BACKGROUND Millard-Gubler syndrome(MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome.Vertebrobasilar artery dissection(VAD) is an unco...BACKGROUND Millard-Gubler syndrome(MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome.Vertebrobasilar artery dissection(VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient.CASE SUMMARY We herein describe an unusual case of young acute ischemic stroke patient,presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging(MRI) indicated a diagnosis of VAD.CONCLUSION Our finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.展开更多
Insufficient blood supply to vertebrobasilarartery is one of the ischemic cerebrovascular diseasesencountered commonly and frequently in old people.Its clinical symptoms are capricious,and severeischemia may jeopardiz...Insufficient blood supply to vertebrobasilarartery is one of the ischemic cerebrovascular diseasesencountered commonly and frequently in old people.Its clinical symptoms are capricious,and severeischemia may jeopardize the life of the patient.Thekey point for saving the patient's life and raising thequality of life is to relieve the symptoms and improveblood supply to the brain.From May 1995 to展开更多
Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular...Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.展开更多
Glossopharyngeal neuralgia (GPN) refers to paroxysmal severe pain located to glossopharyngeal part or ear, which is a rare clinical event. In this report, we describe a patient suffered from glossopharyngeal neuralgia...Glossopharyngeal neuralgia (GPN) refers to paroxysmal severe pain located to glossopharyngeal part or ear, which is a rare clinical event. In this report, we describe a patient suffered from glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia (VBD). A 72-year-old Chinese male was referred to our clinic with a complaint of paroxysmal severe pain in the right external auditory canal and auricle since 1 month, which could be precipitated by feed and accompanied with the vagus nerve irritation (bradycardia, low blood pressure, syncope) sometimes. Both computed tomographic angiography and digital subtraction angiography demonstrated a VBD (maximum diameter 5.7 mm) and a large fusiform aneurysm of basilar artery (maximum diameter 13.8 mm). The diagnosis is established on clinical and radiological signs. This is the first report of this kind in the literature. Although a few cases demonstrate that VBD can cause GPN, it should be considered as a possible etiology in patients with GPN.展开更多
Objective: To study the evaluation value of CTA for vertebrobasilar artery stenosis in patients with posterior circulation cerebral infarction and its correlation with serum biochemical indexes. Methods: A total of 14...Objective: To study the evaluation value of CTA for vertebrobasilar artery stenosis in patients with posterior circulation cerebral infarction and its correlation with serum biochemical indexes. Methods: A total of 148 patients who were treated in Maanshan Shiqiye Hospital between June 2014 and February 2017 due to vertebrobasilar artery stenosis were selected as the research subjects and divided into cerebral infarction group and transient ischemic attack (TIA) group according to the imageological examination. CTA was used to evaluate vertebrobasilar atherosclerotic plaque properties, and enzyme-linked immunosorbent assay kit was used to determine the levels of nerve injury markers, inflammatory response-related molecules and plaque property-related protease molecules. Results: The positive rate of posterior circulation plaque in cerebral infarction group was obviously higher than that in TIA group, and the positive rate of unstable plaque, fibrous plaque and calcified plaque were higher than those in TIA group;serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque, fibrous plaque and calcified plaque were all higher than those of TIA group;serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque and fibrous plaque were all higher than those of patients with calcified plaque, and serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque were all higher than those of patients with fibrous plaque. Conclusion: CTA can accurately assess the property of vertebrobasilar atherosclerotic plaque in patients with posterior circulation cerebral infarction and is closely related to the degree of nerve injury and the change of plaque property.展开更多
