闭锁综合征临床与脑血管造影结果的对比研究

目的:研究椎一基底动脉系统缺血所致闭锁综合征的临床特点与全脑血管造影的情况。方法:对13例经MRI证实的双侧桥脑基底部梗塞的闭锁综合征患者行股动脉插管全脑血管造影术,观察脑供血障碍的情况,并给予静脉和动脉溶栓治疗。结果:13例患者死亡8例,存活5例,超早期静脉溶栓4例,效果不佳,早期动脉溶栓4例,2例闭塞的基底动脉再通,恢复较好。脑血管造影示双侧椎动脉起始部严重狭窄并扭曲2例,优势供血的椎动脉起始部严重狭窄1例,椎动脉V3段闭塞波及基底动脉下段2例,基底动脉起始段闭塞4例,基底动脉中段闭塞3例,基底动脉全程狭窄1例。结论:椎一基底动脉不同部位闭塞或严重狭窄可引起双侧桥脑基底部梗塞,表现为闭锁综合征,死亡率高,早期动脉溶栓有一定效果。

The comparison study of the clinical and cerebral angiographical features of Locked in syndrome

Objective: To observe the clinical and angiographical features of locked-syndrome caused by the ischemia of the vertebrobasilar system. Methods: Transfemoral four-vessel cerebral angiography was performed in 13 cases of Lock-in syndrome, all with MRI confirmed bilateral ventral pontine infarction, to detect the disorders in brain blood supply. Transvenous or transar-terial thrombolysis was given if necessary. Results: 8 of 13 cases were dead, 5 survived. Ultra-early transvenous thrombolysis was performed in 4 cases, but the effect was not satisfactory. Early transarterial thrombolysis was performed in 4 cases, the reca-nalization of the basliar artery and good clinical recovery was observed in 2 of 4. Angiographical findings; severe stenosis and tortuosity of the bilateral vertebral origin was found in 2 cases, severe stenosis of the dormant vertebral artery origin in 1 , occlusion of V3 segment in 3, lower basilar artery in 4, middle basilar artery in 3, and occlusion of the total basilar artery in 1. Conclusions : The occlusion or severe stenosis of different part of vertebrobasilar artery might manifest as locked-in syndrome due to the bilateral ventral pontine infarction, with high mortality. The patients with locked-in syndrome benefited to a certain extent from the early transarterial thrombolysis.