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目的 分析特发性高颅压（idiopathic intracranial hypertension，IIH）的临床特点，以及归纳梳理相关的超声表现。 方法 回顾性连续纳入2021年7月—2023年6月在首都医科大学宣武医院急诊神经内科住院的IIH患者32例。收集患者的基线资料（年龄、性别、身高、BMI、颅内压）、临床表现、MRV或DSA及超声检查的各项参数（颈内静脉的内径及流量、视神经鞘直径、视盘高度等），对数据进行分析和总结。 结果 ①本研究共入组32例患者，年龄（32.0±10.6）岁，男女比例9∶23，身高（162.0±8.3）cm，BMI 27.5（24.0～31.8）kg/m2，颅内压330.0（300.0～396.3）mmHg（1 mmHg=0.133 kPa）。②入组患者的临床表现为头痛16例（50.0%）、视物模糊16例（50.0%）、恶心/呕吐12例（37.5%）、头晕6例（18.8%）、耳鸣/脑鸣6例（18.8%）。③入组的32例患者中，合并糖尿病16例（50.0%）、高脂血症13例（40.6%）、高血压7例（21.9%）、阻塞性睡眠呼吸暂停综合征4例（12.5%）、自发性脑脊液漏2例（6.3%）；入组的23例女性患者中，合并多囊卵巢综合征5例（21.7%）。④超声测量入组患者的视神经鞘直径4.92（4.90～5.09）mm，视盘高度0.83（0～1.28）mm。⑤MRV或DSA结果显示，颅内静脉窦狭窄共7例（21.9%），其中右侧颅内静脉窦狭窄5例（15.6%），左侧颅内静脉窦狭窄2例（6.3%）。⑥颅内静脉窦非狭窄组中，右侧颈内静脉J2、J3段内径大于左侧颈内静脉J2、J3段内径[（6.48±1.69）mm vs.（5.63±1.10）mm，P=0.006；（4.62±1.44）mm vs.（3.42±0.88）mm， P＜0.001]，右侧颈内静脉J2、J3段流量大于左侧颈内静脉J2、J3段流量[（376.8±172.8）mL/min vs.（229.6±93.3）mL/min，（214.4±104.0）mL/min vs.（115.2±62.9）mL/min，均P＜0.001]；颅内静脉窦狭窄组中，狭窄侧颈内静脉J3段内径小于健侧内径[（3.23±1.05）mm vs.（3.99±1.25）mm，P=0.011]，狭窄侧颈内静脉J3段流量小于健侧流量[（91.4±68.7）mL/min vs.（192.9±87.9）mL/min，P=0.004]。 结论 结果显示，IIH与肥胖密切相关，且伴较高的多囊卵巢综合征、自发性脑脊液漏、阻塞性睡眠呼吸暂停综合征、高血压、高脂血症、糖尿病、颅内静脉窦狭窄发病率。同时，颅内静脉窦狭窄侧J3段颈内静脉内径及流量均小于健侧。IIH引起视神经鞘直径的增宽和视盘高度的增高。 Abstract: Objective To analyze the clinical characteristics of idiopathic intracranial hypertension (IIH) and summarize the related ultrasonographic manifestations. Methods A total of 32 patients with IIH hospitalized in the Department of Emergency Neurology, Xuanwu Hospital, Capital Medical University from July 2021 to June 2023 were retrospectively enrolled. Baseline data (age, gender, height, BMI, intracranial pressure), clinical manifestations, MRV or DSA and ultrasound examination parameters (internal diameter and blood flow of internal jugular vein, optic nerve sheath diameter, optic disc height, etc.) of patients were collected, and the data were analyzed and summarized. Results ①A total of 32 patients were enrolled in this study, with age of (32.0±10.6) years, male to female ratio of 9∶23, height of (162.0±8.3) cm, BMI of 27.5 (24.0-31.8) kg/m2, and intracranial pressure of 330.0 (300.0-396.3) mmHg (1 mmHg=0.133 kPa). ②The clinical manifestations of the enrolled patients were headache in 16 cases (50.0%), blurred vision in 16 cases (50.0%), nausea and vomiting in 12 cases (37.5%), dizziness in 6 cases (18.8%), tinnitus and intracranial tinnitus in 6 cases (18.8%). ③Among the 32 enrolled patients, 16 cases (50.0%) had diabetes mellitus, 13 cases (40.6%) had hyperlipidemia, 7 cases (21.9%) had hypertension, 4 cases (12.5%) had obstructive sleep apnea syndrome, and 2 cases (6.3%) had spontaneous cerebrospinal fluid leakage. Among the 23 female patients, 5 cases (21.7%) were complicated with polycystic ovary syndrome. ④The diameter of the optic nerve sheath was 4.92 (4.90-5.09) mm, and the height of the optic disc was 0.83 (0-1.28) mm. ⑤According to MRV or DSA results, there were 7 cases (21.9%) of cerebral venous sinus stenosis, including 5 cases (15.6%) of right cerebral venous sinus stenosis and 2 cases (6.3%) of left cerebral venous sinus stenosis. ⑥In the non-stenosis group, the internal diameters of J2 and J3 segments of the right internal jugular vein were larger than those of J2 and J3 segments of the left internal jugular vein [(6.48±1.69) mm vs. (5.63±1.10) mm, P=0.006; (4.62±1.44) mm