RU2392843C2 - Method of blood circulation disorder diagnostics in carotid and vertebral arterial system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be applied in diagnostics of blood circulation disorders in carotid and vertebral arterial system. It involves arterial pressure response measurement at brachial artery in the first 3 minutes after head turning aside to the maximum possible extent, and comparison of obtained arterial pressure figures to initial values in the given time interval over 1.0-1.5 minute periods. Then the examination is repeated with head turning to the other side and tilting forward and back, and the results obtained are compared to arterial pressure figures determined previously for healthy people.

EFFECT: detection of vertebrogenic and atherosclerotic causes of blood circulation disorders in carotid and vertebral arterial system by non-invasive, simple and viable method, dynamics examination, and assessment of performed therapy efficiency.

3 ex, 12 dwg

Description

The present invention relates to medicine, namely to functional diagnostics, and for the diagnosis of circulatory disorders in the system of carotid and vertebral arteries.

We already know the diagnosis of circulatory disorders in the system of carotid and vertebral arteries - rheoencephalography with functional tests by turns and tilts of the head, which is based on the principle of recording changes in the electrical resistance of tissues due to changing blood supply (Yarullin Kh.Kh. Clinical rheoencephalography. - L .: Medicine , 1967. - p.13-48).

The latter technique, adopted as a prototype, requires special expensive equipment, training of research specialists, and time-consuming calculations and analysis of a large number of indicators.

The aim of the invention is to identify vertebrogenic and atherosclerotic causes of blood supply disorders in the system of carotid and vertebral arteries.

This goal is achieved by measuring the response of arterial pressure to the brachial artery in the first 3 minutes when turning the head to the side to the maximum possible and comparing the obtained values of blood pressure relative to the initial ones in a given time interval with a frequency of 1.0-1.5 minutes, after which study is repeated with the head turning in the opposite direction, as well as with the head tilted forward and backward, and the results are compared with previously established arterial parameters pressure healthy.

Figure 1 - presents the reaction of systolic and diastolic blood pressure when turning the head to the right in a healthy patient; figure 2 - presents the reaction of systolic and diastolic blood pressure when turning the head to the left in a healthy patient; figure 3 - presents the reaction of systolic and diastolic blood pressure when tilting the head forward in a healthy patient; figure 4 - presents the reaction of systolic and diastolic blood pressure when tilting the head back in a healthy patient; figure 5 - presents the reaction of systolic and diastolic blood pressure when turning the head to the right in a patient with instability of the motor segments of the cervical spine; figure 6 - presents the reaction of systolic and diastolic blood pressure when turning the head to the left in a patient with instability of the motor segments of the cervical spine; Fig.7 - presents the reaction of systolic and diastolic blood pressure when tilting the head forward in a patient with instability of the motor segments of the cervical spine; on Fig - presents the reaction of systolic and diastolic blood pressure when tilting the head back in a patient with instability of the motor segments of the cervical spine; figure 9 - presents the reaction of systolic and diastolic blood pressure when turning the head to the right in a patient with hemodynamically significant stenosis of the carotid artery on the left; figure 10 - presents the reaction of systolic and diastolic blood pressure when turning the head to the left in a patient with hemodynamically significant stenosis of the carotid artery on the left; figure 11 presents the reaction of systolic and diastolic blood pressure when tilting the head forward in a patient with hemodynamically significant stenosis of the carotid artery on the left; on Fig - presents the reaction of systolic and diastolic blood pressure when tilting the head back in a patient with hemodynamically significant stenosis of the carotid artery on the left.

The method is illustrated by the following specific examples of its implementation.

Example 1

Patient N., 29 years old, student. Complaints of periodically occurring headaches with prolonged psycho-emotional stress, passing on their own at rest and when taking analgesics. No additional complaints at the time of inspection. From the anamnesis: over the past year I began to notice episodes of headaches, increased fatigue. Objectively: a satisfactory condition, proper physique, satisfactory nutrition. Blood pressure during examination 125/70 mm Hg Heart sounds are clear, the rhythm is correct, the heart rate is 68 beats per minute. In the lungs, vesicular breathing, wheezing is not heard, the respiratory rate of 16 per minute. The abdomen on palpation is soft, painless. No swelling. According to the daily monitoring of blood pressure - arterial hypertension was not detected. On electrocardiography without features. Fundus: no change. X-ray of the chest: the departments of the heart are not enlarged, infiltrative and focal changes in the lung tissue were not detected. X-ray of the skull: no pathological changes were found. Radioisotope renography: kidney function preserved. Urine and blood tests without clinically significant changes.

