“椎基底动脉供血不足”的概念还有用吗？
上海第一人民医院分院神经科 (200081)
椎基底动脉供血不足(VBI)描述了由后循环对脑的供血降低这个共同的病理生理过程所引起的广泛的临床表现。1950年代，在Fisher用“颈动脉供血不足”来描述常常是颈动脉分支梗死前兆的前循环的TIA后，VBI被广泛应用。虽然“颈动脉供血不足”这个晦涩难懂的概念已不再使用，但VBI仍被使用以涵盖后循环的所有TIA。
脑干是神经活动的重要部位，在狭小的空间内分布有颅神经、网状激活系统和上下行的运动感觉神经传导束，一旦出现因血供障碍所引起的神经功能损害，则表现为多种不同但有常常重叠的综合症。VBI的症状主要有：言语不清、恶心和呕吐、麻木、不稳而不能行走或站立(共济失调)、突发眩晕、视觉改变(视力丧失、复视或眼震)以及肢体无力。
VBI的诊断需要进行透露CT、MRI、MRA等检查。近来神经影像学的发展，对VBI的患病有了新的认识，有研究报道约40%的VBI者有脑干梗死。因此，VBI的概念已应用的越来越少，并被“后循环缺血”(posterior circulation ischaemia)概念所替代。
, 百拇医药
但是，VBI仍在我国被神经科、全科、内科、老年科、中医科和骨科广泛使用。VBI最常被用来诊断有颈椎骨质增生的影像学证据、发生于中老年人群的单纯的头晕/眩晕。诊断的理论假设是骨质增生致椎基底动脉血供不足，使得对缺血敏感的前庭神经核功能异常，进而产生头晕/眩晕(顾名思义是供血不足而非缺血)。许多医生没有能够详细地了解病史和做仔细的神经系统检查，而且错误地认为中老年人的单纯头晕/眩晕的主要原因是VBI而不是前庭周围病变或精神疾患。更为糟糕的是，由于认为VBI不是缺血(不是TIA或梗死)，故没有对诊断为VBI的患者进行积极的血管性危险因素检查，对之治疗也不遵循科学证据(控制血管危险因素、阿司匹林或抗凝等)。
为彻底纠正这种混乱的状况，必须采取以下有效的措施。首先，国家的学术性的诊断标准必须依据临床证据而更新，应采用“后循环缺血”的概念来代替有误导意义的概念“椎基底动脉供血不足”。第二，要建立国家级的大的临床数据库。第三，积极推动和开展采用新概念的医学继续再教育。
, 百拇医药 Is the concept “vertebrovascular insufficiency” still usefulness ?
LI Yansheng
Vertebrovascular insufficiency (VBI) describes a wide spectrum of clinical entities with a common pathophysiology that is a decreased blood flow through the arteries that supply blood to the base of the brain. This more commonly used term developed in the 1950s after Fisher introduced the term carotid insufficiency to describe TIAs of the anterior circulation, which frequently serve as the prodrome to carotid branch infarcts. Although carotid insufficiency has been dropped from common medical jargon, VBI persists as the term that encompasses all TIA syndromes of the posterior circulation.
, http://www.100md.com
The brain stem is a focal point of neurologic activity, housing cranial nerves, the reticular activating system, and a series of ascending and descending neurosensory tracts. When this compact area of neurologic activity malfunctions as a result of impaired blood flow, several different but overlapping clinical syndromes can result. Symptoms of VBI include difficulty speaking clearly, nausea and vomiting, numbness, unsteadiness that causes the inability to stand or walk (ataxia),vertigo that begins suddenly, vision changes (such as vision loss, diplopia, or nystagmus),as well as weakness.
, http://www.100md.com
Vertebrobasilar insufficiency is diagnosed using CT or MRI scans of the brain, and sometimes angiography, or magnetic resonance angiography (MRA). Recent developments in neuroimaging provide new perspectives about the disease's prevalence. Some studies utilizing MRI suggest that 40% of patients with vertebrobasilar TIAs have evidence of brainstem infarction.
So the term of “vertebrovascular insufficiency” is used less recently and is replaced by the term “posterior circulation ischaemia”.
, http://www.100md.com
However, VBI is being misused in China greatly, especially by the neurologists, family physicians, general internalists, geriatricians, and orthopedists. VBI is commonly diagnosed in adults and the elderly when there is isolate dizziness/vertigo and imaging evidence of cervical spondylosis by the presumption that spondylosis causing insufficient blood supply to ischaemia-sensitive vestibular nuclear resulting dizziness/vertigo (so called vertebrovascular insufficiency, just as its name implies). Most physicians don’t pay attention to obtaining detail history and do careful neurological examinations and wrongly believing that isolated dizziness/vertigo in adult and elderly are commonly caused by VBI but not peripheral vestibular disorders and psychiatric disorders. So much the worse, the possible cerebrovascular risk factors of the condition are not being extensively probed (MRI, MRA, CTA, DSA, etc), the condition is considered benign (not TIA or warning of stroke), and the drug treatment of VBI is not evidence-based (control cerebrovascular risk factors, aspirin, or anticoagulants).
