Mechanical thrombectomy for acute occlusion of the posterior inferior cerebellar artery: A case report

BACKGROUND Mechanical thrombectomy(MT)has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions.However,recanalization by MT is not recommended for distal vessels such as second-order branches of the middle cerebral artery and posterior inferior cerebellar artery(PICA).Because of the small size and tortuosity of these arteries,the risks of using the available endovascular devices outweigh the benefits of treatment.However,MT appears to be effective in patients with primary distal vessel occlusion in eloquent areas,those with a high National Institutes of Health Stroke Scale score,and those ineligible for recombinant tissue plasminogen activator therapy.Here,we report the use of MT for treating acute occlusion of the PICA using a directaspiration first-pass technique(ADAPT).CASE SUMMARY In this case,the patient received acute occlusion of the PICA with ADAPT when right internal carotid artery stenting was performed.CONCLUSION With the introduction of advanced endovascular devices,MT may now be a feasible treatment for acute occlusion of the PICA.

Modified inferior oblique anterior transposition for dissociated vertical deviation combined with superior oblique palsy:A case report

BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.

Osteochondroma formation after avulsion fracture of anterior inferior iliac spine:A case report

BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis of a longbone, being usually asymptomatic.CASE SUMMARYA 15-year-old patient experienced feeling and sound of a break while kicking aball in soccer game three years prior to his visit to our hospital. A simple X-rayrevealed an avulsion fracture of the apophysis of the anterior inferior iliac spine(AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstratedby magnetic resonance imaging to be a pedunculated osteochondroma in thesuperolateral aspect of the AIIS. For surgical treatment, we performed osteotomyfor surgical excision and excisional biopsy. A mass with smooth surface and anunclear superolateral AIIS border was found intraoperatively. Pathologic examshowed definite diagnosis of osteochondroma. Postoperatively, discomfort duringhip flexion was improved, and the hip joint range of motion during walking wasrecovered at the last follow-up, which was three weeks after the surgery.CONCLUSIONThis is a rare case to demonstrate relevant previous trauma history prior to theformation of osteochondroma.

Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report

BACKGROUND Sudden hearing loss(SHL)is associated with serious systematic conditions such as neoplasms,vascular events,autoimmune diseases,infections,and iatrogenic injury.Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke.It is important to distinguish stroke from benign disease.CASE SUMMARY A 48-year-old male patient presented with SHL and vertigo as first symptoms.Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm,confirming that the patient had cerebral infarction.Treatment with antiplatelet drugs,steroid antiinflammatory drugs,and neurotrophic nerve therapy promoted blood circulation and removed blood stasis,and the symptoms of the patient were significantly improved.CONCLUSION SHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke.

Sudden deafness as a prodrome of cerebellar artery infarction:Three case reports

BACKGROUND To summarize the clinical characteristics of acute cerebral infarction(ACI)in patients with sudden deafness(SD)as the first symptom,improve the awareness of the disease,and help diagnosis and treatment.CASE SUMMARY From 2019 to 2020,three patients with ACI with SD as the first symptom were admitted to our hospital.Pure tone audiometry,head magnetic resonance imaging(MRI),vertebral artery and carotid artery B-ultrasound,head and neck computed tomography angiography,and other examinations were performed.Following the treatment of SD,hearing and dizziness were not significantly improved.Then,the patients developed symptoms of related cranial nerve injury,and brain MRI showed cerebral infarction in the cerebellopontine angle area.All three cases were transferred to the neurology department for relevant conservative treatment.CONCLUSION Patients with ACI with SD as the first symptom usually attend the otolaryngology clinic.Here a diagnosis of SD,which is based on an audiological examination,is made and the corresponding treatment is administered.To reduce the misdiagnosis of this disease,close attention should be paid to the changes in the patient's clinical symptoms and related auxiliary examinations should be performed,such as brain MRI and cerebrovascular imaging.Otolaryngologists should pay attention to the type and severity of hearing loss,the accompanying symptoms,age,high-risk factors for cerebral infarction,and related cranial nerve symptoms in patients with SD.If the patient's early brain MRI does not show abnormalities,monitoring remains essential.The head MRI should be analyzed quickly based on the changes in the symptoms of the patient,to make an accurate diagnosis and provide the timely and correct treatment for the patients.

