Wallenberg综合征病变血管与梗死部位的相关性

目的探讨Wallenberg综合征病变血管与梗死部位的相关性。方法回顾性分析26例Wallenberg综合征患者影像资料。根据影像学方法,将Wallenberg综合征病变血管分为椎动脉病变及小脑后下动脉病变。根据磁共振,将延髓背外侧纵向分为上、中及下三部,横向分为A、B、C、D及E五个部位,分析病变血管与梗死部位的关系。结果 26例患者中,椎动脉病变14例,小脑后下动脉病变12例;椎动脉病变中动脉夹层3例,动脉瘤1例。Wallenberg综合征梗死病灶纵向分布最常见部位是延髓中部(84.62%),其次是延髓下部(34.62%),最后是延髓上部(23.08%);在延髓梗死灶的横向分布方面,Wallenberg综合征梗死灶最常见的部位是延髓背外侧的A部(84.16%),其他依次为B部(80.77%)、C部(46.15%)、E部(34.62%)及D部(26.92%)。椎动脉病变组与小脑后下动脉病变组比较,两组患者在出现延髓中段梗死(P=0.033)及延髓A部(P=0.003)和B部(P=0.012)梗死方面有统计学差异。结论椎动脉病变也是导致Wallenberg综合征的重要原因,动脉夹层是常见的血管病变;椎动脉病变导致的Wallenberg综合征梗死病灶更加容易累及延髓中段,延髓背外侧的A及B部位。     

延髓背外侧综合征15例

延髓背外侧综合征,又称Wallenberg综合征,是神经内科常见病、多发病;但由于其临床表现有时不典型,尤其发病早期,常常以普通头晕或少见临床表现起病,故极易误诊,延误治疗,甚至因出现呼吸衰竭等而危及患者生命.因此,临床医生有必要对此引起足够重视,尽可能早诊断、早治疗以改善患者预后.本文对15例Wallenberg综合征患者的临床资料进行回顾性分析.     

椎动脉异常与Wallenberg综合征发病机制的探讨

Wallenberg综合征（延髓背外侧综合征）又称小脑后下动脉梗死综合征，系由小脑后下动脉（posterior inferior cerevbellar arteries，PICA）供血障碍所致。随着磁共振技术的广泛应用，Wallenberg综合征的临床诊断已不再困难；特别是核磁共振血管成像（MRA）出现后，使人们开始注重导致小脑后下动脉梗塞综合征的原因的探讨，传统的单纯PICA的闭塞病因说受到质疑，椎动脉（vertebral artery，VA）异常导致PICA及延髓背外侧供血障碍开始受到关注。     

CT、MRI检查对Wallenberg综合征的诊断价值

目的　探讨Wallenberg综合征的临床、CT及MRI的特点。方法　分析 12例Wallenberg综合征的临床表现及头部CT与MRI的改变。结果　本组 12例中 ,有 3例同时伴有桥脑受损的症状和体征 ,4例头颅CT检查中仅有 1例发现小脑及枕叶有异常信号改变 ,10例头颇MRI检查 6例在延髓有异常信号 ,其中有 2例同时伴有小脑异常信号改变 ,1例伴有桥脑异常信号改变。结论　Wallenberg综合征的临床特点不完全局限在延髓背外侧 ,少数可伴有桥脑受损的症状、体征。头颅MRI检查优于CT ,但并不是所有Wallenberg综合征MRI检查均有阳性发现     

Wallenberg综合征患者继发意识障碍的原因分析

目的探讨Wallenberg综合征患者继发意识障碍的原因分析。方法37例Wallenberg综合征意识障碍患者行头颅影像学检查,对部分患者出现的异常呼吸形式进行分析,侧脑室前角穿刺测定侧脑室压力患者20例(侧脑室穿刺组),记录意识障碍持续时间,并与保守治疗的17例患者(保守治疗组)意识障碍持续时间进行比较。结果Wallenberg综合征意识障碍患者第四脑室闭塞,急性幕上积水;颅内压明显升高;部分患者出现大脑半球受损的呼吸类型;侧脑室穿刺组患者意识障碍迅速恢复(12.7±5.3)h,异常呼吸类型迅速消失。保守治疗组患者意识障碍恢复慢(10.1±5.2)天,两组比较差异有统计学意义(P<0.05)。结论急性幕上积水可能是Wallenberg综合征意识障碍的主要原因。     

猎人弓综合征研究进展

<正>猎人弓综合征(Bow hunter's syndrome,BHS)又称旋转性椎动脉闭塞综合征,由Sorensen于1978年描述一位猎人转头射箭致Wallenberg综合征时首次提出。BHS少见,是一组由头颈部转动或过伸位时机械性椎动脉闭塞或狭窄引起。临床表现为一过性眩晕,如果不及时治疗,可能导致后循环脑卒中。但目前对该病尚认识不足,现对相关文献予以     

