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the Chapter I. The literature review

History of studying of a question of disturbance of a cerebral hemodynamic at a pathology of cervical department of a backbone.

At studying of disturbance of a circulation of a brain at patients with a various pathology of cervical department of a backbone in the literature basically questions vertebralno-baziljarnoj failures (VBN) are reflected.

The first description of a syndrome vertebrobaziljarnoj failures is made in 1946г. Kubik and Adams on the basis of morphological studying of an intracranial part pozvonochnoj arteries. Only in 1956 Hutchinson and Michell after fundamental patologo-clinical studying have proved possibility of occurrence of symptoms of an ischemia more distally a place of a compression of a vessel, in particular, the most frequent occurrence vertebrobaziljarnoj to insufficiency at lesions ekstrakranialnoj to a part pozvonochnoj to an artery. In 60 % of cases Schwartz and Michell in 1961г. Have established, that the majority of clinically significant conditions for occurrence of lesions in vertebro-basilar systems arise in a proximal part pozvonochnoj arteries. These data have been confirmed at studying of an angiography of 4748 patients with clinic of cerebrovascular diseases. Duffy and Jacobs in 1958 have proved, that presence of one intact pozvonochnogj does not guarantee an artery against a repeated infarct of a brainstem and a cerebellum. In 1961 Fisher, Curier in 1962г. And co-authors have called in question position that in a basis lateralnogo moduljarnogo a syndrome (syndrome Wallenberg and Zaharchenko) lays only an occlusion of a back bottom cerebellar artery, and have come to conclusion, that on the basis of one clinical picture it is impossible to define accurately level of a lesion vertebrobaziljarnogo pool. To a similar conclusion Vereschagin who, since 60th years, has brought the big contribution to studying of questions of clinic and a pathogenesis of this disease together with other authors comes also.

Pathogenesis of disturbance of a cerebral circulation at a lesion of cervical department of a backbone.

Pathological changes in unkovertebralnyh joints quite often lead to shift and a prelum pozvonochnoj to an artery more often at patients with distsirkuljatsiej in vertebrobaziljarnoj to system (Bassil T.E., Vereshchagin N.V., Lutsik A.A.) Great value for definition of character and level of these lesions have an angiography and MRT (Bassil T.E., Pokrovskij A.V., Branchereau A, DiazFD) In the presence of the factors causing mainly kompremirujushchee influence on pozvonochnuju an artery with disturbance of its passableness or a boring of a periarterial sympathetic nervous plexus, is developed syndrome clinic pozvonochnoj arteries.

Syndrome principal cause pozvonochnoj arteries is the cervical osteochondrosis. From positions of the clinician the syndrome pozvonochnoj arteries is defined, basically, as a syndrome vertebrogenno the caused boring (irritatsii a perivascular sympathetic plexus of this artery with expressed painful vegetalgicheskimi and angiodystonic (neurovascular) components in zones of an innervation of the specified plexus and partially behind its limits. Joining to the leader irritativnomu to the pathogenetic mechanism and kompressionnnogo the factor (a prelum pozvonochnoj arteries unkovertebralnymi osteophytes, a disk hernia, articulate processes of vertebra etc.) is possible.

At MRT angiographies are defined prelum signs pozvonochnyh arteries.

Well-known, that from degree of development of a collateral circulation the current and an outcome of disturbances of a circulation depends. Therefore many authors pay the big attention to studying of collateral ways of a blood flow in vertebrobaziljarnoj to system (to Ivanova N.E., Zubkov J.N., Kandel E.I., Metelkina L.P) Vertebrobaziljarnaja the system has anatomic levels of a collateral circulation:

The first system of collaterals - extracranial also consists of the report pozvonochnoj arteries with branches of a subclavial artery (a deep artery of the neck, an ascending artery), and also with branches of an external carotid through fine muscular branches. However, according to Lazorthe, these fine collateral reports have no practical value. According to the same author the most important thing extracranial by collateral blood supply is retromastoidalnyj anastamoz with an occipital artery. The others 3 collateral systems operate at intracranial level. The first system is provided

Functioning Velizieva of a circle (back connecting arteries and bond 2 pozvonochnyh arteries), the second operates through superficial cortical arteries, the third - at level of deep intracerebral arteries.

Anatomic and hemodynamic feature is bond both pozvonochnyh arteries in one basic, that provides blood flow indemnification in amazed pozvonochnoj arteries at the expense of healthy opposite. It is necessary to notice, that in 30-50 % of cases an anatomic structure pozvonochnyh arteries not equally — the left PAS differs in the big diameter, i.e. there is a relative hypoplasia right pozvonochnoj arteries. At the same time it is the anatomic variant of norm which are not leading to any disturbances of a circulation in the Air Forces. In some cases pozvonochnaja the artery departs from a forward or back wall of a subclavial artery that leads to its excess.

The reasons leading to disturbance of a circulation in vertebro - basilar system, can be grouped as follows: ekstravazalnye, intravazalnye, deformations pozvonochnoj arteries and their anomalies (Antonov I.P., Gitkina h.p., Ivanova N.E., Zubkov J.N.). Great value anatomic features of a locating pozvonochnyh arteries (have fig. 1).

Fig. 1 Topographical anatomy pozvonochnyh arteries

L.Vzaimootnoshenie pozvonochnyh arteries with neck muscles, vertebra With and Si. 1 - a trapezoid muscle, 2 - a small back direct muscle of a head, 3 - a branch From a nerve, 4 - the big back direct muscle of a head, 5 - atlantooktsipitalnaja a membrane, 6 - a cross-section process of a vertebra With/, 7 - pozvonochnaja an artery, 8 - a cross-section process of a vertebra With//, 9 - a trunk of nerve С2, 10 (15) - a belt muscle of a head, 11 - the bottom slanting muscle of a head, 12 - the longest muscle of a head, 13 - the top slanting muscle of a head, 14 - an occipital artery.

B.Vzaimootnoshenie pozvonochnoj arteries with the next structures

(It is shown on an axial section at level of vertebra CVII). 1 - an esophagus, 2 -

The bottom thyroid artery, 3 - a long muscle of a neck, 4 - pozvonochnaja an artery and a vein, 5 - an average scalene muscle, 6 — a humeral nervous plexus, 7 - a forward scalene muscle, 8 - a lymph node, 9 - an internal bulbar vein, 10 - a thyroid gland, 11 - an internal carotid, 12 - a larynx.