Impact of Right Ventricular Dysfunction in Morbidity and Mortality in Patients with Inferior Wall Myocardial Infarction Presenting to a Tertiary Care Center of Nepal

Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.

小脑后下动脉(PICA)的显微解剖研究

目的研究小脑后下动脉(PICA)的显微解剖结构。方法对16具(共32侧)完好的人脑标本在显微镜下测量PICA。结果平均管径(1.23±0.48)mm,24侧(75.0%)由同侧椎动脉发出,距椎基汇合点(18.83±4.92)mm,19侧(59.4%)走行于第Ⅸ￣Ⅺ脑神经后方。结论小脑后下动脉是颅后窝椎基动脉系统较重要的分支,变异多;熟悉其解剖结构,在手术中多加保护是非常必要的。

Wallenberg综合征临床特点、CT与MRI

目的 :探讨Wallenberg综合征病因、临床表现及CT、MRI改变。方法 :分析 1992～ 1998年住院诊断为Wallenberg综合征 17例病人病因 ,临床表现 ,CT与MRI改变。结果 :Wallenberg综合征病因主要为小脑后下动脉缺血所致 ,但也有出血性疾病。临床主要表现为 :病灶侧软腭声带麻痹 ,咽反射消失 ( 94 1% ) ,病灶侧面部及对侧痛温觉障碍 ( 88 2 % ) ,病灶同侧Horner征( 82 4 % ) ,病灶同侧小脑性共济失调 ( 70 6% ) ,眩晕 ( 70 6% ) ,恶心、呕吐 ( 58 8% ) ,水平眼震 ( 52 9% ) ,头痛 ( 2 3 5% ) ,呃逆 ( 17 6% ) ,病灶对侧肢体轻瘫 ( 11 8% )。 17例病人发病 72h内行头部CT扫描 ,1例发现延髓有出血 ,另 16例延髓无异常改变。发病 72h内头部MRI检查 ,9例延髓有异常信号改变 ,5例小脑有异常信号改变 ,2例基底节区有异常信号改变。结论 :Wallenberg是一组多病因综合征。MRI检查优于CT ,但并不是所有Wallenberg综合征MRI检查均有阳性发现。

健康人Bassent’s韧带的MRI最佳扫描层面的探索及测量

目的： Bassent’s韧带即胫腓前下韧带远侧束病变是导致前外踝疼痛的重要原因，探索正常人Bassent’s韧带的MRI最佳显示层面并测量，为其急慢性损伤的诊断提供MRI解剖结构对照。方法对32名已签署知情同意书的健康受检者行踝关节MRI扫描，男12例，女20例，年龄23～30岁，平均年龄26岁。踝摆放姿势为中立位，扫描常规（正）横断位（TRA）、矢状位（SAG）、冠状位（COR）T1WI、T2WI快速回波序列后，选择TRA-T1WI为定位像，做与Bassent’s韧带平行的斜COR-T1 WI、斜COR-T2 WI层面成像，再选择斜COR-T1 WI做与Bassent ’ s韧带平行的斜TRA-T1 WI、斜TRA-T2 WI层面成像，获得图像后选择能显示韧带走行的最佳层面，在该层面观察并测量记录韧带的长度及宽度。结果 Bassent ’ s韧带MRI图像显示率为96．7％（29／32），其绕过距骨顶前外缘时稍有弯曲，T1WI及T2WI上均为均匀低信号改变，在斜COR及斜TRA该韧带全长显示佳，斜冠状面测量平均长度为（11．01±0．94）mm，平均直径为（3．06±0．50）mm，胫骨附着点直径较宽，平均为（4．47±0．88）mm；较胫腓前下韧带复合体走形更加趋于水平，两者平均夹角为（22．71±6．72）°。结论磁共振借由其多平面成像的优势，可清晰显示Bassent ’ s韧带，与韧带全长平行的斜面成像可显示其全长，促成韧带个体化MRI检查与诊断。

