Method for detecting the mechanism in alteration of vertebro- basillar circulation in children

FIELD: medicine, neurology.

SUBSTANCE: a patient should be in initial position when his/her sight is directed towards the ceiling and in 3-5 min it is necessary to register a background rheoencephalogram, then a patient should fix the sight at a pointer's tip being at the distance of about 30 cm against the bridge of nose along the middle line, then the sight should be directed into marginal position due to shifting pointer to the left. Then the sight should be returned into initial position and 3 min later it is necessary to register rheoencephalogram of vertebro-basilar circulation, calculate rheographic index (RI), coefficient for RI ratio on returning the sight from left-hand marginal position into initial one (k2) and at k2>1.098 from the left and (or) k2>1.085 from the right one should detect alteration in vertebro-basilar circulation by reflector mechanism. The method excludes biomechanical impact in stimulating proprioceptive receptors of muscular-ligamentous system under stretching.

EFFECT: higher accuracy and reliability of detection.

2 ex, 2 tbl

 

The invention relates to medicine, specifically to neurology.

Known method of rheoencephalography to assess the vertebro-basilar blood flow in children and adults [1, 2, 3]. The method consists in carrying out rheoencephalography the patient in the supine position or sitting by recording rheoencephalography the vertebro-basilar blood flow when the patient's head is in the normal position of rest, as well as conducting functional tests: write rheoencephalogram the vertebro-basilar blood flow at the extreme head rotation to the right or left side. Define eographically index, compare its value in the initial position and the functional test.

However, the described method does not allow to determine the mechanism of changes in the vertebro-basilar blood flow. Functional test of rotation of the head in an extreme situation is a complex physiological mechanisms of change in the vertebro-basilar blood flow: biomechanical effects due to displacement of the vertebrae and muscles of predominantly upper cervical spine, the reflex influence due to irritation of proprioceptive receptors stretched muscular-ligamentous apparatus [4]. In addition, the known influence of rotation of the eyeballs at the same rotation of the head [5].

The task of the invention is the determination of the reflector is even changing mechanism violations of the vertebro-basilar blood flow.

This object is achieved in that are rheoencephalography not the vertebro-basilar blood flow in the patient lying, and looking towards the ceiling, after 3-5 minutes of rest record background rheoencephalogram the vertebro-basilar blood flow, then the patient fixes his gaze on the tip of the pointer, located at a distance of 30 cm from the nose to the middle line, then the patient moves his eyes to the end position after moving to the left side of the pointer, after 5 seconds after turning the eyes produce a record of rheoencephalography the vertebro-basilar blood flow, then eyeballs returned to its original position of rest, when looking towards the ceiling, and after 3 minutes, record rheoencephalogram the vertebro-basilar blood flow, calculate eographically index (RI), the ratio of RI during rotation of the eyeballs to RI the initial state (k1), the ratio of RI after turning eyeballs after 3 minutes of rest to RI the initial state (k2and when the value of k2>1,098 left and (or) k2>1,085 right to determine the change in the vertebro-basilar blood flow by reflex mechanism.

The essence of the invention lies in the fact that it was making a rheoencephalography not the vertebro-basilar blood flow in the supine position, with head and Chany the spine is placed on the cotton-gauze roller in the form of a ring, the eyes of the patient staring at the ceiling. After 3-5 minutes of rest record background rheoencephalogram the vertebro-basilar blood flow. Perform functional test: the patient fixes his gaze on the tip of the pointer, located at a distance of 30 cm from the nose in the midline, then, shifting the pointer in the left side of the patient, transferred his gaze to the end position for 5 seconds after turning the eyes hold the record of rheoencephalography the vertebro-basilar blood flow. After the recording of rheoencephalography eyeballs return to its original resting position, when looking towards the ceiling, and after 3 minutes, record rheoencephalogram the vertebro-basilar blood flow. Calculate eographically index (RI), the ratio of RI during rotation of the eyeballs to RI the initial state (k1), the ratio of RI after turning eyeballs after 3 minutes of rest to RI the initial state (k2and when the value of k21,098 left and (or) 1,085 right, determine the change in the vertebro-basilar blood flow by reflex mechanism.