vs. (3.42±0.88) mm, P＜0.001]. The blood flow in J2 and J3 segments of the right internal jugular vein was greater than that in J2 and J3 segments of the left internal jugular vein [(376.8±172.8) mL/min vs. (229.6±93.3) mL/min, (214.4±104.0) mL/min vs. (115.2±62.9) mL/min, all P＜0.001]. In the cerebral venous sinus stenosis group, the internal diameter of the J3 segment on the narrow side of the internal jugular vein was smaller than that on the healthy side [(3.23±1.05) mm vs. (3.99±1.25) mm, P=0.011]. The blood flow in the J3 segment on the narrow side of the internal jugular vein was lesser than that on the healthy side [(91.4±68.7) mL/min vs. (192.9±87.9) mL/min, P=0.004]. Conclusions The results showed that IIH was closely related to obesity, and was associated with a higher incidence of polycystic ovary syndrome, spontaneous cerebrospinal fluid leakage, obstructive sleep apnea syndrome, hypertension, hyperlipidemia, diabetes mellitus, and cerebral venous sinus stenosis. Meanwhile, the internal diameter and blood flow in the J3 segment on the narrow side of the internal jugular vein were smaller than those on the healthy side. IIH causes a widening of the optic nerve sheath diameter and an increase in the height of the optic disc.

摘要： 目的 探索分层递进式教学模式在血管超声专业对进修医师的培训效果。 方法 纳入2021年1月—2023年3月于首都医科大学宣武医院血管超声科进修的医师124人，根据入科时医师对血管超声和TCD技术的掌握水平进行分层，分为单技术组和颈-脑一体化技术组，采用分层递进式教学模式培训满6个月后，进行理论及实践考核。 结果 单技术组及颈-脑一体化技术组在入科时理论考核成绩和上机操作考核成绩差异无统计学意义。通过分层递进式教学培训后，单技术组的理论考核成绩[（83.8±6.9）分 vs.（65.2±9.6）分，P＜0.001]和上机操作考核成绩[（93.2±4.5）分 vs.（91.4±4.3）分，P＜0.001]均有提高。颈-脑一体化技术组理论考核成绩提高[（86.9±7.7）分 vs.（67.7±6.4）分，P＜0.001]。 结论 分层递进式教学模式在血管超声专业对进修医师具有较好的教学效果和较高的教学满意度。 Abstract: Objective To explore the training effect of hierarchical and progressive teaching mode on continuing educational physicians in the field of vascular ultrasound. Methods A total of 124 physicians studying in Vascular Ultrasound Department of Xuanwu Hospital, Capital Medical University from January 2021 to March 2023 were included. They were divided into the single technique group and the integrated technique group based on their mastery of vascular ultrasound and TCD technology at the beginning. After 6 months of training with hierarchical and progressive teaching mode, the theoretical and operational assessments were examed. Results There was no significant difference in theoretical assessment scores and operational assessment scores between the single technique group and the integrated technique group when enrolled. After the training with hierarchical and progressive teaching, the theoretical assessment scores [(83.8±6.9) points vs. (65.2±9.6) points, P

超声由于其独特的优势已逐渐应用于脑小血管病领域。本文汇总了超声在脑小血管病中应用的相关研究，概述了脑小血管病与血管超声各类评估指标之间的关系，并描述了超声在与脑小血管病并存的心、脑、肾等多系统疾病中的评估、诊断作用，为应用超声对脑小血管病进行全面有效评估提供了理论依据。 Abstract: Ultrasound has been gradually applied to the field of cerebral small vessel disease (CSVD) due to its unique advantages. This paper summarized the studies related to ultrasound in CSVD, and summarized the relationship between CSVD and various evaluation indicators of vascular ultrasound. What’s more, this paper described the role of ultrasound in the evaluation and diagnosis of multi-system diseases such as heart, brain, and kidney coexisting with CSVD, and provided a theoretical basis for comprehensive and effective evaluation of CSVD by ultrasound.

