后循环梗死与椎基底动脉狭窄的相关性分析

目的 探讨MRI所示的后循环梗死灶与DSA发现的椎基底动脉狭窄的相关性.方法 回顾分析30例后循环梗死患者的临床资料,将每例后循环梗死患者头部MRI发现的梗死灶与DSA所见的椎基底动脉狭窄血管进行对照.结果 MRI示单发性梗死22例(其中脑干梗死10例,小脑梗死8例,丘脑梗死2例,枕叶梗死2例),多发性梗死8例.DSA...     

中脑梗死与后循环血管状态之间的关系

目的探讨中脑梗死与后循环血管状态之间的关系。方法所有病例均行头部MRI及全脑血管造影检查。结果 32例新发中脑梗死中,5例为中脑独立梗死,27例为中脑伴发后循环其他部位梗死。行DSA后可观察到椎动脉闭塞者14例,椎动脉狭窄者15例;基底动脉闭塞者6例,基底动脉狭窄者9例;大脑后动脉狭窄者8例,大脑后动脉闭塞者5例;无后循环血管病变者5例。结论中脑梗死多伴发后循环其他部位的脑梗死,且多存在椎基底动脉系统的大血管病变,提示临床医生在遇到相关病例时,应重点排查血管方面的原因。     

脑梗死伴脑桥十字征1例报告

正脑桥梗死后影像学呈脑桥十字征改变者较少见,现报告1例如下。1病例患者,男,56岁。因"头晕1周"于2017年3月17日入住我院。患者曾于2014年5月因言语含糊不清伴双下肢乏力入住我院。查体:构音障碍,右侧Chaddock征(±)。头颅MRI示左侧桥臂急性梗死灶。患者入院第2 d言语不清症状加重,并伴右侧肢体乏力加重,复查头颅MRI示双侧桥     

以皮质蛛网膜下腔出血为首发症状的脑梗死2例报道及文献复习

目的提高对皮质蛛网膜下腔出血(cSAH)为首发症状的大脑中动脉(MCA)狭窄致急性脑梗死的认识。方法报道2例cSAH患者的临床表现、CT和MRI所见、治疗和预后,并复习相关文献进行讨论。结果 2例患者均有高血压病、糖尿病或冠心病史,突发肢体瘫痪,无头痛。头颅CT显示偏瘫对侧大脑皮质沟高密度影,进一步MRI检查提示CT高密度影为SWI低信号出血灶;同时MRA显示偏瘫对侧MCA M1段局限性狭窄,并于同侧放射冠见新发梗死灶。结论 MCA狭窄可以引起cSAH的临床放射综合征,同时伴有新发脑梗死。在cSAH诊断流程中,应该包括应用SWI和MRA检查。     

累及脑桥表面和脑桥内部的单侧孤立性脑桥梗死

目的 探讨累及脑桥表面和脑桥内部的单侧孤立性脑桥梗死的病因、影像学和临床表现.方法 回顾分析50例经磁共振成像(magnetic resonance imaging,MRI)证实的新发孤立单侧脑桥梗死患者的影像学和临床资料,根据MRI表现分为两组,组1:梗死累及脑桥表面(28例),组2:梗死位于脑桥内部(22例).比较两组的梗死灶大小和分布、临床表现、基底动脉病变等情况.结果 组1和组2主要病因分别是基底动脉分支病变(64%)和小血管病变(64%).组1脑桥梗死灶平均最大径值大于组2(P＜0.001).组1基底动脉狭窄患者多于组2(P＜0.001).组1梗死累及多个脑桥动脉供血分区患者多于组2(P＜0.01).组1偏侧瘫痪或/和偏侧感觉障碍患者多于组2(P＜0.05).结论 梗死累及脑桥表面的孤立单侧桥脑梗死的病因以基底动脉分支病变为主,与基底动脉狭窄关系密切,其梗死范围较孤立单侧脑桥内部梗死大.     