V.Vzaimootnoshenie pozvonochnyh arteries with kostno-articulate structures kraniotservikalnogo transition. 1 - IX cranial nerve, 2-Х a cranial nerve, 3 - XI cranial nerve, 4 - the Sou nerve, 5 — a bulbar process of an occipital bone, 6 - a direct muscle of a head, 7 - a cross-section process of a vertebra With/, 8 - an intercross-section muscle, 9 — pozvonochnaja an artery, 10 — С2 a nerve, 11 - atlantoaksialnoe a joint, 12 - a branch of the Sou of a nerve, 13 - dentiform ligament, 14 - atlantooktsipitalnoe a joint, 15 —

Oblong brain.

ekstravazalnye factors represent pathological changes or anomalies of the tissues surrounding pozvonochnye arteries and leading to disturbance of a blood flow in them. At level of initial department pozvonochnoj arteries, on literary data, such role can play a forward scalene muscle (Pokrovskij A.V., Workers of Century S, Zingerman h.p., Potyomkin E.V, Camp JB), a cervical rib, cicatrical changes of a prevertebral fascia with formation connective tissue tjazhej, sochetannye traumatic damages of a humeral plexus and pozvonochnoj arteries (Amar A. Lerg M).

At level of the second department pozvonochnoj arteries in limits kostnoyomyshechnogo the blood flow channel it is broken at the expense of influence vertebrogennyh the factors caused by an osteochondrosis of a backbone more often: in unkovertebralnyh joints in the presence of lateral hernias of intervertebral disks (Vereshchagin N.V., Davis K.R, Ackerman R.H., Kistler J.P.), a subluxation of vertebra on Kovacs and degenerate changes in
Intervertebral joints (Campbell JK, Houser OW, Stevens JC, Wahner EL.). The question on a pathogenesis vertebrobaziljarnoj failures in the literature far is not solved. There are inconsistent opinions on a parentage of symptoms, since position about purely mental parentage of this syndrome, to the assumption of an appreciable role pozvonochnogo a nerve which boring causes a spastic stricture of intracranial peripheric vessels (Vereshchagin N.V., Irger I.M, E.).

In the literature there are rare reports on possibility of a compression of the third department of the PAS the bottom slanting muscle of a head and a forward branch; 2nd cervical root (Bamford J, Jones L, Warlow CP). The prelum of the PAS in the field of a back arch of an atlas is described, especially at congenital anomalies kraniovertebralnogo transition (CHuhrova In; A).

It is necessary to note influence of turns of a head and a neck on a blood flow in pozvonochnoj arteries. The compression at atlas level at turn, heads in an opposite side meets ^ in norm. However, at insufficiency another ' pozvonochnoj arteries the given circumstance can get pathogenetic value (Fisher M, Sotak SN, Hacks W). Osteophytes in unkovertebralnyh joints it is more kompremirujut pozvonochnuju an artery at head turn in the same party (Kaneda N, Irino T, MimaniT).

According to many authors, vertebrogennyj the factor is combined with atherosclerotic stenosing lesions, often causing clinic vertebrobaziljarnoj failures (Ivanov NOT., Zubkov J.N., Edwards WH). More often (75-90 %) a stenosis is localised in the field of a mouth pozvonochnoj arteries, are more rare (8-10 %) in intracranial department. All authors underline a frequent combination of a stenosis and a tortuosity (Kinninga) pozvonochnoj arteries with stenoses of other branches of an aorta in various combinations (Pokrovsk A.V ї, Ausman L, Diaz FG, Vacca DF).

From deformations pozvonochnoj arteries, meet pathological tortuosity and excesses which to a thicket are localised in more often

Initial department pozvonochnoj arteries, are more rare - in the third (Zlotnik E.I, Gitkina L.S, PirogralashvinZ.K, Abramov I.S.).

The literature analysis has allowed us to allocate 2 main mechanisms leading to an ischemia in vertebrobaziljarnoj to system: I) the direct mechanism - when the ischemia results from reduction of volume of a blood flow in pozvonochnoj an artery and its branches as a result of their immediate reflex or mechanical lesion at a cervical osteochondrosis; 2) the indirect mechanism or the steal mechanism "arises", when on pozvonochnym to arteries there passes sufficient or even the enlarged volume of blood which passes through pozvonochnuju an artery transit and krovosnabzhaet other pools where there is a vascular insufficiency. Pools-recipients can be: carotid, subclavial and dr: (Dobkin JA, Mintun MA, Inoue Y, Takemoto). We have paid attention; that the majority of authors underlines value of one or. Several kinds of a pathology in occurrence vertebrobaziljarnoj failures, not recognising a role of other factors or neglecting them. Only a small number of authors last time differed the complex approach in studying of an etiopathogenesis of this syndrome.

Some researchers explain clinical implications of a pathology pozvonochnoj to an artery at a cervical osteochondrosis a mechanical prelum of an artery osteal growths of a backbone. The Specified concept has been based on numerous cases of a traumatic lesion pozvonochnyh arteries or in case of its dressing after which there came serious disturbances cerebral to circulations pool vertebrobaziljarnoj systems [Вarach, Gel-le, cyte. On Krayenbuhl, Vasargil, 1957; V.V. Peker, 1887; L.N.Kuzmenko, 1938; Schneider, Schemm, 1961; Lindenberg, 1966;, etc.].

Rentgenoanatomichesky works about an artery prelum have supported with osteal growths of a backbone the specified representation and have found acknowledgement in clinical practice [Krogdahl, Tor-gersen, 1940; Primbs, Weber, 1956; Kunnert, 1957; Tatlow, Bammer, 1957; Virtama, Kivalo, 1957; Hardin,

Williamson, 1965; Mialon et al., 1995;, etc.]. However by the subsequent experimental and clinical researches it has been proved, that the prelum of one pozvonochnoj an artery cannot cause vertebrobaziljarnuju vascular insufficiency. Only at the congenital or got inferiority another pozvonochnoj arteries (its aplasias; abnormal narrowness, a lesion an accompanying atherosclerosis, a prelum the osteal; by growths etc.) significant vascular insufficiency squeezed pozvonochnoj arteries [E.N.Kosmarsky, 1947, 1951 can be shown; N.V.

Vereschagin, 1965; Jung et al., 1966;, etc.]. Meanwhile it is necessary to note rather; a frequent combination of a prelum pozvonochnoj arteries with functional inferiority of other artery or other main vessels of a head [N.V.Vereschagin, 1980; Jung et al., 1966; 3; L.Brodskaja, 1966; Sheila et al, 1995., and DR]

As it is noted above, founders of the doctrine about "a back cervical sympathetic syndrome" bound occurrence of cerebral disturbances at this disease to a boring of sympathetic fibers of a nervous plexus pozvonochnoj arteries.