In order to identify signs of a violation of blood supply in the system of vertebral and carotid arteries, the patient is tested according to the proposed method. The method is as follows.

Before the study, the patient is informed about the goals and objectives of the study and the possible development of discomfort, such as dizziness, headache, sudden changes in blood pressure, heart rhythm disturbance. Take informed consent to conduct the study. The study is carried out in comfortable conditions with the exception of external influences, sound and noise protective modes at room temperature. The patient should not have tight clothing squeezing the neck area. The study is carried out in a sitting position with the obligatory presence of a chair back, which makes it possible to emphasize the back in order to minimize the isometric contraction of the spinal muscles associated with an upright position. For these purposes, use the vertical back of the chair with a permissible deviation of the back at an angle of no more than 80-90 degrees. The patient sits, leaning on the back of a chair, with relaxed, unbaptized legs. The study is carried out after at least 5 minutes of rest. Immediately before the study, a visual and superficial manual examination of the neck area is carried out. After that, blood pressure is measured in the initial vertical (without tilt), direct (without turns) head position. Within 3 minutes, blood pressure is measured in the starting position at intervals of 1.0-1.5 minutes. Blood pressure is measured on the forearm using any known method in manual or automatic mode using auscultatory, oscillometric and combined measurement principles. Blood pressure measurements with a similar periodicity are subsequently carried out in four successively changing head-neck positions:

1) the maximum turn of the head to the right (turn to the right),

2) the maximum head left (turn left),

3) the maximum inclination of the head forward to fixation of the chin of the chest (tilt forward),

4) the maximum extension of the head back (tilt back).

All motor maneuvers of the head-neck are carried out in a fixed, direct position of the body. Each positional stage of the study is completed by returning the head to its original position - a straight position with a recovery period of 3 minutes. The results are compared with the established blood pressure indicators when turning the head to the right, turning the head to the left, tilting the head forward, tilting the head back in healthy people (table 1).

Table number 1 Head position during the test The rate of change in systolic blood pressure (mmHg) The rate of change in diastolic blood pressure (mmHg) Head turn right 4,5-5,7 2.7-5.6 Head turn left 2.7-6.7 2.5-5.9 Head tilted forward -7.4 - -5.0 -4.6 - -5.6 Head tilt back 2.2-7.8 4.7-6.9

Examination revealed:

Analyze the results. When turning the head to the right at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial vertical (without tilt), direct (without turns) head position is +5 mm Hg, the diastolic blood pressure response relative to the diastolic in the initial position of the head is +5 mm Hg (figure 1). When turning the head to the left at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +6 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (figure 2). With a maximum head tilt forward at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is -7 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is -5 mm RT. Art. (figure 3). When the head is extended backward at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +7 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +6 mm Hg . (figure 4).

Conclusion: the dynamics of systolic and diastolic blood pressure corresponds to the established indicators of systolic and diastolic blood pressure in healthy people. No positional hypertensive signs of circulatory disorders in the carotid and vertebral arteries were detected.

An additional examination is carried out in order to confirm the data obtained according to the claimed method: radiography of the cervical spine with functional tests - instability (displacement) of the motor segments of the cervical vertebrae was not detected; Doppler ultrasound of the brachiocephalic arteries - pathological changes in the carotid and vertebral arteries were not detected.

Radiography of the cervical spine with functional tests and ultrasound dopplerography confirm the results obtained by the claimed method.

Example 2

Patient B-in, 45 years old, laboratory assistant. He entered a hospital with complaints of an increase in blood pressure to a level of 160/100 mm Hg. For 5 years, almost constant headaches, mainly in the occipital region, aggravated in the morning, after sleep, with prolonged work in a slope, shaking riding in vehicles, have been troubling, he feels tightness of the neck muscles, numbness of the fingers in the morning, and increased fatigue.