桥臂梗死的临床及影像特点

目的探讨桥臂梗死的临床及影像特点。方法通过回顾、复习总结6例病例,结合相关文献,总结桥臂梗死的临床及影像特点。结果 6例患者中以女性居多,女5例(83.3%);年龄多发生于中年,其中43~54岁4例,少数发生于少年或老年;多无既往史,少数有糖尿病或冠心病病史。首发症状多以头晕为表现,病情逐渐进展,主要侵犯三叉神经、面神经、前庭神经、外展神经以及小脑。头颅MRI示,病灶位于桥臂处,呈长T1、长T2信号,FLAIR像呈高信号,矢状位及冠状位显示更加明显,增强示无强化。结论桥臂梗死多发生于无脑血管病危险因素的患者,以头晕为主要表现,逐渐进展,应注意与其他疾病鉴别,诊断需行头颅MRI。     

以多灶性脑梗死为首发表现的Trousseau’s综合征(附12例病例分析)

目的探讨以脑梗死为首发表现的Trousseau’s综合征患者的临床特点、诊疗及预后。方法回溯南京医科大学附属南京医院(我院) 2019年1月至2020年12月收治12例以脑梗死为首发表现的Trousseau’s综合征患者的相关临床特点,详述1例以脑梗死为首发表现的典型Trousseau’s综合征患者治疗过程,并复习相关文献进行讨论。结果 12例患者中有8例病理确诊为腺癌,D-二聚体平均值为(12.53±12.00)mg·L-1,梗死灶均累及多个血管供血区域,Trousseau’s综合征评分均≥3分。典型病例为女性,71岁,因"左侧肢体乏力10h"入院。入院后实验室检查:血小板降低,D-二聚体升高;头颅MRI示多灶性脑梗死;FDG-PET/CT示胰腺恶性肿瘤。诊断考虑以脑梗死为首发表现的Trousseau’s综合征。予低分子肝素治疗后症状渐好转。结论以脑梗死为首发表现的Trousseau’s综合征治疗不同于常规脑梗死,预后极差。对于Trousseau’s综合征评分≥3分者应考虑Trousseau’s综合征相关脑梗死可能,以免延误原发病的诊治。     

探究前循环新发脑梗死患者头晕症状与颈内动脉系统血管病变的关系

目的 探究前循环新发脑梗死(ACI)患者头晕症状与颈内动脉(ICA)系统血管病变的关系。方法纳入前循环新发脑梗死患者234例,均接受全脑血管造影(DSA)检查,排除椎基底动脉(VBA)系统血管异常,根据发病前24 h内是否出现头晕症状,分为头晕组与非头晕组。收集患者人口学特征、一般临床资料、影像学资料,进行两组间脑血管危险因素(VRFs)、责任梗死部位、颈内动脉(ICA)系统、侧支循环建立的差异分析。结果 单因素分析高血压、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、VRFs≥3、一侧ICA狭窄合并迂曲、ICA中度迂曲差异有统计学意义(P 0. 05),多因素回归分析显示LDL-C、一侧ICA狭窄合并迂曲为ACI患者伴随头晕症状的脑血管独立危险因素。结论 合并低密度脂蛋白胆固醇越高的ACI患者头晕发生比例增加。一侧颈内动脉存在狭窄合并迂曲,为ACI出现头晕症状的独立危险因素,值得临床工作者重视。     

支架成形术治疗椎-基底动脉狭窄的疗效观察

目的 评价支架成形术治疗椎-基底动脉狭窄的疗效.方法 对34例经数字减影血管造影(DSA)确诊的椎-基底动脉狭窄的患者,采用球囊扩张支架对椎-基底动脉狭窄段进行支架成形术.结果 34例患者共放置36枚支架,手术成功率为100%,术后DSA示狭窄段全部成形良好,无并发症发生,椎-基底动脉狭窄段狭窄程度从术前的(78.3±6.2)%降至(3.6±4.2)%.随访6～38个月,患者临床症状消失31例,明显改善2例,复发1例.未见椎-基底动脉系统短暂性脑缺血发作(TIA)及新发后循环供血系统脑梗死等并发症.结论 支架成形术治疗椎-基底动脉狭窄是一种安全有效的方法.     