The sympathetic plexus pozvonochnoj generates arteries vasoconstrictive impulsatsiju, i.e. is a vasoconstrictor for an artery and its branches. A pathological boring of this plexus at the cervical; an osteochondrosis causes a system vasospasm pozvonochnoj arteries; that is clinically shown by dysfunction krovosnabzhaemyh, them of brain departments, in particular stvolovyh structures and a cerebellum; [B.E.silversmith, 1955; G.J.Lukacher, M.A.Krymon, 1965; Vagge, 1926; Ueon, 1928; Fason, 1957;, etc.].

The indicating of some authors on development possibility is worthy; a syndrome pozvonochnoj arteries at pathological irritatsii zvezdchatogo knot owing to a boring of the terminations sinuvertebralnogo a nerve in is capsulate-copular structures of the backbone amazed with an osteochondrosis [A.I.Arutyunov, M; K.Brot-man, 1960; M.K.Brotman, 1975; I.R.

Schmidt, 1966; A.A.Lutsik, 1968; Primbs, Weber, 1956;, etc.]. Efferent pathological impulsatsija from zvezdchatogo knot can extend on periphery (including on a sympathetic plexus pozvonochnoj arteries), causing widespread vascular dysfunction in top kvadrante bodies and a spastic stricture of branches pozvonochnoj arteries.

As convincing acknowledgement of importance of the vasculomotor theory serve, reflex angiopatichesky a syndrome pozvonochnoj the arteries, developing in connection with pathological impulsatsiej from the amazed disk, and also positive influence of an immobilisation or stabilisation of the amazed segment of a backbone at this syndrome, in some cases even at

Artery compressions.

At a syndrome pozvonochnoj arteries owing to a cervical osteochondrosis the spastic stricture most pozvonochnoj an artery and its large branches [Krayenbuhl, Vasargill, 1957 matters; N.V.Vereschagin, 1964; Jung, Vierling, 1964; Echlin, 1965; R.A.Tkachev, 1967]. Numerous clinical observations

Transient circulatory unefficiency in vertebrobaziljarnoj to system after manipulations on pozvonochnoj an artery disappearing during short time (in some days or even hours), confirm a role of a spastic stricture of this artery in a syndrome pathogenesis.

The constant boring of a sympathetic plexus pozvonochnoj arteries is reflex can cause degenerate changes in cells of a brain and change of a functional condition of the vegetative centres that frames conditions for secondary disorders of vasculomotor regulation [D.G.Herman, E.G.Ketrar, 1966; I.R.Schmidt, 1966]. Meanwhile both specified theories odnostoronne explain a pathogenesis of a syndrome and cannot be universal. The most recognised theory of a pathogenesis of a syndrome pozvonochnoj arteries at a cervical osteochondrosis is the neurovascular theory; at which are considered as mechanical disturbances of a blood flow in pozvonochnoj arteries, and a spastic stricture of its branches owing to a boring of a sympathetic plexus of an artery structures of the amazed backbone [JA.JU.Popeljansky, 1961;

M.K.Brotman, 1975; A.JU.Rat-ner, 1965; A.I.Osna, 1966; I.R.Schmidt, 1966; Sheila et al., 1995; Mialon et al., 1995;, etc.]. The specified theory is based on representation about inseparable unity of functions pozvonochnoj an artery and its sympathetic plexus.

According to data of some researchers, in a pathogenesis of the given syndrome have value other factors: disturbance of a venous circulation in the field of a neck and a head [A.A.Lutsik, 1980; Vaake, 1957]; tonus rising "parasimpatikusa" a labyrinth [Broser, 1957]; adrenaline and Noradrenalinum allocation < синапсах вследствие, раздражения "симпатикуса", обладающего ганглиоплегической функцией [Muller, 1955 и др:],

vznachitelnyj a print on syndrome formation pozvonochnoj arteries is imposed by premorbidal inferiority of various organs and tissues. The compromised vessels поражаются* first of all [JA.JU.Popeljansky, 1961, 1962; I.R.Schmidt, 1966]. From this point of view a condition for; lesions позвоночной* arteries at a cervical osteochondrosis can be, premorbidal inferiority of a brain and cervical department vegetative; nervous system.

Thus, syndrome development pozvonochnoj arteries is caused by traumatic influence of structures of the backbone amazed with an osteochondrosis on pozvonochnuju an artery and its nervous plexus. Thus matters both a prelum of a lumen of an artery, and a boring of its sympathetic plexus; which finally lead to circulation disturbance in vertebrobaziljarnoj to system.

In the literature discussion - about interrelation of an atherosclerotic lesion pozvonochnoj arteries with the discogenic proceeds. This question has not only theoretical, but also practical value. Both the atherosclerosis, and a backbone osteochondrosis amaze a human body approximately at the same age. Hence, there is a possibility of participation in a pathology pozvonochnoj arteries both one, and other factor simultaneously. Extremely important in such cases an establishment of a specific gravity of each of these factors at
The patient requiring high-grade, differentiated treatment. It is represented to us rational to classify possibility of participation of the specified factors in pathology development pozvonochnoj to an artery as follows:

1) pathology development pozvonochnoj arteries owing to a cervical osteochondrosis at absence as clinical, and doklinicheskih (laboratory) signs of an atherosclerosis. Such variant of a pathology is extended enough, especially at osteochondroses of a traumatic genesis;

2) joint participation in a syndrome pathogenesis pozvonochnoj arteries as atherosclerosis, and osteochondrosis. There can be three versions of the specified pathology:

A.Preobladanie of the discogenic factor in pathology development. According to some reports [T.A.Luzhetsky, 1963; V.M.Salazkina, 1968; Gob, 1959; Dechaume, Schott, 1961; Bojme, cyte. no Kovacs, 1956; S.Stefanov, 1965; Jung et al., 1966; Sheila et al., 1995;, etc.], atherosclerotic changes of a wall of an artery quickly enough and often develop in a place of mechanical pressure upon it structures of patholologically changed backbone. At the expressed discogenic insufficiency pozvonochnoj arteries dopolyonitelno the joining atheromatosis, undoubtedly, worsens blood flow conditions [G.A.Luzhetskaja, 1963; N.V.Vereschagin, 1964; M.A.Javchunovskaja, R.A.Kuuz, 1965].