He had a head injury at the age of 38. 1.5 years after the injury, headaches began to be disturbed, mainly in the occipital region of the head, sometimes staggering when walking, instability of blood pressure figures with maximum rises of up to 170/100 mm Hg. Objectively: a satisfactory condition, proper physique, satisfactory nutrition. Upon examination of the figures, blood pressure was 160/90 mm Hg. Heart sounds are muffled, the rhythm is correct, the heart rate is 78 beats per minute. In the lungs, vesicular breathing, wheezing is not heard, the respiratory rate is 17 per minute. The abdomen on palpation is soft, painless. No swelling. On electrocardiography: signs of left ventricular hypertrophy. In blood tests, urine tests without features. Chest x-ray: the heart is moderately enlarged due to the left ventricle. Fundus: hypertensive angioretinopathy. According to the daily monitoring of blood pressure revealed arterial hypertension.

Against the background of antihypertensive therapy in the hospital, the patient notes the stabilization of blood pressure figures, however, headaches continue to be disturbed, mainly in the occipital region.

It is made as described in example 1.

Examination revealed:

Time (minutes) Blood pressure (systolic / diastolic) Change in blood pressure (systolic / diastolic) Starting position of the head one 140/86 2 140/85 ---- 3 140/85 Head turn right one 140/87 2 143/90 3 145/90 + 5 / + 5 Starting position of the head one 150/85 2 145/85 ---- 3 145/85 Head turn left one 145/85 2 148/90 3 150/90 + 5 / + 5 Starting position of the head one 145/85 2 140/85 ---- 3 140/85 Head tilted forward one 145/90 2 149/95 3 160/100 + 20 / + 15 Starting position of the head one 150/90 2 145/85 ---- 3 145/85 Head tilt back one 1145/87 2 150/90 3 152/90 + 7 / + 5

Analyze the results. When turning the head to the right at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +5 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (figure 5). When turning the head to the left at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +5 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (Fig.6). With a maximum head tilt forward at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +20 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +15 mm RT. Art. (Fig 7). When the head is extended backward at the 3rd minute of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +7 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (Fig. 8).

Conclusion: when the head is tilted forward, the pronounced dynamics of systolic and diastolic blood pressure is recorded, which goes beyond the established parameters of blood pressure in healthy people. Positional hypertensive signs of circulatory disorders in the vertebral arteries associated with the presence of a vertebrogenic cause, namely instability of the vertebral segments of the cervical spine.

An additional examination is carried out in order to confirm the data obtained by the claimed method. X-ray of the cervical spine with functional images: with maximum bending of the head, the displacement (instability) of the motor segments C5-C6 of the cervical vertebrae is detected. Doppler ultrasound of the brachiocephalic vessels: pronounced bending of the vertebral arteries in the area of entry into the bone canal. Systolic linear velocity of blood flow in the vertebral arteries - increased. Radiography of the cervical spine with functional tests and ultrasound dopplerography confirm the results obtained by the claimed method.

Example 3

Patient L., 68 years old, a pensioner, over the past 8 years has noted an increase in blood pressure to the level of 180/100 mm Hg. Antihypertensive drugs are not regularly taken. Occasionally, with an increase in blood pressure, Corinfarum is used. During the last year, when turning the head to the left, he noted the occurrence of episodes of dizziness, accompanied by sweating, a sense of fear, pronounced general weakness, headache, mainly of the temporal region on the left. Injuries to the cervical spine - denied. Objectively: the condition is satisfactory. The skin is clean, normal color. Peripheral lymph nodes are not enlarged. In the lungs, vesicular breathing, wheezing is not heard, the respiratory rate is 18 per minute. Heart sounds are muffled, the rhythm is correct, the heart rate is 78 beats per minute. Blood pressure 160/90 mm Hg The abdomen on palpation is soft, painless. No swelling. In blood tests, urine pathological changes were not detected. On electrocardiography and ultrasound examination of the heart, signs of left ventricular myocardial hypertrophy were revealed. According to the daily monitoring of blood pressure revealed arterial hypertension. Based on the examination of the patient, the diagnosis was made: Hypertension II stage. Grade I with a high gradation of risk.

It is made as described in example 1.