以双耳听力下降为首发症状的脑梗死临床观察

目的观察以双耳听力下降为首发症状的脑梗死患者,探讨其病灶分布特点及血管形态异常之间的关系。方法对3例以双耳听力下降为首发症状的脑梗死患者行头MR(包括T1WI、T2WI、DWI、MRA)、TCD、BAEP检查。结果 3例患者均为后循环多灶性梗死,最常累及的部位是小脑、脑桥,均有双侧椎动脉或基底动脉起始段严重狭窄或闭塞,双侧内听动脉均受累。结论以双耳听力下降为首发症状的脑梗死均符合多灶性后循环缺血的特点,血管形态异常是其重要病理基础和致病因素,预后差。     

Embolic internal auditory artery infarction from vertebral artery dissection

A 51-year-old man developed sudden vertigo, right hearing loss and dysphagia. Examination revealed right Horner syndrome, spontaneous torsional-horizontal nystagmus, right central type facial palsy, dysarthria, reduced soft palate elevation without gag reflex, left hypesthesia, right dysmetria and imbalance. Audiometry and bithermal caloric tests documented right sensorineural hearing loss and canal paresis. Brain MRI and cerebral angiography documented right lateral medullary infarction from vertebral artery dissection, without involvement of other parts of the brainstem supplied by the anterior inferior cerebellar artery (AICA). This case suggests artery-to-artery embolism as a possible mechanism of isolated vertigo or hearing loss from labyrinthine infarction.     

A case of infarction in brainstem and cerebellum as a initial symptom with bilateral hearing loss]

A 56-year old male presented with a sudden onset of bilateral hearing difficulty. He complained of dizziness and gait disturbance at the onset and subsequently developed bilateral hearing loss and tinnitus. Brain MRI revealed multiple infarcts in bilateral middle cerebellar peduncles, bilateral cerebellar hemispheres and the right cerebral peduncle. Three dimentional computed tomography angiography (3D-CTA) showed severe stenosis of bilateral vertebral arteries. Infarcts were located in the border zone between anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA), suggesting hemodynamic infarctions. Auditory brain stem responses (ABR) were recorded three times. The initial ABR demonstrated all waves except for wave I on day 14. Wave I on the left was normal, while wave I peak latency on the right was prolonged. On day 61, all waves were recorded, although peak latencies of waves III to V and interpeak intervals of the wave I to III on the right side were prolonged. Involvements of the cochlear nerve and pontine auditory pathway were suggested from the ABR abnormalities in this case.     

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。     

Acute bilateral hearing loss as a “worsening sign” in a patient with critical basilar artery stenosis

We report a patient who presented with an acute-onset transient vertigo and unsteady gait with bilateral hearing loss. Brain MRI revealed a critical basilar artery (BA) stenosis at the lower pons and infarction in various areas on both sides in the territories of the posterior inferior cerebellar arteries (PICA). Further, we could not visualize the right anterior inferior cerebellar artery (AICA). The bilateral hearing loss may be ascribed to stroke due to the critical BA stenosis, causing hypoperfusion injury extending from the PICA to the AICA on both sides. Local intra-arterial thrombolytic therapy with the administration of 1 × 10⁶ IU of urokinase aided partial recanalization of the BA, after which the right AICA reappeared. The neurological function of the patient recovered to normal, and no hemorrhagic complications were observed. Therefore, practitioners should be alert when treating patients with acute bilateral hearing loss, which may be related to an underlying catastrophic stroke.     

The megadolichobasilar artery--a clinical chameleon

The megadolichobasilar artery is a rare vascular disease, which usually becomes apparent either due to cerebral ischemia or due to compression of the brainstem or the cranial nerves, thereby leading to a large variety of neurological symptoms.We report on a patient who suffered a sudden right-sided deafness accompanied by vertigo and vomiting. Initially, an idiopathic sensorineural hearing loss was diagnosed and later on, after no improvement took place in spite of conservative therapy, a rupture of the round window membrane was suspected.Two weeks after the first symptoms had occurred the patient developed a hemiparesis on the left side.Radiology disclosed a dilated and partially thrombosed basilar artery as well as a paramedian pontine infarction.We therefore assumed that the patient's symptoms had been caused by thrombotic occlusion of the labyrinthine artery and several rami ad pontem.The article reviews the great variety of clinical symptoms caused by megadolichobasilar artery and discusses important therapeutic options.     