background The outcome of acute ischaemic stroke due to tandem vertebrobasilar artery occlusion was poor.Endovascular revascularisation may be a positive approach for acute basilar artery occlusion combined with verte...background The outcome of acute ischaemic stroke due to tandem vertebrobasilar artery occlusion was poor.Endovascular revascularisation may be a positive approach for acute basilar artery occlusion combined with vertebral ostium stenosis or occlusion.We reported seven patients with acute vertebrobasilar tandem occlusion by using angioplasty or stenting for proximal lesion and thrombectomy for distal occlusion.Materials and methods Consecutive patients with acute tandem vertebrobasilar artery occlusion at two centres were included in this study.We retrospectively analysed the clinical,technical and functional outcomes of the patients.results From March 2016 to March 2017,seven patients were included.The mean age and National Institute of Health Stroke Scale score at admission was 57 years and 22,respectively.A reverse approach was used in five patients.The Thrombolysis in Cerebral Infarction score 2b-3 was acquired in all patients.There were no procedural complications.The modified Rankin Scale score was 1-2 for three patients and 4 for one patient at 3 months.Three patients died at 3 months of follow-up.Conclusions Endovascular revascularisation may be feasible for acute tandem vertebrobasilar artery occlusion,and more researches are needed.展开更多
Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiag...Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiagnose.Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here.Absence of common causes of stroke including hypoperfusion,blood system diseases,carotid and aortic dissection,and eosinophil elevation,the symptoms of the 2 patients met the diagnostic criteria of VBD.Both patients displayed symptoms that were in line with the Traditional Chinese Medicine(TCM)syndrome pattern of"Qi deficiency and blood stasis".Accordingly,they were comprehensively treated with Supplementing Qi and activating blood circulation method.The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up.A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD.TCM treatment based on syndrome identification might be a promising candidate for VBD management.展开更多
Objective: To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. Methods: 86 VBI patients including 56 cases of low flow ra...Objective: To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. Methods: 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days’ treatment in the two groups. Results: In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly (P<0.05 or P<0.01). Conclusion: Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.展开更多
基金Supported by the National Natural Science Foundation of China,No.81301016the Beijing Municipal Administration of Hospitals’ Youth Programme,No.QML20150303
文摘BACKGROUND Millard-Gubler syndrome(MGS) is caused by a lesion in the brainstem at the level of the facial nerve nucleus, and it is also a rare ventral pontine syndrome.Vertebrobasilar artery dissection(VAD) is an uncommon cause of ischemic stroke. To the best of our knowledge, this is the first case report on the coexistence of MGS and VAD in a young acute ischemic stroke patient.CASE SUMMARY We herein describe an unusual case of young acute ischemic stroke patient,presenting with acute right peripheral facial palsy, right abducens palsy, and contralateral hemihypesthesia, manifesting as MGS. After receiving dual antiplatelet therapy with aspirin and clopidogrel, as well as rosuvastatin, the patient recovered significantly. The high-resolution magnetic resonance imaging(MRI) indicated a diagnosis of VAD.CONCLUSION Our finding further demonstrated that high-resolution MRI is a useful technique to early detect underlying dissection in posterior circulation ischemic stroke.
文摘Insufficient blood supply to vertebrobasilarartery is one of the ischemic cerebrovascular diseasesencountered commonly and frequently in old people.Its clinical symptoms are capricious,and severeischemia may jeopardize the life of the patient.Thekey point for saving the patient's life and raising thequality of life is to relieve the symptoms and improveblood supply to the brain.From May 1995 to
文摘Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.
文摘Glossopharyngeal neuralgia (GPN) refers to paroxysmal severe pain located to glossopharyngeal part or ear, which is a rare clinical event. In this report, we describe a patient suffered from glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia (VBD). A 72-year-old Chinese male was referred to our clinic with a complaint of paroxysmal severe pain in the right external auditory canal and auricle since 1 month, which could be precipitated by feed and accompanied with the vagus nerve irritation (bradycardia, low blood pressure, syncope) sometimes. Both computed tomographic angiography and digital subtraction angiography demonstrated a VBD (maximum diameter 5.7 mm) and a large fusiform aneurysm of basilar artery (maximum diameter 13.8 mm). The diagnosis is established on clinical and radiological signs. This is the first report of this kind in the literature. Although a few cases demonstrate that VBD can cause GPN, it should be considered as a possible etiology in patients with GPN.
基金Natural Science Foundation of Anhui Province No:1308085MH158.
