33例椎-基底动脉瘤的临床观察

目的：探讨椎－基底动脉瘤治疗方法与预后关系。材料与方法：报告３３例椎－基底动脉瘤。动脉瘤破裂致ＳＡＨ１８例，动脉瘤直径从５ｍｍ到４５ｍｍ。其中９例行保守治疗。直接手术治疗中，９例夹闭术，２例瘤壁加固术。１３例行血管内栓塞治疗。结果：９例保守治疗中３例因再次出血死亡。１１例直接手术均痊愈。１３例血管内栓塞治疗后１～３个月后复查造影，闭塞率＞８０％者１２例。结论：椎－基底动脉瘤积极手术治疗可降低死亡率，依动脉瘤部位与大小采用不同手术入路至关重要，血管内栓塞治疗适于直接手术难以达到者，疗效肯定。     

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...     

The mechanism of ischemic stroke in patients with dolichoectatic basilar artery

Basilar artery dolichoectesia (BD) may cause brainstem ischemia by multiple mechanisms, including thrombosis, embolism, occlusion of deep penetrating arteries. The objective of this study was to determine and characterize clinical, imaging findings and hemodynamic mechanisms in patients with cerebrovascular event associated with BD and compare these data with those for patients with BD who did not have stroke. We studied 29 consecutive stroke, two transient ischemic attack (TIA) patients with BD who have been admitted to our stroke unit. We sought the diameter of ectasia, height of the bifurcation, lateral displacement, shape deformities, and blood flow velocity of the basilar artery (BA) by transcranial Doppler. Imaging and hemodynamic findings were compared with those found in a group of 18 patients without stroke or TIA. The main infarct localization was pons, eight (28%) with restricted single lesion, 10 (32%) with multiple lesions involving thalamus, midbrain, posterior cerebral artery (PCA) territory. Patients with BD were more probably to have had stroke fitting a clinical and imaging patterns of multiple infarcts than those with restricted infarct in territories supplied by branches of the BA (60% vs. 40%). Hypertension and atherosclerotic changes of the posterior circulation were more frequent in patients with stroke than those without (P = 0.004 and P = 0.028, respectively), whilst the incidence of other vascular risk factors were not significantly different in two groups. Patients with stroke/TIA had more often low blood flow velocity but not significant in the BA when compared with those for BD patients without cerebrovascular event (71% vs. 39%; P = 0.1). Reduced blood flow velocity in the BA was correlated significantly with distal lesions involving thalamus, midbrain and PCA territory rather than those located in the territory supplied by branches of the BA (P = 0.02). In conclusion, it seems probably that BD may cause vertebrobasilar system ischemia by multiple mechanisms, especially reduced blood flow in the BA and atheromatous changes in the vertebrobasilar system may precipitate thromboembolic stroke.     

基底动脉尖综合征的临床及影像学特征

目的探讨基底动脉尖综合征(TOBS)的临床表现及影像学特征。方法回顾性分析30例TOBS患者的临床资料。结果TOBS的临床主要表现为一过性意识障碍、眩晕、眼动及瞳孔的变化、锥体束损害、偏盲或皮质盲、共济失调及记忆功能损害;磁共振(MRI)表现梗死灶在丘脑、小脑、中脑、枕叶、脑桥、颞叶内侧面及胼胝体压部;数字减影血管造影(DSA)表现为基底动脉及椎动脉闭塞或狭窄。结论诊断TOBS需依赖临床表现和MRI表现,DSA能为病变血管提供定位依据,对治疗及预防TOBS有指导作用。     

Early thrombolysis in stroke due to basilar artery occlusion

Basilar artery occlusion is usually associated with a poor prognosis. Nevertheless, intra-arterial thrombolysis has been shown to improve clinical outcome in selected cases. We report the case of a 29-year-old patient who suffered a severe ischemic stroke due to basilar artery occlusion and who was treated with intra-arterial thrombolysis within 3 h of symptoms onset; treatment was followed by an almost full functional recovery. The young age of the patient, short segment occlusion in the middle tract of the artery, good collateral supply, and early recanalization may account for the favorable prognosis. Received: 7 August 2001 / Accepted in revised form: 18 October 2001     

