椎-基底动脉延长扩张症并脑干梗死3例的临床特点

目的 探讨椎-基底动脉延长扩张症(VBD)并脑干梗死的临床特点。方法 对3例椎-基底动脉延长扩张症并脑干梗死的临床资料进行回顾性分析,总结经颅多普勒(TCD)、CT动脉造影(CTA)及MRI观察其后循环血流动力学和影像学特征。结果(1)3例患者椎-基底动脉高度、位置偏移度及最宽直径的测量值均符合VBD的诊断标准;(2)TCD检查显示3例患者椎-基底动脉收缩期、舒张期峰值血流速度及平均血流速度降低;(3)头颈CTA显示椎-基底动脉不同程度的扩张、延长及迂曲,形成“S”形或“C”形;(4)头MRI显示急性脑梗死病变在延髓或中脑部位;(5)3例患者经抗血小板聚集、降脂等治疗后好转。结论 VBD合并脑干梗死可能存在椎-基底动脉形态和结构的变异及后循环血流动力学障碍。VBD常并发脑干梗死,对脑干梗死的治疗应依据患者临床表现和影像学特点采取个体化的治疗方案。

The clinical characteristics of 3 cases with vertebrobasilar dolichoectasia and brain stem infarction

ObjectiveTo explore the clinical characteristics of vertebrobasilar dolichoectasia(VBD)associated with brain stem infarction.Methods The general clinical manifestation and therapeutic regimen of 3 cases with VBD and brain stem infarction were analyzed retrospectively,and the posterior circulation hemodynamics and imaging features were investigated by TCD, CT angiography(CTA)and MRI.Results(1)The height, position offset and the widest diameter of vertebrobasilar artery in all cases accorded with the diagnostic criteria of VBD.(2)The Vs, Vd and Vm of vertebrobasilar artery detected by TCD decreased in 3 cases.(3)The Head and neck CTA showed that vertebrobasilar artery expanded, extended and twisted as form “S” or “C” to different degree.(4)The acute infarction lesions found by head MRI were medulla oblongata and mesencephalon.(5)3 cases improved after antiplatelet, lipid-lowering and other treatment.Conclusion The morphological and structural variation in vertebrobasilar artery and posterior circulation hemodynamic disturbancein exist in VBD with brain stem infarction. VBD is often is complicated by brain stem infarction, whose treatment should be individualized according to the clinical manifestation and the imaging characteristics.