椎基底动脉扩张延长症临床特点及影像分析

Clinical characteristics and imaging analysis of vertebrobasilar dolichoectasia

目的 探讨椎基底动脉扩张延长症（VBD）临床特点及影像学表现,以提高对VBD的认识.方法 对卫生部中日友好医院神经内科住院的25例于2009年1月至2010年1月经磁共振确诊的椎基底动脉扩张延长患者的临床资料进行回顾分析,总结其临床特点及影像学表现.结果 （1）临床特点：经研究本组患者以后循环缺血（84%）为主,临床表现以不间程度头晕（40%）最常见.（2）影像分析：头颅CT漏诊2例（8%）.头颅MRI及MRA诊断率100%.基底动脉分叉高度及基底动脉侧向偏移均以2级（Smoker分级法）最常见（分别占60%及68%）,且基底动脉以右侧移位多见（60%）.延髓受压变形常见（40%）.基底动脉钙化占（12%）及并发脑积水（4%）少见.另外,VBD常合并后循环颅内血管动脉硬化性斑块（40%以上）.（3）随访结果：随访期（0.5～1.5年）内3例（12%）患者发生严重的脑干梗死,其中2例（8%）死亡.均为基底动脉分叉高度及侧向偏移程度3级者.结论 椎基底动脉扩张延长症临床表现多样,但表现为后循环缺血并不少见,尤其是高龄患者.因其致死及致残率较高,我们必须及早诊断,磁共振对明确诊断及评价预后意义重大.

Objective To discuss the clinical characteristics and imaging findings so as to improve the understanding of vertebrobasilar dolichoectasia （VBD）. Methods The clinical profiles of 25 VBD patients diagnosed by magnetic resonance imaging（MRI）were retrospectively collected during January 2009-Janaury 2010. Their clinical characteristics and imaging findings were analyzed. Results ① Clinical characteristics： Posterior circulation ischemia （84%） was predominant. Different degrees of dizziness （40%） was the most common clinical manifestation. ② Imaging analysis： two cases （8%） had a missed diagnosis by head computerized tomography. The diagnostic accuracy rate of head MRI and MRA was 100%.The degree of bifurcation height or lateral deviation of basal artery was mainly of the 2nd degree according to the Smoke＇s criteria. The lateral deviation of basal artery was mostly of a rightward shift （60%）. The medulla oblongata was often compressed to deformation （40%）. Basal artery calcification （12%） and VBD-associated hydrocephalus （4%） were rare. VBD was usually complicated with arteriosclerosis plaques of intracranial arteries in posterior circulation （〉40%）. ③ Follow-up results： three cases （12%） suffered serious brainstem infarction during a follow-up period of 0.5-1.5 years. Two （8%） of them were dead. The degree of bifurcation height or lateral deviation of basal artery was of the 3rd degree in 3 cases. Conclusion The clinical manifestations of VBD are multiple. But posterior circulation ischemia is not rare, especially for the elderly patients. Because of a high rate of disability and mortality, early diagnosis is essential. MRI is of a great value in confirming the diagnosis and evaluating the prognosis.