CTA对小脑后下动脉动脉瘤的诊断价值(附2例报告)

目的：探讨CTA对小脑后下动脉（ PICA）动脉瘤的诊断价值。方法对2例PICA动脉瘤患者的临床资料进行回顾性分析。结果2例患者为老年，急性发病，经CT确诊蛛网膜下腔出血，发病后3 h内初次CTA检查均为阴性结果。经防止脑血管痉挛、增高血容量、保护脑细胞等治疗3～7 d后，病情好转1例，无效1例。再次行CTA检查发现PICA动脉瘤3个，其中1例患者为左侧PICA 2个动脉瘤合并脑积水，另1例患者左侧PICA有1个动脉瘤。2例患者的PICA动脉瘤均获得良好的影像信息。结论 CTA可作为PI-CA动脉瘤首选的检查方法，能提供其全面的影像资料。对首次CTA检查阴性者，经短期治疗后进行CTA复查仍为理想的选择。

aVR导联ST段改变对不同冠脉血管病变的诊断及鉴别诊断意义

冠状动脉左主干及其主要分支病变均可引起心电图aVR导联ST段的抬高或压低,但不同血管病变所致心肌缺血或梗死的危险分层及临床预后却相差甚远,因此对不同冠脉血管病变的诊断及鉴别诊断非常重要。这其中aVR导联ST段的改变具有重要的临床意义,其诊断及鉴别诊断价值高于其他任何单一或多个导联。本文就aVR导联ST段的抬高或压低对不同冠脉血管病变的诊断及鉴别诊断意义、诊断标准及国外近年来的研究进展进行综述。

Wallenberg综合征的临床差异及相关因素

目的探索Wallenberg综合征的临床表现差异的原因,为临床工作提供宝贵资料。方法回顾性分析41例Wallenberg综合征患者临床及影像资料。并根据年龄、危险因素及病变血管分组,分析各组患者在临床表现上的差异。结果Wallenberg综合征常见的临床症状、体征以眩晕与头晕最多见,其次为构音障碍,小脑性共济失调,感觉障碍,咽反射减弱或消失,吞咽困难,恶心或呕吐,霍纳综合征,眼球震颤。年龄与患者临床症状评分呈负相关(P=0.002)。高血压、糖尿病、高脂血症及吸烟与患者临床表现差异无明显相关。单纯小脑后下动脉病变患者与椎动脉和椎动脉联合小脑后下动脉病变组患者在出现构音障碍(P=0.029)、恶心/呕吐(P=0.033)及吞咽困难(P=0.002)的症状、体征上具有统计学差异。结论Wallenberg综合征临床表现多样;年龄与临床症状越典型程度呈负相关;椎动脉及椎动脉联合小脑后下动脉病变容易导致构音障碍,吞咽困难及恶心/呕吐。

Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region

Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was per- formed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm （1.1-2.5 cm）, which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.

Location of the AICA influences the severity but not occurrence of ISSNHL:A reappraisal using high-resolution 3 T MRI

Objective:To investigate the potential influence of anatomical variation in the anterior inferior cerebellar artery(AICA)on the occurrence and severity of idiopathic sudden sensorineural hearing loss(ISSNHL).Methods:Ninety ISSNHL patients were enrolled.The anatomical location of the AICA was exhibited using high-resolution magnetic resonance imaging(MRI),and the various AICA types classified by previously reported Chavda and Gorrie methods were analyzed.The severity of hearing loss in the ipsilateral ear among different AICA types was compared.Results:Approximately 85.6%of subjects had unilateral ISSNHL(uISSNHL),and the others had bilateral ISSNHL(bISSNHL).In the uISSNHL group,the ratios of different AICA types were similar between the ipsilateral and contralateral ears.The ratios of the different AICA types in the bISSNHL group were similar to those in the uISSNHL group.In the uISSNHL group,pure tone audiometry(PTA)thresholds at 2 kHz,4 kHz and 8 kHz of patients with Chavda type II AICA were higher than those of patients with Chavda type I and type III,with a significant difference at 4 kHz between type I and type II.There was a tendency of the PTA threshold in patients with Chavda type II or Gorrie type C to gradually increase from low to high frequency zones.Conclusion:When the AICA enters the IAC(Chavda type II)or crosses between the 7th and 8th cranial nerves(Gorrie type C),the severity and frequency of hearing impairment in ISSNHL but not the occurrence of ISSNHL will be affected.

