后循环梗死患者基底动脉弯曲的相关性分析

许多临床医师和影像学医师主要关注颅内血管有无狭窄和闭塞,而对血管的弯曲认识度不高,并对血管弯曲是否与缺血性脑卒中的发生也存在争议。基底动脉弯曲是动脉硬化的一种表现,其发生发展与很多危险因素有关,并与后循环的梗死密切相关。本文通过对颅脑M RA的影像分析,进行后循环梗死患者基底动脉弯曲的关联性研究。     

基底动脉侧向偏离弯曲情况临床病例对照观察

目的:调查接受头颅MRI和MRA检查者的基底动脉偏离、弯曲情况。方法:按时间顺序提取于2005年7月至2006年7月在我院核磁共振室同时进行头颅MRI和MRA检查的623人的影像资料,597人为患者,26人为健康体检者。参照Giang等的分类标准按4个等级统计基底动脉偏离、弯曲情况。结果:597例患者中,基底动脉0度偏离弯曲158例,占26.46%;1度289例,占48.40%;2度135例,占22.61%;3度15例,占2.51%。在26名正常体检者中,基底动脉0度偏离弯曲7例,占26.92%;1度17例,占65.38%;2度2例,占7.69%;3度0例。结论:在全部样本中基底动脉3度偏离弯曲者占2.4%。     

椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑梗死的影响

目的 探讨椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑桥和小脑梗死的影响. 方法 回顾性分析郑州人民医院神经内三科自2009年1月至2011年1月收治的91例单侧脑桥或小脑后下动脉脑梗死患者的影像学资料,包括梗死侧别、椎动脉优势、基底动脉弯曲及其方向性关系等,应用多元logistic回归分析寻找基底动脉弯曲的预测因素. 结果 旁正中动脉供血区的脑桥中央是脑桥梗死最多的受累部位,右侧小脑内下部是小脑后下动脉梗死最多的受累部位.椎动脉优势常发生于左侧(69.2％,63/91).91例患者中有76例在椎动脉优势和基底动脉弯曲之间存在相反方向的关系.椎动脉内径是基底动脉中重度弯曲的唯一预测因素,其OR值为2.70,95％CI为1.22～5.98. 结论 椎动脉优势是基底动脉弯曲的重要预测因素,且弯曲多朝向优势椎动脉的对侧.椎动脉优势及其造成的基底动脉弯曲增加了椎基底动脉连接部脑梗死的发生率.     

眩晕患者基底动脉弯曲及其危险因素的研究

目的:研究眩晕患者基底动脉弯曲及其危险因素.方法:调查237例眩晕患者的临床资料,并对其进行头颅MRA或CTA及血脂、血浆同型半胱氨酸检查.采用多因素Logistic回归分析寻找基底动脉弯曲的危险因素.结果:本组237例患者中,基底动脉弯曲者64例(27.0%),基底动脉无弯曲者173例(73.0%).基底动脉弯曲患者...     

基底动脉尖综合征12例临床及影像学分析

目的:探讨基底动脉尖综合征的临床及影像学特征。方法:对12例基底动脉尖综合征患者的临床资料进行回顾性分析。结果:基底动脉尖综合征复杂多样,常见眩晕、意识障碍、肢体不全瘫痪及眼球运动障碍等。影像学特征常为双侧、幕上、幕下多发性病灶,多位于丘脑、中脑、小脑等。本病预后较差。结论:基底动脉尖综合征的诊断主要依据是临床及影像学表现,预后不佳。     

基底动脉型偏头痛64例临床分析

分析６４例基底动脉型偏头痛，发作因素有偏头痛家族史、精神或情绪因素、视觉疲劳、劳累或睡眠不足。前驱表现为眩晕、视觉障碍、恶心、四肢乏力、共济失调、精神症状等。头痛位于枕部、双或单颞侧，发作时间多在１～４小时，间歇期不定。ＴＣＤ检查证实发作期和间歇期多数存在基底动脉痉挛。认为诊断的关键是发作性、以基底动脉缺血表现为前驱症状、随之而出现的搏动性头痛。     

基底动脉尖综合征15例临床分析

基底动脉尖综合征 (TOBS)是因基底动脉尖端部位血循环障碍所引起的一组临床综合征。国内外均有报道 ,据统计约占脑梗死的 7 6% 〔1〕。我院自 1997～ 2 0 0 3年收治并确诊TOBS 15例 ,现分析如下。1　临床资料1 1　一般资料　本组病例中男 10例 ,女 5例 ;年龄 45～ 70岁 ,平均 5 3 7岁 ,5 0～ 65岁 9例 ,占 60 %。均有脑血管病的危险因素 ,既往有高血压病史 11例 ,糖尿病史 5例 ,冠心病史 7例 ,高血脂症 4例 ,长期吸烟史 9例。1 2　临床表现　均为突然起病 ,眩晕、呕吐 11例 ,意识障碍 11例 ,其中嗜睡 7例 ,昏睡 3例 ,浅昏迷 1例。偏盲 …     

基底动脉闭塞症41例临床分析

本文回顾2003-02-2005—02入住我院的41例基底动脉闭塞患者，就其临床表现及影像学等特点作如下分析。     

基底动脉尖综合征16例临床分析

基底动脉尖综合征(top of the basilar syndrome,TOBS) 是由Caplan等(1980)首先报道,现已作为一种特殊类型的脑血管病单独列出[1].现将我科2004-01～2009-05收治的16例TOBS患者临床资料报告如下.     