文摘Objective: To study the evaluation value of CTA for vertebrobasilar artery stenosis in patients with posterior circulation cerebral infarction and its correlation with serum biochemical indexes. Methods: A total of 148 patients who were treated in Maanshan Shiqiye Hospital between June 2014 and February 2017 due to vertebrobasilar artery stenosis were selected as the research subjects and divided into cerebral infarction group and transient ischemic attack (TIA) group according to the imageological examination. CTA was used to evaluate vertebrobasilar atherosclerotic plaque properties, and enzyme-linked immunosorbent assay kit was used to determine the levels of nerve injury markers, inflammatory response-related molecules and plaque property-related protease molecules. Results: The positive rate of posterior circulation plaque in cerebral infarction group was obviously higher than that in TIA group, and the positive rate of unstable plaque, fibrous plaque and calcified plaque were higher than those in TIA group;serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque, fibrous plaque and calcified plaque were all higher than those of TIA group;serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque and fibrous plaque were all higher than those of patients with calcified plaque, and serum NSE, S100B, UCH-L1, GFAP, ICAM-1, VCAM-1, PECAM-1, VE-cadherin, YKL-40, CatS, MMP9, MMP10 and ADAMTS12 levels of cerebral infarction group of patients with unstable plaque were all higher than those of patients with fibrous plaque. Conclusion: CTA can accurately assess the property of vertebrobasilar atherosclerotic plaque in patients with posterior circulation cerebral infarction and is closely related to the degree of nerve injury and the change of plaque property.
基金This work was supported by the National Natural Science Foundation of China(Contract grant number:81471390 to N.M.,81371290 to Z.R.M.)Beijing High-level Personnel Funds(Contract grant number:2013-2-19 to Z.R.M.).
文摘background The outcome of acute ischaemic stroke due to tandem vertebrobasilar artery occlusion was poor.Endovascular revascularisation may be a positive approach for acute basilar artery occlusion combined with vertebral ostium stenosis or occlusion.We reported seven patients with acute vertebrobasilar tandem occlusion by using angioplasty or stenting for proximal lesion and thrombectomy for distal occlusion.Materials and methods Consecutive patients with acute tandem vertebrobasilar artery occlusion at two centres were included in this study.We retrospectively analysed the clinical,technical and functional outcomes of the patients.results From March 2016 to March 2017,seven patients were included.The mean age and National Institute of Health Stroke Scale score at admission was 57 years and 22,respectively.A reverse approach was used in five patients.The Thrombolysis in Cerebral Infarction score 2b-3 was acquired in all patients.There were no procedural complications.The modified Rankin Scale score was 1-2 for three patients and 4 for one patient at 3 months.Three patients died at 3 months of follow-up.Conclusions Endovascular revascularisation may be feasible for acute tandem vertebrobasilar artery occlusion,and more researches are needed.
基金the 2019 Major Difficult Diseases Clinical Collaboration Capacity Building Project of Traditional Chinese and Western Medicine-cerebral Infarction(No.YW082)。
文摘Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiagnose.Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here.Absence of common causes of stroke including hypoperfusion,blood system diseases,carotid and aortic dissection,and eosinophil elevation,the symptoms of the 2 patients met the diagnostic criteria of VBD.Both patients displayed symptoms that were in line with the Traditional Chinese Medicine(TCM)syndrome pattern of"Qi deficiency and blood stasis".Accordingly,they were comprehensively treated with Supplementing Qi and activating blood circulation method.The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up.A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD.TCM treatment based on syndrome identification might be a promising candidate for VBD management.
文摘Objective: To observe the therapeutic effect of acupuncture plus Ligustrazine on vertebrobasilar insufficiency (VBI) by transcranial Doppler (TCD) sonography. Methods: 86 VBI patients including 56 cases of low flow rate velocity type (LFVT) and 30 cases of high flow velocity type (HFVT) were randomly divided into Ligustrazine group (26 LFRT and 14 HFVT) and acupuncture plus Ligustrazine group (30 LFVT and 16 HFVT). The blood flow velocity (BFV) of vertebral artery (VA) and basilar artery (BA) in systole before and after treatment was measured with TCD and therapeutic effects were evaluated after 10 days’ treatment in the two groups. Results: In the acupuncture plus Ligustrazine group, the total effective rate was 93.3% and 88.5% in cases of LFVT and HFVT respectively, and BFV of VA and BA increased in LFVT patients while that in HFVT patients decreased significantly (P<0.05 or P<0.01). Conclusion: Owing to its dual regulation on blood flow of VA and BA, the therapeutic effect of acupuncture plus Ligustrazine was better than that of simple Ligustrazine.