Diffusive atherosclerotic changes pozvonochnoj arteries are the reason of a pathological tortuosity, petleobrazovaniju and loss of its elasticity that promotes an artery prelum osteal growths and there can be an independent cause of infringement of a circulation [N.V.Vereschagin, 1962, 1964; E.V.Schmidt, etc., 1967, 1980; E.M.Barkauskas, P.L.Pauljukas, 1982; Kunnert, 1957].

B.Sovmestnoe equivalent participation of an atherosclerosis and an osteochondrosis in insufficiency pozvonochnoj arteries mutually burdens disease [V.M.Salazkina, 1968; Jung et al., 1966]. If leading value in a pathogenesis has
Atherosclerotic stenozirovanie arteries the additional mechanical prelum its osteal growths of a backbone is the important aggravating factor [N.V.Vereschagin, 1964; In; M.Salazkina, 1968; Bauer et al., 1961; Dechaume, Schott, 1966]. The acute circulatory unefficiency can result from a hemorrhage in an atherosclerotic plaque in connection with an artery boring osteal growths of a backbone;

According to indicatings of the big number of researchers, frequent enough stenozirovanie pozvonochnyh arteries it is caused by presence ateromatoznyh plaques [M'I. Irger, 1959; De Bekej, etc., 1960; N.V.Vereschagin, 1962, 1964, 1965; T.A.Luzhetsky, 1962; Fischer, 1951; Becker, 1961;, etc.].

In overwhelming majority of observations atherosclerotic narrowing has segmentary character and settles down in most: proximal departments pozvonochnyh arteries, usually at a place othozhdenija them from subclavial arteries. The establishment of this fact has the big practical value as pozvonochnye arteries in the extracranial departments are accessible for; a surgical intervention which at early revealing in them okkljuzirujushchego process can warn a full occlusion of a vessel and prevent development of a cerebral stroke.

The various have important value; vascular factors in the form of a pathological tortuosity, deformations, excesses, elongations, and also anomalies pozvonochnyh arteries or interfacing anatomic elements of a backbone. Thus the volume blood flow sharply decreases and there are various hemodynamic disorders, that [E.I.Zlotnik, h.p. Gitkina, 1963 finally leads to disturbance of a cerebral circulation; B.V.Petrovsky, etc., 1970; E.V.Schmidt, 1975; Z.L.Brodsky, 1977; N.P.Kavtaradze and dr., 1978; N.V.Vereschagin, 1980; E.M.Barkauskas, 1982; Barkauskas, Pauljukas, 1988; V.B.Semenjutin, etc., 1987; and dr;]. One of mechanisms of development of cerebral vascular insufficiency in these cases — a septal stenosis or narrowing of a lumen of a vessel in the field of an excess. It can lead to reduction and even a blood flow stopping in distal, sites of an artery,
To occurrence of a turbulent blood flow, that along with other pathological changes of arteries (depression of a rigidity of their walls, an additional spastic stricture) or with disturbance of warm activity and rheologic properties of blood frames conditions for disturbance of a cerebral circulation [E.V.Schmidt, 1975; N.P.Kavtaradze, etc., 1978; N.V.Vereschagin, 1980; E.M.Barkauskas, 1982; Mialon, 1995;, etc.].

Anomalies pozvonochnyh arteries or interfacing anatomic elements of a backbone are conducting etiopatogeneticheskim the factor of cerebral vascular insufficiency at a plural lesion pozvonochnyh arteries.

The forward scalene muscle, deep cervical fascia or long muscle of a neck also can kompressirovat pozvonochnuju an artery.

Powers, etc. [1961] for the first time have described a prelum pozvonochnoj arteries medial edge of a forward scalene muscle and a shchito-cervical trunk at posterolateral othozhdenii it from a subclavial artery. Hardin and Poser [1965] have informed on 15 cases of a compression of an artery a deep fascia of the neck bound to rotation of a head. Engel from co-workers. [1996] observed a prelum pozvonochnoj arteries in a fibrous ring suhozhilnymi fibers of a long muscle of a neck and a forward scalene muscle at head turn. Thus the vessel compression became perceptible below an occurrence place in the channel of cross-section processes With III

According to some authors, this dynamic occlusion at level "skaleno-vertebralnogo a triangle" is shown clinically if kontrlateralnyj the blood flow in another ' pozvonochnoj arteries is insufficient in connection with its anomaly or a lesion.

pozvonochnaja the artery can be squeezed in initial department fibers of a sympathetic nerve which go to pozvonochnomu to a nerve from zvezdchatogo knot or from ansa subclavia. These nervous formations are pressed into a forward wall of an artery and cause not only a mechanical prelum
Vessel, but also irritatsiju its sympathetic plexus. Some authors name such prelum "a pseudo-occlusal compression".

The third segment pozvonochnoj arteries is closely bound to head and neck movements, especially with the rotatory. Owing to these reasons many dynamic factors can participate in an artery compression above SSH a vertebra.

In 1884 Gerlach [cyte. On P.A.Pauljukas, 1991] on autopsy has found out, that excessive rotation at SI level — SSH leads to a stretching pozvonochnoj to an artery. Sheila, etc. [1995] have proved, that the stretching begins at head turn on 30 ° in an opposite side and becomes expressed at turn more than 45 °. In the subsequent many reports have confirmed compression possibility pozvonochnoj arteries at this level at excessive rotation and ekstenzii heads and necks. The stenosis or even an artery occlusion can arise in a place of one of flexures on a way to a skull over an atlas arch.

Some authors note prelum possibility pozvonochnoj arteries in a perforation place atlanto-oktsipitalnoj membranes at the moment of atlas shift at a head and neck hyperextension or a compression of a vessel a forward branch of the joint venture of a root between cross-section processes of the joint venture-SSH, at the moment of head rotation. Is reflex reduced bottom slanting muscle of a head can lead also to a compression pozvonochnoj to an artery and its nervous obrazoyovany.

The majority of authors agree in opinion, that a similar external compression pozvonochnoj the arteries, whatever character it wore, can matter, if there is a lesion or anomaly of development kontrlateralnoj pozvonochnoj arteries.

One of conditions of development of a collateral blood flow for indemnification of the arisen ischemia of a brain is the pressure gradient between vessels which arises at a stenosis of one of them.

E.V.Schmidt, etc. [1967] was distinguished by 4 levels on which the collateral circulation for a brain is realised:

1) the extracranial;

2) on the basis of a brain ("villiziev a circle");

3) on a brain surface (anastomoses between back cerebral arte rijami);

4) in a brain.