, 百拇医药
To thoroughly change the chaotic situation, effective measures should be adopted. First at all, national academic diagnostic criteria should be updated according to the evidences and the misleading term “vertebrovascular insufficiency” should be replaced by the term “posterior circulation ischaemia”. Secondly, national wild clinical database should be established. Thirdly, continue medical education programs with newly defined term should be promoted., 百拇医药(李焰生)
椎基底动脉供血不足(VBI)描述了由后循环对脑的供血降低这个共同的病理生理过程所引起的广泛的临床表现。1950年代，在Fisher用“颈动脉供血不足”来描述常常是颈动脉分支梗死前兆的前循环的TIA后，VBI被广泛应用。虽然“颈动脉供血不足”这个晦涩难懂的概念已不再使用，但VBI仍被使用以涵盖后循环的所有TIA。
脑干是神经活动的重要部位，在狭小的空间内分布有颅神经、网状激活系统和上下行的运动感觉神经传导束，一旦出现因血供障碍所引起的神经功能损害，则表现为多种不同但有常常重叠的综合症。VBI的症状主要有：言语不清、恶心和呕吐、麻木、不稳而不能行走或站立(共济失调)、突发眩晕、视觉改变(视力丧失、复视或眼震)以及肢体无力。
VBI的诊断需要进行透露CT、MRI、MRA等检查。近来神经影像学的发展，对VBI的患病有了新的认识，有研究报道约40%的VBI者有脑干梗死。因此，VBI的概念已应用的越来越少，并被“后循环缺血”(posterior circulation ischaemia)概念所替代。
, 百拇医药
但是，VBI仍在我国被神经科、全科、内科、老年科、中医科和骨科广泛使用。VBI最常被用来诊断有颈椎骨质增生的影像学证据、发生于中老年人群的单纯的头晕/眩晕。诊断的理论假设是骨质增生致椎基底动脉血供不足，使得对缺血敏感的前庭神经核功能异常，进而产生头晕/眩晕(顾名思义是供血不足而非缺血)。许多医生没有能够详细地了解病史和做仔细的神经系统检查，而且错误地认为中老年人的单纯头晕/眩晕的主要原因是VBI而不是前庭周围病变或精神疾患。更为糟糕的是，由于认为VBI不是缺血(不是TIA或梗死)，故没有对诊断为VBI的患者进行积极的血管性危险因素检查，对之治疗也不遵循科学证据(控制血管危险因素、阿司匹林或抗凝等)。
为彻底纠正这种混乱的状况，必须采取以下有效的措施。首先，国家的学术性的诊断标准必须依据临床证据而更新，应采用“后循环缺血”的概念来代替有误导意义的概念“椎基底动脉供血不足”。第二，要建立国家级的大的临床数据库。第三，积极推动和开展采用新概念的医学继续再教育。
, 百拇医药 Is the concept “vertebrovascular insufficiency” still usefulness ?
LI Yansheng
Vertebrovascular insufficiency (VBI) describes a wide spectrum of clinical entities with a common pathophysiology that is a decreased blood flow through the arteries that supply blood to the base of the brain. This more commonly used term developed in the 1950s after Fisher introduced the term carotid insufficiency to describe TIAs of the anterior circulation, which frequently serve as the prodrome to carotid branch infarcts. Although carotid insufficiency has been dropped from common medical jargon, VBI persists as the term that encompasses all TIA syndromes of the posterior circulation.
, http://www.100md.com
The brain stem is a focal point of neurologic activity, housing cranial nerves, the reticular activating system, and a series of ascending and descending neurosensory tracts. When this compact area of neurologic activity malfunctions as a result of impaired blood flow, several different but overlapping clinical syndromes can result. Symptoms of VBI include difficulty speaking clearly, nausea and vomiting, numbness, unsteadiness that causes the inability to stand or walk (ataxia),vertigo that begins suddenly, vision changes (such as vision loss, diplopia, or nystagmus),as well as weakness.
, http://www.100md.com
Vertebrobasilar insufficiency is diagnosed using CT or MRI scans of the brain, and sometimes angiography, or magnetic resonance angiography (MRA). Recent developments in neuroimaging provide new perspectives about the disease's prevalence. Some studies utilizing MRI suggest that 40% of patients with vertebrobasilar TIAs have evidence of brainstem infarction.
So the term of “vertebrovascular insufficiency” is used less recently and is replaced by the term “posterior circulation ischaemia”.
, http://www.100md.com
However, VBI is being misused in China greatly, especially by the neurologists, family physicians, general internalists, geriatricians, and orthopedists. VBI is commonly diagnosed in adults and the elderly when there is isolate dizziness/vertigo and imaging evidence of cervical spondylosis by the presumption that spondylosis causing insufficient blood supply to ischaemia-sensitive vestibular nuclear resulting dizziness/vertigo (so called vertebrovascular insufficiency, just as its name implies). Most physicians don’t pay attention to obtaining detail history and do careful neurological examinations and wrongly believing that isolated dizziness/vertigo in adult and elderly are commonly caused by VBI but not peripheral vestibular disorders and psychiatric disorders. So much the worse, the possible cerebrovascular risk factors of the condition are not being extensively probed (MRI, MRA, CTA, DSA, etc), the condition is considered benign (not TIA or warning of stroke), and the drug treatment of VBI is not evidence-based (control cerebrovascular risk factors, aspirin, or anticoagulants).
, 百拇医药
To thoroughly change the chaotic situation, effective measures should be adopted. First at all, national academic diagnostic criteria should be updated according to the evidences and the misleading term “vertebrovascular insufficiency” should be replaced by the term “posterior circulation ischaemia”. Secondly, national wild clinical database should be established. Thirdly, continue medical education programs with newly defined term should be promoted., 百拇医药(李焰生)