21例老年人基底动脉尖综合征临床及CT分析

The clinical features and the CT analyses for 21 elderly patients with top of the basilar syndrome

目的探讨老年人基底动脉尖综合征(TOBS)的临床特征、头颅CT表现,以加深对该病的认识,避免误诊. 方法对21例60岁以上老年TOBS患者的临床资料进行分析. 结果 21例患者均以突发意识障碍为首发症状,能迅速恢复,但苏醒后睡眠过度7例(33.3%);均有眼球运动障碍,且难于恢复;均无明显的肢体瘫痪.8例(38.1%)记忆力明显下降.少见的症状是视觉障碍(14.3%)、幻视(9.5%)、偏身感觉异常(9.5%).21例患者中主要基础疾病有高血压15例(71.4%)、心脏病13例(61.9%)、糖尿病9例(42.9%).8例(38.1%)被误诊,发病第3～5天行头颅CT薄层扫描均能明确诊断. 结论 TOBS临床表现多样、复杂;老年人突发眩晕、意识障碍,伴有眼球运动障碍,无明显肢体瘫痪时应高度警惕TOBS.发病第3～5天复查头颅CT并薄层扫对基层医院诊断TOBS是行之有效的方法.TOBS可能以脑栓塞为主;高血压、心脏病、糖尿病是老年人TOBS最重要的危险因素.

Objective To study the clinical features and head CT characteristics of the top of the basilar syndrome (TOBS) in elderly patients, and to understand TOBS well in order to avoid misdiagnosis. Methods Clinical materials of 21 TOBS cases ( age > 60) were analysed. Results All 21 patients had symptoms of sudden Loss of consciousness, but could recover promptly. Seven patients (33.3%) showed oversleep after reviviscence. They all had oculomotor paralysis and were hard to recover. Their limbs showed no obvious paralysis. Memory dropped markedly in 8 cases (38.1%). Other symptoms were dysopia(14.3%) and photism (9.5%) and abnormal hemi-sensation of the body (9.5%). Among 21 cases, 15 had hypertension, 13 heart disease, 9 diabetics, and 8 were misdiagnosed as intracerebral hemorrhage, or subarachnoid hemorrhage, or myocardial infarction, with misdiagnosis rate being 38.1%. The examination with CT on the first day of the disease onset could only eliminate the intracerebral hemorrhage, while brain infarction could be diagnosed by thin CT scanning during the 3 rd to the 5th day of the disease course. Conclusions Clinical symptoms of TOBS are diversity and complex. Much attention should be paid to those elderly who suffered from hypertension, diabetes or heart disease and lost consciousness suddenly with oculomotorius paralysis, but without obvious limbs paralysis. Examinations by ECG and CT or MRI wieh diffusion should be taken to avoid misdiagnosis. Repeated CT examination and thin scanning during the third-fifth days would be helpful in diagnosing brain infarction. These are effective means for grass root hospitals to diagnose TOBS. It is shown that cerebral embolism is a main pathogenesis of TOBS. Hypertension, heart disease and diabetes might be the most important risk factors of TOBS for the elderly.