永存动脉是永久性颈内动脉和椎基底动脉之间的异常吻合，是一种较罕见的脑血管变异。通常，永存动脉具有供血功能，不引起任何特殊临床症状，但若伴发动脉粥样硬化性病变和其他血管变异，会导致临床表现复杂化。目前，超声是临床评估头颈血管病变的首选检查方法，正确诊断永存动脉，可以更准确地解释与其相关的临床表现，在进行相应手术或介入操作时，可避免不当操作的风险。永存动脉多为影像学检查偶然发现，其影像学表现具有特征性。目前，国内外不乏对永存动脉的影像学诊断报道，但缺乏超声对永存动脉分型及其血流动力学的评估报道。本文结合文献，创新性地提出永存动脉的超声诊断思路和分型，旨在提高对永存动脉的早期准确诊断率。 Abstract: Persistent artery is an abnormal anastomotic branch between the permanent internal carotid artery and the vertebrobasilar artery, which is a rare cerebrovascular variation. Typically, persistent arteries have a blood supply function and do not cause specific clinical symptoms; however, when accompanied by atherosclerotic lesions of the arteries and other vascular variants, they result in a complex clinical presentation. At present, ultrasonography is the first choice for clinical evaluation of cerebral and cervical vascular abnormalities. Correct diagnosis of persistent arteries improves clinical interpretation and reduces the risk of improper operation during related surgical or interventional procedures. Most persistent arteries are discovered incidentally through imaging, and their imaging manifestations are characteristic. There are many reports on the imaging diagnosis of persistent arteries at home and abroad, but few on ultrasonography staging and hemodynamics. Based on the literature, this paper innovatively proposed an ultrasound diagnostic concept and staging of the persistent artery in an effort to improve the early and accurate diagnosis of the persistent artery.

背景 偏头痛与右向左分流（right-to-left shunt，RLS）的关系尚有争议。本研究旨在明确中国偏头痛 患者右向左分流的阳性率、分流类型以及分流量大小，分析偏头痛与右向左分流的关系。 方法 该研究为多中心-病例对照研究（北美临床研究注册号NCT0242569)。由中国9家分中心共同完 成，连续纳入2015年6月-2016年8月就诊于分中心且符合据第三版国际头痛疾病分类-β测试版（The International Classification of Headache Disorders 3rd Edition Beta Version，ICHD-3β）诊断偏头痛的患 者（18～65周岁），为偏头痛组。偏头痛组共纳入931例（女性695例），其中先兆偏头痛240例（女性174 例），无先兆偏头痛691例（女性521例）。健康对照组共282例。 结果 先兆偏头痛组RLS阳性率和大量分流比例高于无先兆偏头痛组（63.7% vs 39.9%，P＜0.001； 32.1% vs 16.5%，P＜0.001），两组中量和小量分流比例无差异（P =0.141；P =0.061）。无先兆偏头痛 组RLS阳性率和大量分流比例高于对照组（39.9% vs 29.4%，P＜0.001；16.5% vs 6.4%，P＜0.001）， 两组间中量和小量分流的比例无差异。 结论 偏头痛患者（包括有先兆和无先兆偏头痛患者），右向左分流阳性率高于正常对照组，且以大 量右向左分流为主，中至小量右向左分流及分流的类型与对照组相比无差异。右向左分流，特别是大 量的右向左分流，可能与偏头痛有关。 Abstract: Background The association between Right-to-left shunt (RLS) and migraine was still controversial. The aim of this study was to investigate the prevalence, grade and volume of RLS in Chinese patients with migraine and to evaluate the relationship between RLS and migraine. Methods It was a multi-center case-control study with North America Clinical Study Registration No. NCT02425696, and underwent jointly by 9 sunb-centers in China. The patients, aged between 18 years old to 65 years old, who received consultation services in sub-centers and were diagnosed as migraine according to The International Classification of Headache Disorders 3rd Edition Beta Version (ICHD-3 β) during June 2015 to August 2016, were consecutively enrolled into migraine group. There were 931 patients in migraine group, among which, there were 695 cases of female. There were 240 cases of migraine with aura and 691 cases of migraine without aura. There were 282 healthy adults in control group. Results The prevalence of RLS were 63.7% and 39.9% in the migraine with aura group (MA+) and migraine without aura group (MA-), respectively, which were significantly higher than that of healthy group (29.4%, P