The response of neurons and microglia to blast injury in the rat brain

Rats subjected to a single non-penetrative blast were examined for possible neuronal damage and glial reaction by immunohistochemistry and electron microscopy. The most dramatic feature in rats killed between 1 and 14 days after the blast was the widespread response of microglial cells in various parts of the brain in which the cells were hypertrophied and their surface antigens, like complement type three receptors (CR3), were upregulated. The blast wave also induced the vigorous expression of major histocompatibility complex (MHC) class I and II (Ia) antigens. In rats killed 21 days after the blast, the elevated immunoreactivity of microglia had subsided and at 28 days both the microglial external morphology and immunoreactivity were comparable to those of normal animals. In rats killed 4–7 days after the blast, the neurons in the cerebral and cerebellar cortex appeared normal except for the occurrence of some ‘darkened dendrites’. The incidence of ‘darkened’ den-drites was most common in rats killed at day 14 but they were absent at 21 and 28 days. Microglial cells were closely associated with some of the ‘darkened’ dendrites. Results in this study show that a non-penetrative blast in rats provokes a widespread microglial activation suggesting increased endocytosis and immunological responses. However, it remains uncertain whether such a drastic response was a direct activation of the cells by the blast wave or elicited indirectly by some chemical factors released from the damaged brain tissues.     

基底动脉尖综合征的临床和影像学特征

目的 探讨基底动脉尖综合征( TOBS)的临床和影像学特征.方法 回顾性分析43例TOBS患者临床资料.结果 本组患者临床表现主要有意识障碍(38例,88.4％)、眼球运动障碍(31例,72.1％)、瞳孔异常(28例,65.1％),同时伴眼球震颤、肢体瘫痪、共济失调、构音障碍等.MRI检查示病灶常为双侧(67.4％),...     

P-选择素在基底动脉尖综合征患者血清中的表达及尤瑞克林对其影响

目的观察基底动脉尖综合征患者血清P-选择素的动态变化及尤瑞克林对P-选择素表达的影响。方法将22例急性基底动脉尖综合征(TOBS)患者随机分为尤瑞克林治疗组和常规治疗组各11例,两组均给予常规抗血小板聚集、抗自由基、活血化瘀治疗,治疗组加用尤瑞克林治疗;测定患者治疗前、治疗后7d和21d血清P-选择素水平,并测定21例正常对照者血清P-选择素水平。结果与正常对照组比较,TOBS患者治疗前血清P-选择素水平显著升高(P<0.01);与治疗前相比,常规治疗组在治疗后7d下降无统计学意义(P>0.05),治疗后21d差异具有统计学意义(P<0.05);尤瑞克林治疗组在治疗后7d P-选择素水平下降显著(P<0.05),治疗后21d下降更加明显(P<0.01)。两组之间相比,治疗前血清P-选择素水平无显著性差异,治疗后尤瑞克林治疗组下降明显,治疗后7d(P<0.05),治疗后21d(P<0.01)。血清P-选择素水平与NIHSS评分呈正相关。结论血清P-选择素在TOBS患者中发病后升高,治疗后逐渐出现下降,尤瑞克林可降低血清P-选择素水平。     

大鼠基底动脉闭塞对脑干血流影响的实验研究

目的：观察大鼠基底动脉闭塞后对脑干血流变化的影响。方法：两点凝闭基底动脉，应用激光多普勒技术测量基底动脉闭塞前及闭塞后30、60、120分钟血流值。结果：基底动脉闭塞后脑干局部血流较闭塞前显著降低。结论：两点闭塞基底动脉效果可靠，激光多普勒可用来观察局部血流动力学变化。     

经眶颧-海绵窦入路夹闭基底动脉瘤的应用解剖研究

目的 探讨在经眶颧-海绵窦入路手术中增加基底动脉上段显露的方法。方法在10例标本上模拟经眶颧-海绵窦入路，观察磨除前、后床突后对基底动脉上段的显露情况。结果磨除前床突后形成的间隙为床突间隙；前床突下颈内动脉与动眼神经间的膜为颈内动脉动眼神经膜。沿此膜可进入海绵窦；磨除后床突后，暴露鞍背、上斜坡，即可显露基底动脉上段。结论在经眶颧-海绵窦入路手术中磨除前床突和后床突，可增加对基底动脉上段的显露。     