A case of brain stem infarction with bilateral hearing loss]

The study case was a 66-year-old man who had bilateral neurosensory hearing impairment due to brain stem infarctions. He noticed mild hearing loss, frequent vertigo and tinnitus. About one month later, his hearing took a sudden turn for the worse, and he suffered from dysarthria, dysphagea and abasia. Neurological examination revealed pseudobulber palsy, left hemiparesis, cerebeller ataxia, disturbance of pain and temperature sensation on the right face and left side of the body. Brain stem auditory evoked potentials (BAEPs) showed a delayed small wave V with the abscence of previous waves on the right side and no significant waves on the left side. Brain magnetic resonance images (MRI) revealed infarctions in the bilateral middle cerebellar peduncles, including in the right lateral portions of pons, and the right lower pontine base. We believe that not only peripheral, but also central auditory pathways adjacent to infarctions were damaged. Magnetic resonance angiography (MRA) showed severe stenosis or occlusion of left vertebral artery and basilar artery. We concluded that hypoperfusion of the vertebrobasilar artery territories caused ischemia of the cochlear nerve and the auditory tracts in the brain stem, which resulted in bilateral hearing loss.     

A case of bilateral cerebellar infarction in the distribution of the bilateral superior cerebellar artery]

We reported a case of bilateral cerebellar hemorrhagic infarction in the distribution of the bilateral superior cerebellar artery. A 58-year-old man suddenly developed dizziness and transient loss of consciousness. The neurological examination revealed left hearing disturbance, left sensory disturbance involving face, dysarthria and bilateral ataxia. This patient was considered to be classic clinical syndrome of right superior cerebellar artery. CT and MRI revealed hemorrhagic infarction corresponding to the full territory of the bilateral superior cerebellar artery. The right posterior cerebral artery was filling through the right posterior communicating artery on the right carotid angiography taken 2 hours after the onset. Bilateral vertebral angiography on the 18th day demonstrated no occlusions in the basilar artery and the bilateral superior cerebellar artery. Hemorrhagic infarction corresponding to the full territory of the bilateral superior cerebellar artery, sparing other territories as the present case, is extremely rare. In this case, cerebral embolism (top of the basilar syndrome) was suggested because of existence of atrial fibrillation and sudden onset.     

脑桥梗死部位与椎基底动脉狭窄或闭塞的关系

目的 探讨脑桥梗死部位与椎基底动脉狭窄或闭塞之间的关系.方法 连续入选2005年2月至2007年9月收住北京宣武医院神经内科的新发脑桥部梗死患者139例,所有病例均行头部MRI以及全脑血管造影检查,排除有可疑心源性栓子来源的患者.将病例分为A(旁中央动脉组)、B(短旋动脉组)、C(长旋动脉组)、D(混合组)4组,并对各组进行与椎动脉、基底动脉狭窄或闭塞以及无血管病变的相关性研究.结果 139例患者中A、B、C、D组各占78(56.1%)、3(2.2%)、7(5.0%)、51(36.7%)例.左或右侧椎动脉闭塞者56例(40.3%),左或右椎动脉狭窄者60例(43.2%),基底动脉闭塞者14例(10.1%),基底动脉狭窄者14例(10.1%),无后循环血管改变者16例(11.5%).A组与椎动脉闭塞、基底动脉闭塞及无血管病变者相关,x2值分别为3.945、6.824、4.485,P值分别为0.043、0.021、O.041.D组与基底动脉闭塞相关,x2值为10.952,P值为0.006.对以上两者进行Logistic回归分析,发现A组与椎动脉闭塞更相关(OR值为2.261),D组与基底动脉闭塞更相关(OR值为15.750).结论 脑桥不同部位的梗死与椎基底动脉的狭窄或闭塞关系密切,提示临床医生在遇到相关病例时,应提高警惕,及时做血管检查.

