椎动脉夹层致延髓内侧梗死1例报道并文献复习

目的报道1例椎动脉夹层导致延髓内侧梗死病例。方法回顾性描述1例椎动脉夹层致延髓内侧梗死患者的临床资料、实验室和影像学检查结果,并复习相关文献进行分析。结果患者为青年男性,颈部扭伤后出现延髓内侧梗死,高分辨MRI检查确认病因为梗死侧椎动脉夹层。结论椎动脉夹层致延髓内侧梗死病例文献报道较少,临床需引起重视,提高诊断率。     

因椎动脉异常压迫引起的脊髓压迫症1例报告

脊髓压迫症冈椎动脉异常压迫引起的临床病例在国内外文献报道中很少见。我们遇到1例双侧椎动脉异常压迫颈髓（C1段）的患者，并对其成功实施了脊髓减压术。     

恶性组织细胞病致延髓压迫1例报告

现报告恶性组织细胞病引起延髓压迫1例如下.1 病例 女,70岁.因头晕2周,伴吞咽困难、声音嘶哑1周于2011年9月8日入院.患者2周前无明显诱因出现头晕伴视物旋转,有短暂意识朦胧、跌倒发作2次,伴恶心、右侧额颞部针刺样痛,无耳鸣耳聋.在当地医院予改善循环、营养神经等治疗无好转.     

延髓背外侧综合征病因自发性椎动脉夹层7例临床研究

目的 分析椎动脉夹层的临床表现与影像学特征,总结自发性椎动脉夹层与延髓背外侧综合征的临床关系.方法 收集我科诊断的7例椎动脉夹层病例的病史资料,分析其临床表现、MRI/MRA及DSA的特点.结果 7例患者均有枕颈部疼痛史,临床上均表现为延髓背外侧综合征的部分或全部症状;MRI检查发现6例表现为延髓背外侧、小脑梗死灶,1例无梗死灶;MRA/DSA检查7例均发现椎动脉颅内段(V4段)夹层:1例表现为椎动脉夹层闭塞,1例表现为线样征,其余5例表现为瘤样扩张.结论 自发性椎动脉夹层发病年龄较轻,发病前通常有枕颈部疼痛.我们认为自发性椎动脉夹层是延髓背外侧综合征的重要病因,并非罕见.对表现为延髓背外侧综合征的年轻患者,及时准确的病因诊断对治疗和预后有重要影响.

Abstract：

Objective To analyze the clinical and radiologieal features of vertebral dissection and summarize the relationship of spontaneous vertebral artery dissection (sVAD)and Wallenberg syndrome.Methods Seven cases with vertebral artery dissection were gathered from our hospital,and their clinical features and the characteristics of MRI/MRA and DSA were analyzed.Results Seven patients all had occipital headache or neck pain and clinically manifested Wallenberg syndrome.Six patients manifested the dorsolateral medullary and cerebellar infarctions in MRI,however one patient had no infarction.All of sVAD occurred in vertebral intracranial segment(V4 segment),one patient with vertebral occlusion,one patient with string sign,five patients with aneurysm expansion.Conclusions sVAD often affects young adult who presented with occipital headache or neck pain before ischemic stroke.sVAD is an important cause for Wallenberg syndrome,and prompt and ColTect etiological diagnosis is important for the therapy and prognosis.     

颅脑损伤合并糖尿病性胃轻瘫1例

<正>1病例资料病人,男,42岁,因交通事故致头部外伤后头痛、头昏5 h入院。既往有糖尿病史10余年。入院时体格检查:神志清楚,GCS评分15分,双侧瞳孔等大等圆,直径2.5 mm,对光反射灵敏;四肢肌力5级,肌张力正常。入院后头颅CT示左侧额叶挫伤性小血肿,左侧额部硬膜下薄层血肿,蛛网膜下腔出血,左侧顶骨骨折。入院后予保守治疗,予脱水、止血、神经营养药物应用等处理。病人伤后有头痛、恶心、呕吐,予肌     

枳术丸治疗糖尿病胃轻瘫

糖尿病引起的胃轻瘫是一种胃排空延缓的疾病,泛指无机械性肠梗阻存在时,禁食一夜后胃内仍有食物残留,胃动力学检查显示胃动力障碍和胃排空延迟.其典型临床表现为恶心、早饱、餐后腹胀、厌食、暖气、体质量减轻等.     

枳术丸治疗糖尿病胃轻瘫

糖尿病引起的胃轻瘫是一种胃排空延缓的疾病，泛指无机械性肠梗阻存在时，禁食一夜后胃内仍有食物残留，胃动力学检查显示胃动力障碍和胃排空延迟。其典型临床表现为恶心、早饱、餐后腹胀、厌食、暖气、体质量减轻等。其发生与糖尿病自主神经病变及胃肠道激素调控平衡有关。多数糖尿病胃轻瘫患者早期胃部症状较轻或无胃部症状，体格检查也可无特殊异常发现，因此容易漏诊。症状严重者如不积极治疗，极易导致酮症。现代医学对此症主要给予胃肠动力剂，药用西沙比利等。笔者近年来运用枳术丸结合中医辨证分型治疗该病，取得满意疗效。     

“开关征”-椎动脉压迫致颈内静脉狭窄二例DSA分析

目的探讨椎动脉压迫致同侧颈内静脉狭窄的DSA重要征象-开关征。方法分析2例颈内静脉狭窄患者的DSA影像学表现,并对照1例颈内静脉狭窄和1例颈内静脉闭塞患者的DSA表现。按照椎动脉弯曲的不同走行方式对椎动脉进行分型。结果本文2例患者椎动脉走出枢椎的横突孔后,1例水平向外、1例向前外走行,再穿过寰椎横突孔,从而形成了对颈内静脉的压迫。颈内静脉随着后方椎动脉的搏动,呈现压迫由轻到重,由重到轻连续变化的现象。压迫加重时,颈内静脉由狭窄至不全闭塞至致闭塞,造影剂由通过受限直至不能通过;压迫逐渐减轻时,颈内静脉由闭塞至不全开放至致开放,造影剂由不能通过至可以通过直至顺利通过,始终处于开-关-开-关的动态变化中。对于这种颈内静脉狭窄段随着其后方椎动脉的搏动,狭窄程度发生规律性变化的现象,作者命名其为"开关征"。结论 "开关征"是提示存在椎动脉压迫导致颈内静脉狭窄或闭塞的重要征象。     

Cervical Radiculopathy Caused by Vertebral Artery Loop Formation : A Case Report and Review of the Literature

Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient''s symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.     

Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery

We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient''s symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.     

特发性椎动脉夹层1例

1病例简介患者,男性,36岁,公司职员。主因“突发右侧肢体无力3d”,于2005年10月19日21:00收入我院。患者于入院前3d晨起床刷牙时突发右侧肢体麻木,从右下肢向上肢发展,伴右侧肢体无力及左侧顶枕部疼痛。右肢体无力表现为右手持物不稳,     

Rotational Vertebral Artery Compression : Bow Hunter's Syndrome

Bow hunter''s syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature.     

Intractable Hiccup as the Presenting Symptom of Cavernous Hemangioma in the Medulla Oblongata: A Case Report and Literature Review

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.