For a better understanding of the essence of the method proposed specific examples:

Example No. 1. Patient M. 8 years from the orphanage. Turned 24.04.03 complaining of recurring headaches in the occipital region. History of Natal trauma of the cervical spine and myopia of the labs degree. When viewed posture asymmetrical: the right shoulder higher than the left at 1.0 cm, tilt and rotation of the head to the left, the rotation of the shoulder girdle - the right shoulder forward. Movement of the cervical spine: slight limitation of rotation to the right with the appearance of pain in the upper cervical spine at the end of the maximum rotation. Severe pain with seal periarticular tissues was noted in the Atlanto axial joint and in the projection of the transverse processes of the vertebrae WithII-CIIIright at rest and during maximum turning in the right direction. Noted moderate pain place the insertion of the muscle, levator scapulae right, as well as in the projection of the transverse processes: leftIII-CIVthe right CIV-CVCV-CVI. Identified toning the upper portion of the trapezius muscle on the right 1 tbsp. In normal and complicated poses Romberg sustainable, coordinatorsee sample performs confidently. Signs of paresis, pathologic reflexes, disorders of sensitivity is not revealed. In the sample Fisher harmonious deviation of the left hand by 3.0 see If the ophthalmologist is determined spasm of accommodation, the fundus of the eye intact. When x-rays of the upper cervical spine by the method of [3, 5]: uni-directional rotation of the vertebrae CIWithIIright, hypoplasia of the arc of Atlanta.

Given the clinical picture is from and the x-ray examination, these lesions cranio-vertebral Department, the diagnosis of the patient: cervico-cranially due traumatica-fibrations option defeats the cranio-vertebral Department, neurogenic rotation CIWithIIright, hypoplasia of the arc of Atlanta. Chronic course.

When conducting rheoencephalography the vertebro-basilar blood flow revealed the following results: background study RI left - 0,129 Om, right -0,102 Om; after samples RI left - 0,132 Om, on the right is 0.102 Om, k1left - 1,023, right - 1,000; 3 min RI left - 0,146 Om, right - 0,130 Om, k2left - 1,132, right - 1,275.

Since k2left more 1,098, in this patient, we define reflex mechanism changes the vertebro-basilar blood flow. Furthermore, the k2right more 1,085 that also allows you to define a reflex mechanism changes the vertebro-basilar blood flow.

Example No. 2. Patient P., from the orphanage, 8 years. He complained of recurrent headaches after school whining character in the temporal and frontal areas of short duration - up to 30 minutes, held their own. History of childbirth urgent, rapid. Before the year was exhibited diagnosed with Perinatal Central nervous system". Examination: posture type stooped back, a small tilt of the head to the left. A minor limitation of tilt to the left and R is to be treated right in the cervical spine. The asymmetry of the paravertebral muscles of the upper cervical spine: on the left is more developed. Mild pain: upper third of the sternocleidomastoid muscle on the right; anterior and middle stair muscles left; capsules Atlanto-axial joints on the right. In the Romberg stable when the sample Fisher deviation of the hands is missing. Coordinatorsee sample performs confidently. Sensory and motor disorders are not identified. When radiography of the cervical spine with functional tests revealed: unidirectional rotation of CIWithIIright violation tropism Atlanto-axial joints with lower left articular site.

Given the clinical picture and the x-ray examination data destruction cranio-vertebral Department, the diagnosis of the patient: cervico-cranially due to osteo-dysplastic option defeats the cranio-vertebral Department with the rotation of the CIWithIIright, anomaly tropism Atlanto-axial joints. Chronic course.