基底动脉急性闭塞患者支架再通预后与侧支代偿之间的关系

目的探讨急性基底动脉近端或中段闭塞行Solitaire~(TM)支架再通后3个月预后与术前侧支循环代偿之间的关系。方法对天坛医院2014-01—2014-12期间33例因基底动脉近端或中段急性闭塞行SolitaireTM支架机械再通患者的资料进行回顾性分析,根据再通术前脑血管造影(DSA)所示侧支循环代偿情况进行分级(Ⅰ-Ⅳ级),将患者侧支循环代偿程度分级,术前NIHSS评分,闭塞血管再通时间,有无高血压、糖尿病、高脂血症,是否合并基础狭窄、合并溶栓、合并支架植入等与SolitaireTM支架机械再通3个月预后情况〔分为预后良好(MRS评分0~2)和预后差(MRS评分3~6分)两组〕分别进行单因素分析,并将两组间比较P0.10的因素与3个月预后情况行多因素Logistics回归分析,筛选出影响3个月预后的独立风险因素。结果与SolitaireTM支架机械再通3个月预后差的基底动脉近端或中段急性闭塞患者比较,预后良好的患者侧支循环代偿程度较好(H=13.6,P=0.001)、再通术前NIHSS评分低(t=-3.315,P=0.004);其他相关因素两组间比较差异无统计学意义(均P0.05)。其中,血管代偿程度分级、术前NIHSS评分和合并高血压病(P=0.066)等三种因素P0.10,对这三种因素进行多因素Logistics回归分析显示,代偿程度分级(OR=7.536,P=0.017)和术前NIHSS评分(OR=1.150,P=0.039)是影响患者预后的独立风险因素。结论术前NIHSS评分、血管代偿程度分级是评估近端或中段急性基底动脉闭塞患者3个月预后的独立风险因素,而且术前血管代偿程度分级评价近端或中段急性基底动脉闭塞患者3个月预后的灵敏度更高。     

眶上锁孔入路治疗基底动脉上段动脉瘤的解剖学研究及初步临床应用

目的探讨眶上锁孔入路治疗基底动脉上段动脉瘤的可行性和适应证,并报告其初步临床应用经验。方法 8具福尔马林固定的尸头标本,完成眶上锁孔入路开颅后,通过视神经颈内动脉三角(即第二间隙),观察基底动脉上段的显露,并在神经导航系统辅助下完成解剖数据测量。在临床应用中,经眶上锁孔入路夹闭基底动脉上段动脉瘤9例。结果眶上锁孔入路通过第二间隙可显露基底动脉上1/3段,双侧小脑上动脉和大脑后动脉(P1段和部分P2段)。可观察到的基底动脉最低点与后床突水平间的直线距离为(5.0±1.2)mm,磨除后床突,距离可显著增加(3.4±1.0)mm(P0.05)。可观察到的基底动脉延长线最远点到颅前窝的垂直距离为(12.4±2.3)mm,去除眉弓及部分眶顶,距离可显著增加(3.3±1.2)mm(P0.05)。9例基底动脉上段动脉瘤通过眶上锁孔入路成功夹闭,术后随访6～12个月,病人恢复好。结论眶上锁孔入路可显露不高于颅前窝水平10mm,不低于后床突水平5mm的基底动脉。磨除后床突和切除眉弓及部分眶顶可分别增加基底动脉近端、远端的显露。眶上锁孔入路中,经第二间隙夹闭基底动脉上段动脉瘤是手术最佳路径。     

Recurrent cranial nerve palsies, midbrain infarction and hydrocephalus due to megadolichobasilar artery

A 67-year-old man presented four recurrent, alternating facial palsies, two right abducens palsies and eventually a right extrinsic third nerve palsy due to brain-stem infarction in a 37-year time-span. Neuroradiological examinations showed hydrocephalus and an elongated, tortuous, estasic basilar artery. This patient presented in his lifetime the whole clinical spectrum of the dolichoectasic basilar artery complications.

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Sommario Viene descritto un paziente di 67 anni che, dai 30 anni, presentò 4 paralisi ricorrenti, alternanti del nervo facciale, 2 paralisi del nervo abducente destro ed infine una paralisi estrinseca del terzo nervo cranico di destra secondaria ad infarto mesencefalico. Gli esami neuroradiologici evidenziarono un'arteria basilare allungata, tortuosa, ectasica ed idrocefalo. Tale paziente ha presentato nella sua vita l'intero spettro clinico delle complicazioni legate alla megadolicobasilare.

     

后循环供血区缺血性脑卒中患者的椎、基底动脉血管形态改变的影像学分析

目的 探讨后循环供血区缺血性脑卒中(PCIS)患者的椎动脉、基底动脉血管形态的影像学改变。方法 回顾分析2012年1月～2016年2月136例PCIS患者的MRI、CTA影像学资料,总结该类患者血管形态学改变的影像学特点,同期前循环缺血性脑卒中127例为对照组。结果(1)PCIS组136例血管形态改变者128例,占94.12%,其中扭曲45例(33.09%),狭窄35例(25.74%),纤细23例(16.91%),闭塞13例(9.56%),异常粗大7例(5.15%); 非PCIS组127例,血管形态改变者46例(36.22%),其中狭窄17例,扭曲、纤细等29例;(2)2组血管形态异常发生率比较有明显差异(P<0.01)。结论 PCIS患者椎动脉、基底动脉血管形态存在异常改变。椎、基底动脉扭曲、发育纤细、粗大等和狭窄性病变的血管形态改变可能均为PCIS的重要危险因素之一。     

