33例基底动脉尖综合征临床及影像学分析

Clinical and Image Analyses of 33 Cases of Top Of The Basilar Syndrome(TOTBS)

目的：探讨基底动脉尖综合征（TOBS）的病因、发病机制、危险因素、临床表现、影像学特点、治疗及预后。以期加深对基底动脉尖综合征的了解，提高对基底动脉尖综合征的诊断与治疗，减少误诊误治的发生率。方法回顾性分析本院2013～2014年期间收治33例基底动脉尖综合征患者。结果原发性高血压是最常见危险因素（75.7%），其次为心脏疾病和2型糖尿病；主要发病机制为脑栓塞，临床表现常以眩晕及意识改变急性起病，主要表现为不同程度的意识障碍、眼球运动障碍、瞳孔对光反射及瞳孔改变和双侧病理征。MRI影像结果表明：基底动脉尖综合征患者的中脑或丘脑合并小脑、颞叶、枕叶等多部位脑梗死。原发性高血压是基底动脉尖综合征最常见危险因素；MRI影像学表现可为基底动脉尖综合征诊断提供可靠依据。结论 TOBS临床表现特点多样，其死亡率较高，早期诊断和合理积极的治疗对可改善疾病的预后。

Objective To deepen the understanding of Top Of The Basilar Syndrome（TOTBS）, improve its diagnosis and treatment, and reduce its incidence of misdiagnosis and therapeutic error by means of studying the etiology, pathogenesis, hazards, clinical manifestation, image features, therapy and prognosis of TOTBS.Methods Retrospectively analyze the 33 TOTBS patients treated in Ningde Mindong Hospital in 2013 to 2014.Results Followed by cardiac disease and diabetes, primary hypertension is the most common hazard （75.7%）, most likely, pathogenesis of TOTBS is embolism, its clinical manifestations usually are dizziness and acute-onset caused by disturbance of consciousness, with symptoms of disturbance of consciousness, disorder of ocular movement, pupil changes and bilateral pyramidal sign in varying degrees. Manifestation of MRI Image Data The TOTBS patients suffer from cerebral infarction in more than one parts, such as in midbrain or thalamus as well as in epencephalon, temporal lobe and occipital lobe. primary hypertension is the most common hazard of TOTBS, MRI image manifestation can be counted as the reliable evidence of TOTBS diagnosis.Conclusion The clinical manifestation of TOTBS can be varied in symptoms, the death rate of TOTBS patients is quite high, and early diagnosis and proper therapies can greatly improve its prognosis.