I.F. Toole [1995] allocates 3 basic groups of anastomoses:

1) from external somnolent to an internal carotid:) through an orbital artery; through branches of an external carotid which, punching a firm cover of a brain, anastomose with intracranial branches (so-called "a wonderful network");

2) from external somnolent to vertebrobaziljarnoj to system through occipital branches of an external carotid;

3) a vertebrosubclavial anastomosis: on the party roundabout by at a segmentary occlusion pozvonochnoj arteries or on an opposite side.

According to Lazorta from co-workers. [1977], to the major ^istochnikom collateral blood supply both vertebrobaziljarnoj systems, and verhneshejnogo spinal cord department is so-called retromastoidalnyj an anastomosis located at extracranial level, known under different other names: suboktsipitalnyj an anastomosis, suboktsipitalnoe merge, suboktsipitalnyj an arterial crossroads, knot Bosniac. pozvonochnaja the artery in the distal department, approximately at atlas level, gives constant large muscular branches which anastomose with arteries of two various systems: with branches of occipital arteries (from system of an external carotid), with ascending and deep cervical arteries (from system of a subclavial artery). At an occlusion pozvonochnoj arteries these branches provide adequate inflow of blood to its distal segment.

In one of observations Lutsika at punktsionnoj a carotid angiography at the patient with a clottage of the right internal carotid it is revealed, that through an external somnolent (occipital) artery it was filled
All extracranial department with the same name pozvonochnoj arteries. Undoubtedly, suboktsipitalnyj the anastomosis has been taped thanks to excessive difference of intravascular pressure in system of the right carotid, caused by a clottage of an internal carotid.

Thus, through "anastomoticheskoe suboktsipitalnoe merge", formed by branches of occipital, ascending and deep cervical arteries with a final segment pozvonochnoj arteries is supported a hemodynamic not only a cerebral trunk and the big hemispheres, but also the top cervical department of a spinal cord [Lazort, etc.1977; Sheila et al „.1995].

However development of a high-grade collateral circulation is defined by many other things; factors. Major of them are presence of adequate ways of blood supply and a condition of the general and regionarnogo circulations, including level of arterial pressure [B.V.Petrovsky, etc., 1970; JA.M.Komarovsky, E.E.nechaeva ^ 1978; Sheila et al., 1995;, etc.]. One of ways join at once, for formation of others time is required. It is thus found out etapnost; in development collateral krovoyoobrashchenija [And; P.Gannushkina, 1973]. In the course of its development the stage of a diffusive vasodilatation is replaced by a stage of exarticulation of separate collaterals. According to it there is a reorganisation of the vessels which have appeared in the conditions of a superfluous or reduced blood flow [to N.V.Vereschagin, 1980].

At a fast obliteration of time it is not enough for formation of collaterals. In these cases quite often even well developed collaterals have not time to prevent development of an ischemia of a brain. Certain value is given to an occlusion level of development. It is considered, that the more proximally from "villizieva a circle" the occlusion is located, the is available possibilities to join in action to different floors and levels collateral krovoyoobrashchenija [Sheila et more and!., 1995].

It is important to underline, that normal development "villizieva a circle" appears only at 25 % of people [Mialon et al., 1995]. Functional
Possibilities of a collateral circulation can worsen because the atherosclerotic lesion can cover arteries of collateral system, breaking their passableness and reducing a blood flow [Sheila et al., 1995], or owing to evolutionary inferiority of system of anastomoses [Mialon et al., 1995]. Meanwhile George and Laurian [1995] have found signs vertebrobaziljarnoj failures at 9 of 12 persons at presence suboktsipitalnoj anastomoticheskoj networks that has allowed authors to draw a conclusion on the small importance of these collaterals.

The cited data testify that in this case disease development was influenced by some factors: the cervical osteochondrosis which has caused a reflex syndrome pozvonochnyh of arteries, and in the subsequent — a stenosis of a mouth of vessels: Thus the hypoplasia of a back connecting artery and an atherosclerotic lesion of carotids, most likely, interfered with development of a high-grade collateral blood flow through "villiziev a circle" and suboktsipitalnyj an anastomosis. Only the combined medical influence on pozvonochnye arteries, including a surgical intervention, has allowed to restore an adequate blood flow in both pozvonochnyh arteries and to eliminate disease symptoms.

Thus, conditions which influence efficiency of a collateral circulation, are various; a specific gravity of each of them in a concrete case is not identical, and at the analysis it is necessary to consider both their complex influence, and a prevalence of one or several factors over others.

According to some авторов1 [D.G.Herman, 1981], in a genesis of cerebrospinal disturbances plays a certain role transnejronalnaja pathological afferentatsija when structural changes in vessels head or a spinal cord lead irritatsii to a reticular formation.

1979 Lutsik A.a. - with co-authors have described 16 cases of formation of the spinal cerebral syndrome caused by a cervical osteochondrosis, and also for the first time have proved possibility of development of a reflex angiospastic tserebro-spinal syndrome cervical
Osteochondrosis owing to pathological impulsatsii from amazed mezhyopozvonkovyh disks.

V.B.Sokolova's (1962) anatomic data, V.I.Zjablova (1964),

A.A.Belikova (1964) to a certain extent help to comprehend morphological substrate of occurrence of a spastic stricture of spinal vessels at a backbone pathology. They find out extensive communications between nerves of intervertebral disks and other deep tissues with the sympathetic plexuses accompanying koreshkovo-medulljarnye, pozvonochnye and forward spinal arteries which first of all are exposed travmatizatsii osteoarticular structures of the amazed backbone.

In any of four periods of a cervical osteochondrosis (Osno, 1999) the spinalno-cerebral vascular syndrome in connection with a lesion pozvonochnoj arteries can be generated.

In the first and second period of intradisk pathological process probably development of spinalno-cerebral vascular insufficiency of a reflex genesis. In the damaged structures of cervical department of a backbone there is a boring of the nervous terminations sinu-vertebralnogo nerve Ljushka which together with a sympathetic plexus pozvonochnoj arteries is formed at the expense of branches zvezdchatogo knot. Discogenic irritatsija zvezdchatogo knot it is shown by vasculomotor disorders from the party pozvonochnoj an artery and spinal cord vessels. As bright acknowledgement of a reflex parentage of a dystonia pozvonochnoj the artery was served by reproduction, and then disappearance of spinalno-cerebral vascular insufficiency after deretseptsii the amazed intervertebral disk.

In the third - the "hernial" period of an osteochondrosis foraminalnaja the hernia can squeeze together with a root koreshkovo-medulljarnuju an artery, and lateralnaja a hernia — pozvonochnuju an artery.

In the fourth period as pozvonochnaja an artery, and the main vessels of a spinal cord can be injured at movements or be squeezed by osteal growths, capsulate cicatrixes.