增加血流动力学导致基底动脉重构的形态学及病理学早期观察

目的 探讨基底动脉血流动力学改变后基底动脉形态及病理变化.方法 新西兰大白兔双侧颈总动脉结扎以代偿性增加椎基底动脉血流,分别于术前及术后1d、1周、2周经颅多普勒检测基底动脉血流速度;术后1周、2周分别行脑血管造影,并且测量基底动脉直径及迂曲程度;对基底动脉病理切片EVG、Masson染色分析.结果 颈总动脉结扎后基底动脉血流明显增快(10.99 ml/min对比36.53 ml/min,P＜0.001),术后1周、2周基底动脉直径增大(0.60 mm对比0.82 mm;0.73 mm对比1.03 mm,P＜0.001),内弹力层完整,平滑肌层增生;并且迂曲成角,57.1％基底动脉向左侧弯曲,较术前差异有统计学意义(P＜0.05).结论 基底动脉血流动力学增加是导致基底动脉迂曲成角的主要原因.     

Endothelium-dependent relaxation to hydrogen peroxide in canine basilar artery: a potential new cerebral dilator mechanism

In prostglandin F_2α(PGF_2α)-precontracted isolated canine basilar arterial rings, hydrogen peroxide (H₂O₂) produced endothelium-dependent relaxations at concentrations of from 4.4 × 10⁻⁷–∼4.4 × 10⁻⁵ M. Removal of extracellular Ca²⁺ ([Ca²⁺]₀) attenuated the relaxant effects of H₂O₂. Complete inhibition of H₂O₂ relaxant action was obtained after buffering intracellular Ca²⁺ ([Ca²⁺]_i), in the endothelial cells, with 10 μM 1,2-bis (2-aminophenoxy) ethane-N,N,N′,N′-tetraacetic acid (BAPTA-AM). The H₂O₂-induced relaxations could be abolished completely by 1200 u/ml catalase and was suppressed significantly by 0.5 μM atropine, 150 μM N^G-monomethyl-arginine (L-NMMA), 50 μM N^G-nitro-L-arginine methyl ester (L-NAME), 1 μM Fe²⁺, or 5 μM methylene blue. These inhibitory effects of L-NMMA, L-NAME, or atropine could be reversed partly by 50 μM L-arginine. The Fe²⁺ inhibition of H₂O₂-stimulated relaxation was reduced significantly by either 1 mM deferoxamine (a Fe²⁺ chelator) or 100 μM dimethyl sulfoxide (DMSO, a ^•OH scavenger). Such relaxant effects of H₂O₂ were enhanced, significantly, by an acetylcholinesterase antagonist, neostigmine. A variety of pharmacological antagonists (of diverse vasodilator agents) could not inhibit the relaxant action of H₂O₂. Our observations suggest that at suitable pathophysiological concentrations, H₂O₂ could induce release of an endothelium-derived relaxing factor (EDRF), probably nitric oxide (NO), from endothelial cells of the canine cerebral artery. The H₂O₂ relaxant effects are clearly Ca²⁺-dependent, require formation of cyclic guanosine monophosphate (cGMP), and may be associated with release of endogenous acetylcholine (ACh).     

Endovascular treatment of acute basilar artery occlusion: Outcomes,influencing factors and imaging characteristics from the Tama-REgistry of acute thrombectomy (TREAT) study

ObjectiveThe effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO.MethodsWe retrospectively investigated patients with ABAO who underwent MT using modern stent retrievers and an aspiration device between January 2015 and March 2019 at 12 comprehensive stroke centers. Functional outcomes and 90-day mortality rates were analyzed as primary outcomes. Factors influencing outcomes were analyzed as secondary outcomes. Relationships between outcome and affected area of infarction on arrival were also analyzed.ResultsSeventy-three patients were included. Good outcome (modified Rankin Scale (mRS) score 0–2) was achieved in 25/73 patients (34.2%) and the all-cause 90-day mortality rate was 23.3% (17/73). Successful recanalization (modified Thrombolysis In Cerebral Infarction grade 2b and 3) was achieved in 70/73 patients (95.9%). In univariate analyses, age, National Institutes of Health Stroke Scale score, and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) differed significantly between good and poor functional outcome groups. Age and pc-ASPECTS were significantly associated with functional outcomes in the logistic regression model. Positive findings for the midbrain on diffusion-weighted imaging on pc-ASPECTS and brainstem score were significantly associated with poor outcomes.ConclusionMT with modern devices for ABAO resulted in highly successful recanalization and good outcomes. A positive finding for the midbrain on initial imaging might predict poor outcomes. Further studies are required to confirm our results.