| Background and ObjectiveVertigo is one of the most common symptoms in neurology clinic and the incidence rate of elderly patients over the age of 60 is as high as 30%.Vestibular Paroxysmia(VP)is one of the most common causes of vertigo has not caused the attention of clinician,the incidence of VP accounts for about 3.2%~4% of dizziness and vertigo outpatients.VP is mainly manifested as recurrent vertigo,often accompanied by tinnitus,postural instability and other symptoms.At present,the pathophysiological mechanism of VP is not very clear,most scholars think that the pathophysiological mechanism is similar to that of trigeminal neuralgia and hemifacial spasm,related to neurovascular cross-compression(NVCC).Because of the clinical symptoms and examinations of VP are not specific,lead the clinician lack of knowledge of VP and attention to VP is not enough,it is often misdiagnosed as benign paroxysmal positional vertigo,Meniere’s disease and other peripheral vertigo disease,therefore,to improve the knowledge and understanding of VP is helpful to increase the correct diagnosis rate of vertigo patients.In recent years,domestic and foreign literatures of VP gradually increased,most of the studies is about the VP’s clinical characteristics,the imaging of magnetic resonance imaging(MRI)and the characteristics of brainstem auditory evoked potential,the treatment of antiepileptic drugs and microvascular decompression etc.We had also made VP patients and other patients with vertigo disease(non VP patients)comparative study of features between images,however the imaging features of different responsibility vascular of VP without further discussion,there also has not been reported about this aspect.In previous studies we found that different vascular compression in VP with different characteristics,such as direct compression of vertebral artery has the characteristics of heavy pressure and high incidence,and there is no relevant research on this type of oppression.Therefore,our study is to explore the MRI characteristics of VP caused by vertebrobasilar artery compression,in order to enable clinicians to have a better understanding of this type of VP.Methods64 cases of VP were collected and further divided into vertebrobasilar artery compression group(observation group,32 cases)and non-vertebrobasilar artery compression group(control group,32 cases).Three dimensional time of flight magnetic resonance angiography(3D-TOF-MRA)scan were carried out in all the cases,and whether there was NVCC and the subtypes of NVCC were judged by a professional radiologist.Furthermore the subtypes of NVCC,the distance between NVCC site and the brainstem,the diameter of both vertebral artery and basilar artery and the variation of bilateral vertebral artery diameter were also collected and analyzed.ResultsThere was statistically significant between the two groups in NVCC type(χ2 =14.874,P =0.002,P<0.05),in observation group the NVCC type mainly composed of I type and IV type compression,the control group is dominated by I type and III type compression,the heavy pressure compression(III type and IV type compression)(52.78%)in observation group was higher than that of the control group(37.84%).The distance between NVCC site and brainstem in observation group(6.26 ± 2.02)mm was significantly shorter than control group(8.17 ± 1.98)mm(t =–3.872,P =0.000,P<0.01);while there was no difference between the two groups in vertebral artery diameter which was(3.53 ± 0.42)mm in observation group and(3.44 ± 0.31)mm in control group respectively(t =0.962,P =0.340,P>0.05);And there was no difference in the diameter of basilar artery between observation group(3.74 ± 0.41)mm and control group(3.65 ± 0.29)mm(t =0.992,P =0.326,P>0.05)either;But the bilateral vertebral artery diameter different in observation group(1.09 ± 0.31)mm was significantly higher than of the control group(0.82 ± 0.35)mm(t =3.330,P =0.001,P<0.05).Conclusions1.In vertebrobasilar artery compression subtype of VP,I type and IV type NVCC type is common,and compared to non-vertebrobasilar artery compression VP,the degree of compression is more severe.2.The distance between NVCC site and brainstem in vertebrobasilar artery compression subtype of VP was the closer compared to non-vertebrobasilar artery compression VP,the distance most between 6~10mm.3.The differences of bilateral vertebral artery diameter between was larger compared to non-vertebrobasilar artery compression VP4.Vertebral artery dominance and / or vertebrobasilar artery tortuosity may play an important role in the pathogenesis of vertebrobasilar artery compression subtype of VP. |
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