Abstract：

Objective To investigate the correlation between stenosis or occlusion of vertebralbasilar artery and the location of infarctions in pontine. Methods All 139 patients with acute pontine infarction who were admitted to the Department of Neurology,Xuanwu Hospital,Beijing,during February,2005 and September,2007 were studied. All patients received the examinations of head MRI and digital subtraction angiography (DSA). Patients with possible cardiac embolism were excluded from the study. All the cases were then divided into four groups: A( paracentral artery group); B (short rotary artery group); C (long rotary artery group) and D (combined group). Results In all 139 cases,78 cases (56. 1% ) were in A group,3 (2. 2% ) in B group,7 (5.0%) in C group and 51 (36.7%) in D group. Fifty-six cases (40. 3% ) have occlusion in vertebral artery,60 cases (43.2%) have stenosis of vertebral artery. Cases having stenosis or occlusion in basilar artery are 14 cases (10. 1% ) each. Sixteen cases (11.5%) have unimpaired vertebral-basilar artery. A group is related to occlusion of vertebral artery and basilar artery and unimpaired artery ( x2 =3. 945,6. 824,4. 485 ,P = 0. 043,0. 021,0. 041 respectively). D group is related to occlusion of basilar artery ( x2 = 10. 952,P = 0. 006). Logistic binary analysis found that A group is more related with occlusion of vertebral artery ( OR = 2. 261 ),while D group is more related to occlusion of basilar artery ( OR = 15. 750). Conclusions There is a significant correlation between stenosis or occlusion of vertebral-basilar artery and the locations of infarctions in pontine. The physicians are suggested to perform the examinations on cerebral vessels such as brain MRI or DSA in patients with infarctions in pontine.     

Medulloblastoma Manifesting as Sudden Sensorineural Hearing Loss

We present a rare case of medulloblastoma which presented with unilateral sudden sensorineural hearing loss as an initial symptom. A 19-year-old man was admitted to our hospital with a chief complaint of dizziness and facial numbness on the right side. His illness had begun two years previously with sudden hearing loss on the right side, for which he had been treated as an idiopathic sudden hearing loss. Magnetic resonance imaging demonstrated abnormal signals located mainly in the right middle cerebellar peduncle. We performed partial resection of the tumor by suboccipital craniotomy. The histopathological diagnosis was medulloblastoma. Intrinsic brain tumor is an extremely rare cause of sudden sensorineural hearing loss and is therefore easily overlooked as was in the present case. The present case highlights not only the need to evaluate patients with sudden sensorineural hearing loss by magnetic resonance imaging but also the importance of paying attention to intrinsic lesions involving the brainstem. Although this condition like the presented case might be rare, intrinsic brain tumor should be considered as a potential cause of sudden sensorineural hearing loss, as it may be easily missed leading to a delay in appropriate treatment.     

Unilateral sudden deafness as a primary symptom of brainstem and cerebellar infarction]

We report a case with a unilateral sudden sensorineural hearing loss caused by an infarction of brainstem and cerebellum. The patient was a 74-year-old male presented with a sudden onset of hearing loss and tinnitus in the right ear and dizziness. Steroid was administered on suspicion of idiopathic sudden deafness. However, the initial symptoms were deteriorated approximately 2 weeks later. He newly complained of the numbness of the right face and double vision, and he was transferred to our hospital for further evaluation. Neurological examination demonstrated horizontal nystagmus, diminution in the right facial sensation, right peripheral facial palsy, right hearing loss and cerebellar ataxia. Urgent MRI disclosed fresh infarctions of the right middle cerebellar peduncle and cerebellum localized in the territory of anterior inferior cerebellar artery. In general, idiopathic sudden deafness and Meniere's disease are frequent diagnosis in cases of sudden hearing loss with vertigo, but these symptoms may rarely be caused by cerebrovascular disorder. In patients with risk factors for arteriosclerosis, cerebrovascular disorder should be taken into consideration even if idiopathic sudden deafness may be suspected clinically. We emphasize the diagnostic importance of careful observation on neurological findings and early detection of radiological abnormalities on MRI.