The majority of authors is allocated with 3 groups of lesions pozvonochnyh arteries which can form a spinalno-cerebral vascular syndrome:,

1) a lesion of actually vascular wall;

2) a pathological tortuosity and anomalies of development;

3) ekstravazialnye (including discogenic) factors.

Lutsik with soav. Offer a little bit other classification of the reasons causing disturbance of a blood flow in vertebralnyh arteries:

1) discogenic vertebrobaziljarnaja vascular insufficiency (a syndrome pozvonochnoj arteries);

2) not discogenic vertebrobaziljarnaja vascular insufficiency;

3) vertebrobaziljarnaja the vascular insufficiency caused by a combination of discogenic and not discogenic etio-pathogenetic factors. 70 % of patients are carried to the most widespread third group.

To not discogenic etiological factors ‘ are carried: an atherosclerotic lesion pozvonochnyh arteries (a stenosis, a pathological tortuosity, a clottage); periarterial cicatrixes; anomalies of development (fetalnaja a pathological tortuosity and excesses); anomalies othozhdenija, locatings and occurrences; a hypoplasia; an atresia; anomaly Kimmerli which can affect on pozvonochnuju an artery on an atlas arch.

The atherosclerosis as the lesion reason pozvonochnyh arteries at persons of young age meets, naturally, is more rare (20,6 % on Lutsik with soav., 1999), than at patients is more senior 40 years. Anomaly of development pozvonochnyh arteries is taped at the majority sick (78,7 %).

More often a cause of illness are the combined lesions both pozvonochnyh arteries, and the combination isolated porazheyonija one artery with the combined lesion makes another on different works 26 - 27 %.

N.V.Vereschagin [1980] considers, that various kinds of lesions, no less than anomalies ekstrakranialnyh departments pozvonochnyh arteries, srav -

nitelno seldom happen isolated, and is much more often they meet in various combinations.

Difficult character of a lesion pozvonochnyh arteries appreciably predetermines hemodynamic disturbance in two interfacing vascular regions — head and a spinal cord. Apparently, it occurs first of all at the expense of appreciable reduction of possibilities of collateral indemnification, first of all in the vascular structures of a spinal cord which are in less favourable conditions in comparison with a brain.

L.M.Briskmana's works from co-workers. [1971] have taped signs of disturbance of a cerebral blood flow at transient disorders of a cerebral circulation in system pozvonochnyh arteries. Among 100 patients with transient disturbances of a circulation in system of carotids there was no patient with a spinal syndrome, and among the same number of patients with circulation disturbance in system pozvonochnyh arteries sochetannoe disorder of a cerebral and spinal circulation is revealed at 20 % of patients. It testifies about close anatomoyofunktsionalnoj communications of a circulation head and a spinal cord in system pozvonochnyh the arteries which branches are forward and back spinal arteries.

Various forms of a pathology pozvonochnyh arteries differ from each other not only on an aetiology and a morphgenesis, but also on mechanisms of disturbances of a blood flow in them. Development both sudden, and an accruing occlusion of arteries, including under the influence of a number ekstravazalnyh the factors, making mechanical and reflex impact on size of their lumen is Thus possible. Change of passableness of vessels at various forms of a pathology can have proof or reversible character.

In the conditions limiting possibility of a collateral circulation, these kinds of a lesion of arteries at patients become a determinative in development of disturbances of a cerebrospinal hemodynamic.

At formation of a spinalno-cerebral vascular syndrome the functional unity of system of spinal arteries and veins can matter also. At disturbance of venous outflow, apparently, is reflex there is a spastic stricture of arteries that warns excessive rising of pressure in vessels pozvonochnogo the channel [A.J.Kuzmichev, 1971].

Lesion of vessels an atherosclerosis, accompanying insufficiency of other vascular pools of a head, a vasculitis, a pathological condition of the brain can promote occurrence of vasculomotor spinal disorders at discogenic insufficiency pozvonochnyh arteries.

According to some authors [D.G.Herman, 1981], in a genesis of tserebro-spinal disturbances plays a certain role transnejronalnaja pathological afferentatsija when structural changes in vessels head or a spinal cord lead irritatsii to a reticular formation.

Certain value of disturbance of the general hemodynamic, rheologic properties of the blood, accompanying cardiovascular insufficiency [have I.P.Gannushkina, 1973; A.M.Briksman, 1971; E.V.Schmidt, 1975; V.J.Neretin other, 1981;, etc.].

Lutsik with soav. In 1979 have described 16 cases of formation of the spinal cerebral syndrome caused by a cervical osteochondrosis, and also for the first time have proved possibility of development of a reflex angiospastic tserebro-spinal syndrome of a cervical osteochondrosis owing to pathological impulsatsii from the amazed intervertebral disks.

At a pathology of cervical department of a backbone disorder of a venous circulation of a brain (A.Lutsik, 1997) is often enough observed.

Modern methods of research have allowed to dilate representations about patofiziologii a venous cerebral circulation (M.J.Berdichevsky 1986, 1989; N.V.Babenkov 1982, 1995; I.I.Kagan 1994, 1995у A.R.Sharret, 1993; J.Auque, T.Civit, 1996; S.Bracard, M.Braun, J.F.Neder, S.Uelut, 1996; J.Auque, 7.C.Huot, 1996).

Research morfofunktsionalnyh patterns at venous stagnation in a brain were engaged in I.I.Kagan from co-workers. (1994, 1995, 1996}, S.V.Remezov (1995). It is established, for example, that character of venous outflow from a skull cavity depends on position of the patient (standing or laying) and character of breath (it is independent or WILLOWS). Compensatory outflow of venous blood from a brain is carried out on pozvonochnym to venous plexuses, on diploicheskim to veins, on veins of system of an external bulbar vein and on deep veins of a brain (I.I.Kagan from co-workers., 1994, 1995, 1996; J.F.Meder et al., 1994; X.Auque et al., 1996, etc.). At occurrence and increase of intracranial venous stagnation there is an including of one or several collateral outflow tracts of blood (N.V.Babenkov, 1982).

Venous outflow is not passive process, and is caused by functional and organic damages central reguljatornyh the vegetative centres. Many authors note great value of a dystonia and a hypotension of cerebral veins in formation of intracranial venous stagnation (I.S.Glazunov from co-workers., 1971; M.J.Berdichevsky, 1981, 1989; V.M.Kuzin, T.I.Kolesnikov, 1996; J.Stevenson, 1995; S. Bracard, 1996).

