia and vascular; the vessel wall and lumen of STA and its frontal branch were showed clear under Ultrasound,and there weren’t intimal thickening in the vessel wall,but the shape of STA might be flexed like the trans “S”in the auricular temporal regions,which cuold be found in normal adults and migraine. 2.The normal value of lumen diameter(cm),PSV(cm/s),EDV(cm/s),RI(%)and PI of the main vessel of STA were :0.195 ± 0.018,109.637 ± 14.229,22.482 ±7.183,0.795 ± 0.055 and 1.895 ± 0.398 respectively; the value of same measurement index in its frontal branch were :0.068± 0.011,60.677± 11.315,13.778 ± 3.789,0.769± 0.055 and 0.195 ± 0.018 respectively;the CSA value of GON was 0.036 ±0.005 cm2. 3.The comparison of measured value of the CSA of GON between the left or right side in normal groups and among the normal groups and their corresponding study groups hadn’t statistical significance(P>0.05). Migraines maight have headache complicated with damage of GON under ultrasound,the ratio of them among the three subgroups of the research group were respectively 42.55%,36.84% and 60.00%,and the rate of nerve injury among the three groups had no significant difference(P>0.05).4.The measured value of the lumen diameter, PSV, EDV, RI and PI of STA and its frontal branch on the left or right side hadn’t statistical significance(P>0.05).5. A comparative analysis of STA in normal groups and their corresponding study groups, the cases of the flexed shapes in the auricular temporal regions of STA in study groups were more than that in the normal groups,the difference wrere statistically significant in young research group and middle-age research group(P<0.05),but wasn’t in old research group(P>0.05);the mean value of the lumen diameter, PSV, EDV, RI and PI of the main vessel and the frontal branch of STA between the normal groups and their corresponding study groups displayed no statistical significance(P>0.05). 6. Analysis of STA of the onset of attacks and headache-free periods in study group, compared with the normal group, the mean values of RI and PI of the main vessel of STA were smaller, and the mean values of the EDV of the main vessel of STA and those of the PSV and EDV of the frontal branch of STA were bigger in the study group during attack period,the mean value of the RI and PI of the frontal branch of STA were bigger in the study group during interval period,those difference displayed statistical significance(P<0.05).Compared with the interval period, the mean values of the EDV of the main vessel of STA and the mean value of the PSV and EDV of the frontal branch of STA were bigger,and the mean value of the RI and PI of the main vessel and the frontal branch of STA were smaller in the study group during attack period,those difference had statistical significance(P < 0.05).Conclusion: 1. Ultrasound can clearly show the normal and abnormal images and have a significance on position of GON. The main vessel and the frontal branch of STA clearly visible under ultrasound, the shape of STA might be flexed in the auricular temporal regions.2.The normal range of lumen diameter(cm),PSV(cm/s),EDV(cm/s),RI(%)and PI of the main vessel of STA are :0.159-0.231、81.060-138.21、8.117-36.848、0.685-0.905、1.093-3.032 respectively;the range of normal value of the same measurement index in its frontal branch are:0.045-0.089、38.046-83.307、6.200-21.355、0.658-0.880、1.100-2.690 respectively;the range of normal value of the CSA of GON attached to fascia where it runs out trapezius muscle is : 0.037 ± 0.005cm2.3.The measured value of the CSA of GON on the left or right side in normal groups and among the normal groups and their corresponding study groups have no difference.Migraines may have headache complicated with damage of GON under ultrasound. 4.The measured value of lumen diameter, PSV, EDV and RI of the main vessel and the frontal branch of STA on the left or right side in normal groups have no difference,and the same in migraine patients and normal persons of the same age. 5. Young migraine and auldt migraine may be associated with the flexed shape in the auricular temporal regions. 6.The EDV of the main vessel of STA and the PSV and EDV of the frontal branch of STA are accelerated, and the RI and PI of the main vessel and the frontal branch of STA are decreased in the study group during attack period,while the RI and PI of the frontal branch of STA are increased in the study group during interval period.Part two Analysis of Lesion of Peripheral Nerve by High Frequency UltrasoundObjective: To characterize the Ultrasonic imagings and clinical date of paients with symptoms of single limb. Methods: Ultrasonographic and clinical data of 139 patients with symptoms of single limb in our hospital from October 2013 to October 2015 were reviewed.One hand,the 139 patients were divided into bilateral nerve injury group and unilateral nerve injury group,according to the symptoms, the two groups were reassigned to 2 subgroups: sensory disturbance and motor disturbance,and analyzed the features of symptoms of location, age, etiology and the situation of nerve damage. Results: The result showed that 85 patients were bilateral nerve damage and 54 cases were unilateral nerve damage(8 cases presented as nerve damage was opposite to symptoms)in 139 patients, the age of the bilateral nerve damage group were older than the unilateral nerve injury group(P<0.05), the location of symptoms presented at left or right in the two groups had no statistical significance(P>0.05), as well as the gender(P>0.05); symptoms of single limb were common in upper limb, and the main cause was peripheral nerve entrapment. Among the damage of upper limb nerves of the four groups, median nerves injuried were common except of the subgroup showed as motor disturbance in unilateral nerve injury group,which were common with ulnar nerve damdge; in the lower extremity nerves, either the patients showed as motor disturbance and the patients showed as sensory disturbance were focused on tibial nerves and peroneal. Conclusion: The peripheral nerve damage in the paients with symptoms of single limb are mainly present in upper limb and common in the median nerve and ulnar nerve and peroneal nerve and tibial nerve,the majority always showed as bilateral nerve injury, paients with symptoms of single limb are showed as bilateral nerve damage or unilateral nerve damage may be associated with age,and most of them are caused by peripheral nerve entrapment. |
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