Wallenberg 综合征 15 例临床分析

目的探讨Wallenberg综合征临床特点、治疗方法及预后。方法回顾性分析15例Wallenberg综合征患者的临床资料。结果本组患者以急性或亚急性起病,以眩晕(66.7%)、构音障碍(60%)、吞咽困难(47%)、Horner征(73.3%)、共济失调(53.3%)及交叉性感觉障碍(53.3%)为常见临床表现。15例行MRI检查均显示延髓背外侧梗死,11例采用抗凝、抗血小板、活血化瘀治疗,4例采用东菱抗栓酶治疗,其中10例于7～10d后症状缓解,1～2个月后症状基本消失,4例遗留不同程度的感觉障碍和共济失调,1例死亡。经治疗眩晕、恶心、呕吐、声音嘶哑及吞咽困难恢复较快,感觉障碍和共济失调恢复最慢。结论动脉粥样硬化致椎基底动脉血栓形成是Wallenberg综合征的主要病因,但不是唯一原因,本病积极治疗后预后较好。     

Wallenberg综合征的眼球运动障碍

Wallenberg 综合征又称延髓外侧综合征,主要见于小脑后下动脉和椎动脉闭塞时。当延髓外侧损害时,常可出现许多复杂的眼球运动障碍,其病理生理与神经解剖间的关系,国内研究甚少。本文综合近年来国外有关文献,拟在眼球位置及运动障碍、眼球震颤、平稳跟踪与持久性凝视障碍及扫视障碍等方面作一综述。     

Wallenberg综合征的眼球运动障碍

Wallenberg综合征又称延髓外侧综合征，主要见于小脑后下动脉和椎动脉闭塞时，当延髓外侧损害时，常可出现许多复杂的眼球运动障碍，其病理重量民神经解剖间的关系，国内研究甚少，本文综合近年来国外有关文献，拟在眼球位置及运动障碍、眼球震颤、平稳跟踪与持久性凝视障碍及扫视障碍等方面作一综述。     

延髓背外侧综合征15例临床分析

<正>延髓背外侧综合征又称Wallenberg综合征,是由于小脑后下动脉或一侧椎动脉闭塞所致延髓背外侧部损害而出现的一组临床综合征,临床表现有突发头晕、交叉性感觉障碍、Horner征、球麻痹及共济失调等一系列症状。我科自2008年1月至2010年12月对确诊的15例延髓背外侧综合征患者的临床资料进行     

Neuroform支架在治疗症状性颅内动脉狭窄中的应用

目的评价使用Neuroform支架在治疗症状性颅内动脉狭窄的安全性、可行性。方法症状性颅内动脉狭窄患者11例,其中前循环狭窄2例(1例狭窄位于颈内动脉眼段交通段,1例狭窄位于大脑中动脉M1段),后循环狭窄9例(3例狭窄位于基底动脉,6例狭窄位于基底动脉交界处);均进行支架成形术治疗,术后全脑血管造影复查及使用美国国立卫生研究院脑卒中量表(NIHSS)进行评定。结果11例患者支架全部置放成功,造影复查显示动脉直径狭窄率从术前(85.6±7.4)%降至术后(35.7±12.1)%。按NIHSS评分评估,11例患者术后症状明显改善,其中1例患者术后15天出现Wallenberg综合征,随访1~12个月,其他患者未出现脑缺血再发作及支架内再狭窄。结论应用Neuroform支架治疗症状性颅内动脉狭窄合并路径血管纡曲不光滑的患者,可以提高手术成功率,减轻临床缺血症状和改善预后。     

Coronary-subclavian steal: presentation and management: two case reports

Subclavian stenosis is a highly prevalent and underrecognized clinical entity. In patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery, subclavian artery stenosis can cause coronary-subclavian steal, leading to myocardial ischemia. Traditionally, this has been treated surgically with a vascular bypass operation. Two cases of coronary-subclavian steal syndrome are presented, 1 treated percutaneously with angioplasty and stent, and 1 treated with a combined endovascular-surgical procedure.     

白细胞介素-6与低氧性肺动脉高压关系的探究

肺动脉高压（PAH）是一种常见的临床症状,凡是能引起血管阻力增大、血流量增多的因素都可成为其诱因。低氧性肺动脉高压（HPH）则是以低氧性肺动脉收缩和低氧性肺血管重构引起的肺动脉压持续升高为特征的病症。急、慢性低氧均可引起白细胞介素-6（IL-6）的分泌,导致炎症细胞浸润,继而通过对动脉内膜的改建引起PAH。     

Unusual causes of intermittent claudication: Popliteal artery entrapment syndrome, cystic adventitial disease, fibromuscular dysplasia, and endofibrosis

Opinion statement  In the general population, vascular causes of exercise-induced limb discomfort are most often the result of peripheral artery disease (PAD) due to atherosclerosis. However, several other clinical entities can often mimic the symptoms of atherosclerotic PAD of the lower extremities, particularly among younger patients with fewer risk factors for atherosclerosis, who often are more athletically fit than patients with PAD. Treatment for these entities often requires percutaneous or surgical intervention. This article reviews four uncommon vascular causes of exercise-induced limb discomfort: popliteal artery entrapment syndrome, cystic adventitial disease of the popliteal artery, fibromuscular dysplasia of the lower-extremity arteries, and endofibrosis of the iliac artery.     