V.I.Frenkel (1960) results results of pathomorphologic researches at intracranial venous stagnation and the venous encephalopathy, showing prevalence of dystonic changes of venous walls in different departments of a brain. Data H.J.Leuetal testify to the expressed morphological changes of veins of a brain at intracranial venous stagnation also. (1979, 1980), A.V.Nuetal. (1980). According to authors, absent-mindedness of these changes also speaks mnogoochagovost, polimorfnost neurologic implications.

Numerous researches show complexity of interferences of various components of system vessels — blood-liquor-brain, in the practical relation the primary link thus is the extremely inconvenient to allocate

In a chain of consistently developed disturbances. So, S.E.Leljuk (1995,1996) considers, that the functional cerebrovascular reserve is the polyfactorial size which is immediately not dependent from one parametre.

It is obvious, that in a pathogenesis of disturbances of a cerebral circulation especially important role is played by two factors: 1) insufficiency of inflow of blood to brain tissues in a zone stenozirovannoj or the corked artery and 2) insufficiency or a delay of venous outflow. These two pathological processes among themselves closely vzaimosvjazanny as at circulation disturbances in cerebral arteries, as a rule, venous outflow to some extent changes. In turn the pathology of veins of a brain leads to disturbance of an arterial hemodynamic and a brain metabolism.

Now presence of a rich innervation of arteries and brain veins is established, presence of difficult nervously - reflex mechanisms of regulation of an arterial and venous tonus (is proved T.A.Grigoriev, 1954; B.A.Dolgosaburov, 1958; B.G.Gafurov, B.S.Busakov, 1992;.Edvinsson et al. 1994;, etc.). Venous outflow began to be represented not by the passive process depending only from hydrodynamic and hydrostatic factors. Many authors attach special significance in formation of intracranial stagnation of an arterial dystonia and a hypotension of cerebral veins (B.E.Votchal, V.P.Zhmurkin, 198 8; M.I.Holodenko, G.B.Kulesha, 1966. V.P.Zajtsev, 1968, - E.I.Gusev from co-workers., 197 9, 1992, - V.I.Tolstonogova from co-workers., 1986;

M.J.Berdichevsky, 1989; J. Stevenson, 1995; S. Bracard, 1996). Functional disturbances of the central regulation of an arterial and venous tonus, among other reasons, arise owing to a lesion of cervical department of a backbone, especially at a cervical osteochondrosis (G.B.Kulesha, 1966; O.I.Smirnova, I.V.Mironov, 1986у S.A.Anashkina, E.N.Leksin, 1986; R.I.Borisenko from co-workers., 1986; M.J.Berdichevsky, 1989; E.M.Burtsev from co-workers., 1986, 1994; M.A.Karpenko, 1996; N.A.Shuvahina, A.I.Antoniev, Z.N.Tsogoeva, 1986;

D.D.Molokov, E.M.Burtsev, 1996; N.V. Nikolaev, 1996; S.A.popova, 1996; V.E.Smirnov, 1996; A.R.Rahimdzhanov from co-workers., 1997)

Arterial distsirkuljatsija and venous stagnation in a brain, irrespective of the reason, its caused, leads as a result to development of a cerebral ischemia, which, being a basis for development of various clinical forms of disturbances of a cerebral circulation. I.V.Gannushkinoj's researches testify to active influence of venous stagnation in a brain on a microcirculatory bed, an arterial hemodynamic from co-workers. (1996, 1997). T.S.Gulevskaja (1994) noticed, that in a pathogenesis of a lesion of white substance at an arterial hypertonia changes korkovo-medulljarnyh arteries, a microcirculatory bed and also a venous circulation and gemato - likvoro-entsefalicheskogo barriers that leads to a vascular dementia have major importance.

D.D.Molokov and E.I.Burtsev (1996), being based on data REG and ultrasonic dopplerografii, notice presence giperkonstriktornyh reactions of cerebral arteries at carrying out of antiorthostatic assays at sick of an encephalopathy, that, according to authors, can lead to reduction of a cerebral blood flow and a brain ischemia.

A.L.Shibalev (1997), having investigated a condition of a cerebral hemodynamic and bioelectric activity of a brain in the peracute period of disturbances of a cerebral circulation by means of EZG, UZDG, TKDG and REG monitoring, notices, that at total disturbance of a cerebral blood flow and wet brain disturbance of venous circulation led to growth of peripheric resistance and anticipated increase of an ischemia and a clinical aggravation of symptoms. Thus, expression of venous disorders has both diagnostic, and prognostic value.

Ordering of representations about pathogenetic heterogeneity of a cerebral ischemia is one of the most urgent problems angionevrologii (N.V.Vereschagin from co-workers., 1986-1999).

Now an atherosclerotic lesion of the main arteries consider as the reason of an infarct of a brain only in 30-40 % of cases (M J.Harrison, J.Marshall, 1988; L.Wechsler, 1988), cardiogenic embolisms — in 15-20 %, 25-30 % make lacunar strokes as result of hypertensive changes of fine arteries, 10 % are bound to haemorheologic disturbances. Thus in 35 — 40 % of cases the reason of an ischemic stroke to establish are not possible, despite careful complex inspection of patients with application of the most up-to-date methods of inspection (N.V.Vereschagin, 1993; V.J.Neretin,

S.V Cats, I.L.Vostrikova, 1999). It is underlined and possibility of development of disturbance of the cerebral circulation caused by a pathology of cervical department of a backbone (anomaly of development, an osteochondrosis) which risk increases at disturbance of venous outflow from a skull cavity (B.I.Sharapov, 1966; F.E.Gorbacheva from co-workers., 1994, 1995; P.Duus, 1995; A.I.Isajkin, 1996).

Thus, the stroke can be caused various pathogenetic mechanisms, they are united only by brain territory on which final processes (N are developed. V.Vereschagin, J.J.Varakin, 1996).

Irrespective of level of vascular system of a brain (an artery, the microcirculatory bed, veins, venous sine) on which there was a pathological dystonic or obstructive process, haemorheologic or other disorders, to resultants will be a diffusive or local cerebral ischemia. An ischemia consequence inevitably is wet brain with the subsequent deterioration of conditions both venous, and a microcirculatory and arterial blood flow. Thus the vicious circle is formed, to break off which probably only influencing on the basic links of a pathogenesis of a cerebral ischemia.

The concept "ischemia" can be defined as a condition of the lowered or full blocking of the blood flow which result is inadequate delivery of oxygen and loss of functions by the amazed tissues (F. Clastre, 1994).