Examination revealed:

Time (minutes) Blood pressure (systolic / diastolic) Change in blood pressure (systolic / diastolic) Starting position of the head one 145/86 2 140/85 ---- 3 140/85 Head turn right one 145/90 2 147/90 3 150/90 + 10 / + 5 Starting position of the head one 150/85 2 145/85 ---- 3 145/85 Head turn left one 155/90 2 165/95 3 177/105 + 32 / + 20 Starting position of the head one 145/85 2 135/85 ---- 3 135/85 Head tilted forward one 135/85 2 140/90 3 140/90 + 5 / + 5 Starting position of the head one 135/90 2 135/85 ---- 3 135/85 Head tilt back one 140/87 2 142/90 3 145/93 + 7 / + 8

Analyze the results. When turning the head to the right at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +10 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (Fig.9). When turning the head to the left at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +32 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +20 mm Hg . (figure 10). With a maximum head tilt forward at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position is +5 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is +5 mm Hg . (Fig.11). When the head is extended backward at 3 minutes of measurement, the response of the systolic blood pressure relative to the systolic blood pressure in the initial position of the head is +7 mm Hg, the response of the diastolic blood pressure relative to the diastolic blood pressure in the initial position of the head is + 8 mm Hg . (Fig. 12). Conclusion: when turning the head to the left, pronounced dynamics of systolic and diastolic blood pressure was recorded, exceeding the established parameters of blood pressure in healthy people. Positional hypertensive signs of a disturbance in the blood supply to the left carotid artery associated with an atherosclerotic cause.

An additional examination is carried out in order to confirm the data obtained by the claimed method. Doppler ultrasound of the brachiocephalic arteries: a 2.2 cm plaque was revealed on the left side of the bulb of the main carotid artery and the proximal part of the internal carotid artery, an increase in the linear blood flow velocity in the main carotid artery, and the internal carotid artery was distal to the plaque. Hemodynamically significant stenosis of the internal carotid artery on the left is more than 70%. Doppler ultrasound of the brachiocephalic arteries confirms the results obtained by the claimed method.

In total, 185 patients were examined using this method: 122 women and 63 men aged 25 to 65 years. Of these, 48 patients were in the healthy group; In 107 patients, the claimed method revealed a vertebrogenic cause of a blood supply disturbance in the vertebral artery system (instability of the cervical vertebrae), 30 patients revealed an atherosclerotic cause of a blood supply disturbance in the carotid artery system (hemodynamically significant carotid artery stenosis).

The present method is not obvious for specialists faced with cerebrovascular pathology (general practitioners, cardiologists, neurologists, doctors of functional diagnostics). In practice, the prototype of the claimed method, which is based on a positional change in the head-neck, does not use a blood pressure measurement to detect a violation of blood supply in the carotid and vertebral arteries. For these purposes, subjective sensations of the patient and conductometric indicators of rheoencephalography are used. We have shown for the first time that using simple and accessible methods for measuring blood pressure using any apparatus for measuring blood pressure using functional tests with turns and tilts of the head, we can reliably characterize the signs of a decrease in blood supply in the system of carotid and vertebral arteries, which is a consequence of vertebral or atherosclerotic cause.

The claimed method is a non-invasive method of choice. A significant advantage of the method is its accessibility, ease of use, cost-effectiveness, high information content and specificity, the ability to conduct research in dynamics, in particular, evaluating the effectiveness of the therapy.

Claims (1)

A method for diagnosing circulatory disorders in the system of carotid and vertebral arteries by means of functional tests with turns and tilts of the head relative to the body, characterized in that in order to identify the vertebrogenic and atherosclerotic causes of circulatory disorders, the response of blood pressure to the brachial artery is measured in the first 3 minutes when the head is turned to the side to the maximum possible and compare the obtained values of blood pressure relative to the original in a given time interval with periodicity 1.0–1.5 min, after which the study is repeated with the head turning in the opposite direction, as well as tilting it back and forth and comparing the results with previously established blood pressure indicators in healthy individuals: the rate of change in systolic blood pressure at turning the head to the right - 4.5-5.7 mm Hg, when turning the head to the left - 2.7-6.7 mm Hg, tilting the head forward - (-7.4) - (- 5 , 0) mmHg, with a tilt of the head back - 2.2-7.8 mmHg, the rate of change of diastolic blood pressure at head turn to the right - 2.7-5.6 mm Hg, when turning the head to the left - 2.5-5.9 mm Hg, with the head tilted forward - (-4.6) - (- 5 , 6) mmHg, with the head tilted back - 4.7-6.9 mmHg

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