延长扩张型椎-基底动脉夹层动脉瘤伴脑桥小脑角缺血性卒中进展致死二例

Ponto-cerebellar ischemia progressing to death in dolichoectatic vertebrobasilar dissecting aneurysm: report of two cases

延长扩张型夹层动脉瘤是一种内弹力层广泛断裂,可伴管壁增厚多发夹层,内膜内外可见广泛血栓形成的动脉瘤样突起病变。为探讨延长扩张型椎-基底动脉夹层动脉瘤伴脑桥小脑角缺血性卒中患者与急性蛛网膜下腔出血的关系,笔者报道分析了2020年5—10月南京医科大学第一附属医院神经外科连续收治的2例延长扩张型椎-基底动脉夹层动脉瘤伴脑桥小脑角缺血性卒中患者数天内死亡的病例资料。1例患者死亡原因经影像学证实为急性蛛网膜下腔出血;另1例因病情进展迅速,死因未经影像学证实,仅通过症状及血压波动特点考虑患者的死因可能为急性蛛网膜下腔出血。结合文献报道,提示出现脑桥小脑角缺血症状和病情恶化可能是椎-基底动脉夹层动脉瘤腔内血栓进展致动脉瘤破裂蛛网膜下腔出血的前兆。临床医师应该对此提高警惕,争取尽早完善术前准备,及时手术,避免动脉瘤破裂致死。

Dolichoectatic vertebrobasilar dissecting aneurysm(DVDA)is a kind of aneurysm with extensive disruption and fragmentation of the internal elastic lamina,wall thickening with multiple local dissections and extensive thrombus inside and outside the intima.To investigate the relationship between ponto-cerebellar ischemia in DVDA and subarachnoid hemorrhage(SAH),we reported and analyzed two DVDA patients with ponto-cerebellar ischemia and died within a few days after admission to the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University from May to October 2020.One patient died because of acute SAH confirmed by imaging.The death of the other patient was not confirmed by imaging due to the rapid progression of the disease and SAH was suspected based on the symptoms and fluctuation of blood pressure.Combined with literature reports,aneurysm rupture and SAH in DVDA may be heralded by new or worsened symptoms from ponto-cerebellar ischemia due to progression of intracavitary thrombosis of vertebrobasilar dissecting aneurysm.Clinicians should be vigilant for the signs of ponto-cerebellar ischemia and strive to improve preoperative preparation as soon as possible.Timely surgery should be performed to avoid fatal rupture of the aneurysm.