急性冠状动脉事件患者ICAM-1的变化及其临床意义分析

目的评价急性冠状动脉事件患者血管细胞间黏附分子1(ICAM-1)浓度及与脑缺血危险性的关系及临床意义。方法对沈阳军区总医院2009年1月至2010年03月入院急性冠脉综合征患者134例,双抗体夹心酶联免疫吸附法测定ICAM-1,并随访患者180 d内出现脑血管疾病的情况。结果轻度狭窄组、中度狭窄组、重度狭窄组3组间ICAM-1表达差异有统计学意义。中度狭窄组和重度狭窄组ICAM-1浓度显著增高,与对照组和轻度狭窄组比较差异有统计学意义。重度狭窄组中有36%出现TIA,与ICAM-1浓度随着血管狭窄的程度加重而增加的现象一致。而在冠状动脉左前降支发生狭窄超过50%的所有患者中,脑血管疾患的发生率也明显增加。结论 ICAM-1浓度和急性冠脉综合征患者冠脉狭窄程度及主要心血管不良事件率相关,监测ICAM-1浓度变化具有重要临床意义。     

Importance of Absent Ductus Arteriosus in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

Tetralogy of Fallot without pulmonary valve syndrome is almost always associated with an absent ductus arteriosus. Patients with right aortic arch and retroesophageal left subclavian artery have a vascular ring if the left ductus arteriosus or its remnant and the Kommerell diverticulum are present. We report the cases of 2 infants in whom the role of an absent ductus arteriosus or its remnant is noteworthy. Both patients had a combination of tetralogy of Fallot with absent pulmonary valve syndrome and right aortic arch with retroesophageal left subclavian artery without a vascular ring. The absence of the ductus arteriosus has a role in the pathogenesis of tetralogy of Fallot with absent pulmonary valve syndrome. The absence of a ductus arteriosus in the right aortic arch with retroesophageal left subclavian artery precludes a vascular ring.     

Metabolic syndrome, peripheral vascular disease and coronary artery disease: A concise review

Metabolic syndrome has a very strong association with both forms of cardiovascular (CV) disease - coronary artery disease and peripheral vascular disease. There is also a marked interrelationship between the two forms of CV disease. When one form of CV disease is present, the other should be strongly suspected and the possible occurrence of associated vascular events should be clinically evaluated. When three of the five major components that define metabolic syndrome are present, the clinical evidence indicates that one or both forms of CV disease are present, at least in incipient form. To give maximum clinical benefit to the patient at risk, the clinician must be aware of these associations, look for them and institute the measures that can reduce the risk of progression.     

Subclavian artery occlusion causing acute myocardial infarction in a patient with a left internal mammary artery graft.

Although atherosclerotic disease of the subclavian artery has previously been reported to cause coronary-subclavian steal syndrome, acute myocardial infarction because of occlusion of the subclavian artery in a graft-dependent coronary circulation is an uncommon and previously unreported mode of clinical presentation. Increasingly, patients undergoing high-risk cardiopulmonary procedures have comorbidities with extensive atherosclerotic disease of many vascular beds including coronary, cranial, and peripheral. Our discussion reviews the clinical presentation of such a case and highlights some of the important treatment options available when confronted with such a finding. The successful outcome achieved by percutaneous stenting of the subclavian artery and salvage of the graft may indicate that this modality is the initial treatment of choice in such cases.     

Successful Coronary Artery Bypass in Ehlers-Danlos Type IV Syndrome Case Report and Review of the Literature

Atherosclerotic coronary artery occlusive disease is very rare in cases of Ehlers-Danlos type IV syndrome. We report what we believe is a unique case of successful coronary artery bypass grafting for atherosclerotic coronary artery disease in a patient with this syndrome and examine the possible implications for the natural progression of the disease through a review of the literature. Nevertheless, we reiterate previous investigators'' advice that any invasive procedure on these patients should be approached with extreme caution and that surgery should be performed as a last resort, considering the significantly elevated risks.Key words: Adult, atherosclerosis, coronary artery surgery, coronary artery disease, Ehlers-Danlos syndrome/classification/genetics/surgery, genetic predisposition to disease, male, vascular diseases/etiologyAtherosclerotic coronary artery occlusive disease is very rare in cases of Ehlers-Danlos type IV syndrome. We report what we believe is a unique case of successful coronary artery bypass grafting (CABG) for atherosclerotic coronary artery disease in an Ehlers-Danlos IV patient and examine the possible implications for the natural progression of Ehlers-Danlos IV—also called vascular Ehlers-Danlos syndrome (v-EDS)—through a review of the literature.     

急性冠脉综合征病理生理研究概况

急性冠脉综合征(ACS)是由于冠状动脉内血栓形成所致心肌严重缺血产生的一组进展性的临床综合征。本文从ACS的病理生理特点入手,系统概述了国内外近几年来对ACS的研究现状,尤其是基于ACS不稳定斑块、炎症反应和血管内皮功能阐述了ACS的发病机制。