When conducting rheoencephalography the vertebro-basilar blood flow revealed the following indicators: background RI left - of) 0.157 Om, right - 0,111 Om; after holding the samples RI on the left was 0.138 Om, right - 0,105 Om, k1left - 0,879, right - 0,946; three minutes after sample RI left - 0,144 Om, right - 0,120 Om, k2with the eve - 0,917, right - 1,081.

Since k2left less 1,098 and right less 1,085, this patient we do not specify a reflex mechanism changes the vertebro-basilar blood flow.

The proposed method was evaluated in 15 patients children ages 8,6±0,3 years, with the defeat of the cranio-vertebral Department electroencephalography analyzer of EEG "ENCEPHALAN-131-03" model-08. The results of the study are given in table 1. When comparing RI when turning the eyeballs with the background values significant differences had been received. After 3 minutes after turning the eyeballs RI increased from left to 0,011 Om - 8,6%, right on 0,014 Om - 12,0% (p<0,05), indicating that the reaction increased pulse volume pool the vertebro-basilar arteries to conduct functional tests. Reaction three minutes after turning the eyeballs inherently reflexive - on eye movements, because the conditions of this breakdown excludes movements in the cervical spine.

About the increase of pulse blood within 3 minutes after turning the eyeballs is evidenced by the increase in k2compared to the k10.07 left right and 0.12 (p<0,05) (table 2). To estimate a significant increase in RI to conduct functional tests it is advisable to use the k2- the ratio of RI after turning the eye is the unit after 3 minutes of rest to RI the initial state. Since the range of k2covers part of the range of k1then a more precise boundary increase RI 3 minutes after turning left eye should be considered a value >1,098 left and (or) >1,085 right. Smaller values of these boundaries correspond to the average value of RI when turning left eye when he did not differ significantly with respect to RI baseline studies (see table 1).

The method can be used in neurology, chiropractic medicine, medical physical culture to determine the reflex mechanism changes the vertebro-basilar blood flow.

Literature

1. Rheography in clinical practice. Moonkin, Lubiano. Moscow. Medical research firm NMG, 1997, 250 S.

2. Information support HH Clinical rheoencephalography. M.: Medicine, 1983, 271 S.

3. Mozheiko LI Vertebroneurological aspects of defeats the cranio-vertebral region in children: author... discard. the honey. Sciences. - Perm, 1996.

4. Popeljanskij AU Orthopedic neurology. Kazan, 1997. 1, 2.

5. Levit, K., Sachse I., Janda Century Manual medicine. - M.: Medicine, 1993, 512 S.

Table 1.
BackgroundWhen turning left eyeAfter 3 minutes after turning
RI(Om)RI(Om)k1RI(Om)k2
left0,128±0,0330,129±0,0231,03±0,130,139±0,028*#1,10±0,13#
right0,116±0,0270,115±0,0171,02±0,130,130±0,023*#1,14±0,14#
* - p<0.05 the Student - identified reliability in comparison with the background;

# - p<0.05 the Student - identified reliability compared performance when the turn indicators in 3 minutes after turning the eyeballs.
Table 2
k1k2
Left0,963-1,0981,035-1,166
right0,956-1,0851,071-1,216

The method for determining the mechanism of changes in the vertebro-basilar blood flow in children by writing rheoencephalography the vertebro-basilar blood flow in the patient lying notable Thu who enter the patient in the initial position, in which his eyes were fixed on the ceiling, and after 3-5 min record background rheoencephalogram, then the patient fixes his gaze on the tip of the pointer, located at a distance of 30 cm from the nose to the middle line, then the patient moves his eyes to the end position after moving to the left side of the pointer, after 5 seconds after turning the eyes produce a record of rheoencephalography, then his gaze returns to its original position and after 3 min record rheoencephalogram the vertebro-basilar blood flow, calculate eographically index (RI), the ratio of RI after returning the gaze from the leftmost position to the initial position (k2and when the value of k2>1,098 left and (or) k2>1,085 right to determine the change in the vertebro-basilar blood flow by reflex mechanism.



 

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