The brain is very sensitive to an ischemia because it has a high metabolic rate, but small reserves of high-energy Natrii phosphases or karbogidratov. Ischemic damage of a brain is caused by a combination of several pathophysiological factors. The first development of a serious hypoperfusion and a hypoxia. Other factor - wet brain, an acidosis and a passive vasodilation in ishemizirovannoj areas. The processes occurring at a cerebral ischemia are difficult enough, however it is considered, that there is a zone damaged, but still the teleorgánic tissue surrounding the centre of an ischemia (V Omar, J.McCord, J.Downej, 1991).

Patofiziologija a critical ischemia it is bound to reduction of a blood flow and perfused pressure in distal areas of circulation, leaders to microcirculation deterioration. Irrespective of ischemia type — cerebral ^ myocardial, peripheric, pathophysiological mechanisms are always caused by the same wide range of disturbances, including hemodynamic, rheologic and metabolic (E.I.Gusev, V.I.Skvortsova, A.V.Kovalenko, M.A.Sokolov, 1999; E.I.Gusev, V.I.Skvortsova, E.J.Zhuravleva, E.V.Jakovleva, 1999; Wilterdink J.L., Easton J.D., 1994).

Diagnostics of disturbances of a cerebral circulation at a lesion of cervical department of a backbone.

Subjective character of many symptoms at a lesion of cervical department of a backbone with disturbance of a cerebral circulation does necessary use of the additional tool methods helping obektivizirovat disturbance of a cerebral blood flow.

Some authors find appreciable changes at REG, specifying in reduction krovenapolnenija back departments of a brain according to the lesion party (Barre JA, 1926). Use ehopulsografii for PAS inspection (Karpenko V. S, 1987, Konovalov A.N., Kornienko V. N, 1997) is described also

The advanced and adequate method of research of a functional condition of a brainstem is research of the somatosensory caused potentials. In the literature there are individual reports with the limited number of the surveyed patients with VBN. Criteria of disturbance of a circulation in a brainstem (by Osna A.I., 1977, Alberts VJ „Gray L, 1992) are not specified.

UZDG rather recently it is applied in diagnostics okkljuzirujushchih lesions of the main vessels. According to various authors results of this research correlate with data AG in 80-85 % cases (Abbot KN, 1961, Ausman L, 1987). If this method finds wide application at a pathology of carotids reports on its application at a pathology pozvonochnoj arteries remain small; last circumstance is bound to anatomic features of a course pozvonochnoj arteries, its deep zaleganiem about a backbone. In this connection, the qualified research pozvonochnoj an artery demands good anatomic knowledge and long training, much more, than at research of carotids. In the literature till now there is no general program of research pozvonochnoj arteries, but the majority of authors survey it in 2 h points - І th distal behind a mastoid, where lotsiruetsja a blood flow on a site pozvonochnoj arteries between С1-С111 (Abbot KN, 1961, Adams RD, 1953), 2nd point - proximal - at level of a free site pozvonochnoj arteries from a mouth to an input in transverse foramen CY1 of a vertebra (Berguer R, Bauer RB, 1981). Authors pay attention at an estimation of results to absence of a blood flow, it assimetriju, and also on a condition of a compensatory overflow on back connecting arteries. Nikitin J.M. considers an index assimetrii more than 50 % as a stenosis sign, co-authors (Hakim AM, Melanson D, 1993) describe 5 possible types of a graphic representation of rate of a blood flow on pozvonochnoj arteries depending on a rate parity in a diastole and in a systole.

Existing methods UZDG of research pozvonochnoj an artery far do not settle possibility of this method. We did not meet in the literature of a mention accessible to us on research pozvonochnoj an artery in various functional positions of a head and a neck.

Usual spondilografija cervical department of a backbone can tap anomaly of vertebra, cervical a rib, anomaly kraniovertebralnogo transition or various signs of an osteochondrosis, especially at slanting pictures (Vereschagin N.V, Borisenko V. V, Vlasenko A.G, 1993). Functional pictures tap presence of subluxations and change of articulate processes (Campbell JK, Houzer OW, Stevens JC, 1978). A solving stage in diagnostics development vertebrobaziljarnoj failures and surgeries pozvonochnoj arteries was introduction in practice in 1949 g vertebralnoj angiographies which was made snachalo perkutanno. The risk of development of serious complications at vertebralnoj angiographies was about 25 % and it braked application of a method for clinical use. As alternative in 1955г. The retrograde brachial angiography which is used has been offered and to this day (Jung A, Vierling JP, 1965).retrogradnaja the catheterization pozvonochnoj arteries from femoral has been described for the first time in 1956г. However, the angiography for inspection vertebrobaziljarnoj systems was rather unsafe manipulation, and doctors often refused it for acknowledgement of the clinical diagnosis vertebrobaziljarnoj failures. Development of surgical methods of correction of a pathology pozvonochnyh arteries has in the late fifties led to method perfection vertebralnoj to an angiography. In turn, expansion of diagnostic possibilities of an angiography has led to working out of new methods of surgical treatment (Branchereau A, Magnan NOT, 1990, Caplan LR, 1992).

Recently has received development a new method of an angiography, invasive - a digital intravenous angiography. However, according to a number of authors, this method is not suitable for preoperative diagnostics of a lesion
vertebrobaziljarnoj systems because of bad visualisation of a mouth and its details ekstrakranialnoj parts (Hardin SA, 1965, Higano S, Uemura F, 1990)

Thus, the most adequate estimation of branches of back circulation demands a traditional angiography (Daseler EN, Anson In J, 1959). In an arsenal of modern methods of inspection there are such methods which are non-invasive and render the important help in diagnostics by visualisation of change of density of a cerebral tissue depending on its blood supply (KTG) or by studying of distribution of radioisotope substances which are entered into an organism intravenous or inhalation by. Only separate authors at a pathology of cervical department of a backbone consider disturbance of a circulation not only in pozvonochnoj, but also in carotid pool. Still the smaller number of works is devoted studying of a venous circulation and its interrelation with an arterial blood flow at a pathology of cervical department of a backbone. At studying of disturbances of a cerebral blood flow at patients with cervical department of a backbone authors are based basically on ultrasonic, angiograficheskih and magnitno-resonant methods of research. Possibilities of radiological methods of research in diagnostics of disturbances of a cerebral circulation are studied insufficiently.

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A source: TSATHLANOVA DIVIDING IVANOVNA. RADIAL DIAGNOSTICS of DISTURBANCES of the CEREBRAL CIRCULATION AT the PATHOLOGY of CERVICAL DEPARTMENT of the BACKBONE. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2005. 2005

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  6. the Chapter I Review of the literature
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