基底动脉显著偏离弯曲引发面肌痉挛(附2例报道)

<正>我们的大宗影像调查工作提示,少数人的基底动脉显著偏离桥脑中央并呈弯曲状态(待发表),而基底动脉显著弯曲能引发头晕。最近我们又发现2例基底动脉显著偏离弯曲引发面肌痉挛病例,报道如下。     

椎基底动脉延长扩张症与前循环障碍关系的研究(附5例报告)

目的观察椎基底动脉延长扩张症(VBD)与前循环障碍的关系。方法回顾性分析VBD与颈内动脉闭塞/狭窄并存病例的临床及影像学资料。结果 5例患者中,临床表现为双眼同向偏盲或视力障碍3例,一侧肢体运动障碍2例,Gerstmann综合征1例。CT/MRI显示分水岭性脑梗死(后型)2例,大脑前及大脑中动脉供血区梗死各1例,无明显改变1例;CTA/MRA显示同时伴有一侧颈内动脉闭塞3例,双侧颈动脉狭窄及发育不良(烟雾病)各1例;基底动脉长度为34.0~39.5 mm,直径为4.6~4.8 mm;颅内椎动脉最大处直径为4.4~4.8 mm。结论 VBD可与颈动脉闭塞或狭窄共存,临床表现更为复杂。长期的前循环障碍可能是VBD形成的重要促发因素,应兼顾前后循环状况制定治疗方案。     

Neurofibromatosis Type 1 Associated with Vertebrobasilar Dolichoectasia and Pontine Ischemic Stroke

Neurofibromatosis type 1 (NF1) is a heterogeneous, common, neurocutaneous disorder presenting different complications during a life span, including cerebrovascular dysplasia. To our knowledge this is the first reported case of NF1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. We describe a 57‐year‐old man with NF1 who presented an acute onset right‐sided facial palsy and hemiplegia, dysarthria, and gait imbalance. Magnetic resonance imaging showed an acute left paramedian pontine infarct and a hypoplastic right vertebral artery. Brain Computed Tomography Angiography revealed the occurrence of vertebrobasilar dolichoectasia. Co‐occurrence of VBD and NF1 might not be merely casual and it may significantly heighten the mortality rate in this multisystem disorder. We suggest a possible role of VBD in the genesis of our patient's clinical‐radiological features and prompt the early detection of asymptomatic arteriopathy in individuals with NF1 in order to ameliorate patients’ quality of life and life expectancy.     

Vertebrobasilar Dolichoectasia Causing Symptomatic Hydrocephalus Due to Third Ventricular Compression

Vertebrobasilar dolichoectasia sometimes presents with symptoms related to mass effect like cranial nerve palsies, or with ischemia or hemorrhage. Symptomatic hydrocephalus as a complication of vertebrobasilar dolichoectasia is extremely uncommon. Furthermore, there are few cases of vertebrobasilar dolichoectasia, in which cerebrospinal fluid flow disorder mechanisms are clearly demonstrated in neuroimaging findings. Here, we describe a patient with vertebrobasilar dolichoectasia who presented with symptomatic hydrocephalus due to direct compression against the third ventricle, which was immediately relieved by ventriculoperitoneal shunt. This patient exhibited a progressive clinical course of acute hydrocephalus; however, a subclinical ventricular dilatation may have been present before the onset. Therefore, a careful follow-up is warranted to treat symptomatic hydrocephalus that may develop in patients with vertebrobasilar dolichoectasia.     

先天性右侧椎基底动脉发育不良致基底动脉尖综合征1例

基底动脉尖综合征是一种特殊类型的椎基底动脉系统血管病。本文报道了1例因先天性血管发育不良导致的基底动脉尖综合征病例，结合相关文献，对该病的临床表现和诊断进行了回顾。     

The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia

Objective

Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD.

Methods

There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS.

Results

The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028).

Conclusion

Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery.     

Vertebrobasilar infarcts in patients with dolichoectatic basilar artery

We reported 18 patients who had stroke in the posterior circulation with dolichoectatic basilar artery. TIAs preceded posterior circulation infarct in 5 patients. Strokes involved medulla oblongata (3), pons (4), cerebellum (4), mesencephalon (4), thalamus or occipital lobe (3). Dolichoectatic basilar artery also produced hydrocephalus in one patient. The mechanism of stroke may be due to penetrating artery occlusion, basilar artery thrombosis or an embolism from the abnormal basilar artery. Short-term prognosis was poor seeing that 4 patients died within 12 days of stroke.     

椎动脉优势与后循环缺血性眩晕的关系

目的 探讨椎动脉优势在后循环缺血性眩晕(VAIV)中的临床意义.方法 前瞻性收集经头颅MRA检查发现的椎动脉优势的VAIV患者41例为研究对象,以非椎动脉优势的患者36例为对照,比较两组患者的基底动脉情况及眩晕严重程度.将椎动脉优势组患者根据椎动脉直径差异分为轻度变异组(0.04～0.70mm)、中度变异组(0.70～1.17 mm)、重度变异组(≥1.17 mm)3组,比较3组患者的眩晕严重程度差异.所有患者均随访1年,观察椎动脉优势与阳性事件发生(眩晕反复发作或发生后循环脑梗死)的关系.结果 (1)椎动脉优势组基底动脉形状异常率为70.73％(29/41),明显高于非椎动脉优势组33.33％(12/36)(x2=10.77,P＜0.01);(2)椎动脉优势组眩晕严重程度(3.3±1.2)高于非椎动脉优势组(2.3±0.6)(t=1.99,P＜0.01);不同变异3组间两两比较,椎动脉优势重度变异组眩晕严重程度(4.0±1.1)大于轻度变异组(2.9±0.9)(t=2.07,P＜0.05);(3)随访1年后,椎动脉优势组阳性事件发生率(65.85％)高于非优势组(30.56％)(x2=9.56,P＜0.01).结论 椎动脉优势的VAIV患者基底动脉异常率高,眩晕程度更严重,更容易反复发作眩晕或发生后循环脑梗死.