engleski

Functional Transcranial Vertebrobasilar Doppler in Cervicogenic Headache

Cervicogenic headache (CEH) is a complex syndrome characterized by deep unilateral skeletomuscular pain, autonomic reactions and a number of concomitant phenomena, with yet unclear etiopathogenesis and pathophysiology. The aim of this study was to analyse the hemodynamic changes in vertebrobasilar (VB) arteries in patients with CEH and comparison of these changes with radiological findings and neuropsychological profiles of patients. In 1999 we diagnosed CEH in 50 out-patients of the Department of Neurology Osijek, the 42 female and 8 male, aged between 20 and 60 years (average age 44.88 years). The diagnosis of CEH was established in accordance with the criteria of Headache classification committee of the IHS (Cephalalgia 8, Supplement 7, 1988) and Sjaastad (Headache 30:725-726, 1990). Functional Transcranial Doppler (TCD) of VB arteries was carried out in neurological ultrasound laboratory on DWL Doppler system with 2 MHz probe in standard head position, maximum ventroflexion and dorsoflexion, right and left neck rotation. Normal values of blood flow velocity (BFV) are standardised (for vertebral artery 36+-9 cm/s, and for basilar artery 42+-10 cm/s). Standard and functional cervical spine-radiographs and neuropsychological examination with Cornell index of neuroticism were performed diagnostically. Results: Functional TCD VB was abnormal in 39 (78%), and normal in 11 (22%) patients. According to the character of the disclosed TCD changes we found signs of compressive cervical syndrome (change of BFV in different positions of neck and head) in 11 (28.2%), vasospasm (accelerated flow in all arteries in standard and functional positions) in 20 (51.3%), atherosclerotic changes (diminished BFV in all arteries in standard position and functional positions) in 4 (10.25%), and combination of atherosclerotic and compressive changes in 4 (10.25%) patients. Comparation of TCD results, radiological and neuropsychological findings showed high correlation (93.3%) between compressive TCD syndrome and degenerative changes on cervical spine. In group of 15 patients with compressive TCD syndrome 40% of them had moderate and 53.3% significant and heavy degenerative changes, while in the rest of our group of 35 patients without compressive TCD syndrome 54.3% of them had moderate and only 17.1% had heavy degenerative changes. Z-test showed statistically significant difference (p<0.05). In other hand we found a high correlation (90%) between vasospasm and neuroticism. In group of 20 patients with vasospasm on TCD 35% had moderate grade and 55% high grade of neuroticism, while in the rest of our group of 30 patients without vasospasm 33.3% of them had moderate and 36.7% had high level of neuroticism. The differences were not statistically significant, but suggest about connection of these phenomena. Conclusion: The many of the patients with CEH had TCD abnormalities. Functional TCD VB gives useful information about character of this hemodynamic changes and in differentiating the etiopathogenetic factors and pathophysiological machanisms of CEH. We think that Functional TCD VB is useful method for routine screening diagnostic, especially in small neurological centres.

Cervicogenic headache; Transcranial Doppler Ultrasonography.

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