Study of the Neural Basis for Subjective Feature Binding

While it is known that the brain perceives color and motion asynchronously, the specific locations in which the brain binds signals remain unknown. This study distinguishes subjective perception of the capability to bind features and the objective accuracy in feature binding. The stimuli were the same for individual subjects, consisting of random dots (red and green, or yellow and blue) moving either vertically or horizontally. Subjects responded to questions regarding the color or the direction of motion of the dots (objective judgment) and rated their capability in performing the task (subjective judgment). The imaging results of contrasting subjective judgment showed that the activation of the anterior rostral cingulate cortex (rACC) and inferior frontal gyrus (Brodmann area [BA] 45/47) during incapable-of-binding responses, compared with the capable-of-binding responses. It is suggested that the rACC is for uncertainty of subjective judgment and BA 45/47 is for the increased burden on working memory. In contrast, there was no imaging results of contrasting the correct and incorrect responses (i.e., objective judgment), and neither was there for the interaction between subjective and objective judgment. The results of conservative conjunction analysis indicated common and shared brain areas for the 2 distinctive binding situations (the correct and capable-of-binding vs the incorrect and incapable-of-binding), including increased activity in the intraparietal lobe (IPL) and the junction areas of the posterior rostral ACC (dACC) and the prefrontal areas, but decreased activity in the medial portion of the IPL, suggesting that feature binding requires maintaining attention. These results clearly isolated subjective judgment from objective judgment and support the view that maintaining attention is involved in feature binding of color and motion.

Evaluate the correlation between stenotic lesions of vertebral artery and posterior circulation ischemia

Objective:To investigate the correlation between severe stenosis or occlusion of vertebral artery(VA)and posterior circulation ischemia(PCI).Methods:A retrospective study of 408 patients with severe stenosis or occlusion of the V1-V4 segment with unilateral VA was confirmed by cervical vascular ultrasound(CDU),CT angiography(CTA),and/or DSA.According to the severe stenosis or occlusion lesions,the patients were divided into V1 segment lesion group(267 cases),V2 segment disease group(40 cases),and V3-V4 segment disease group(101 cases).Depending on whether there were symptoms of posterior circulation ischemia,408 patients were divided into symptom group(195 cases)and asymptomatic group(213 cases).CDU test recorded and analyzed hemodynamic parameters:systolic peak flow rate(PSV),end diastolic flow rate(EDV),resistance index(RI),VA tube diameter(VAD).Meantime,we had assessmented the correlation between severe stenosis or occlusion of VA and PCI.Results:1.Compariing the lesion sites in affected and healthy sides of VA,there were significant differences in PSV,EDV and VAD(p=0.000).There was no significant difference in intervertebral RI when V2 was severe stenosis(p=0.762).2.When the severely stenosis or occlusion happend in V1 or V3-V4 segment,the blood flow spectrum of the affected side was significantly different from the healthy side.3.The stenosis sexual lesion of V1 and V2 had no significant correlation with PCI symptoms(dependency coefficient was 1.06,p=0.053;0.123,p=0.323);and V3-V4 stenosis sexual lesions were moderately associated with PCI symptoms(dependency coefficient=0.217,p=0.027).Conclusions:Severe stenosis or occlusion of V3-V4 segment is likely to appear PCI.CDU can effectively diagnose lesion of VA's evere stenosis or occlusion,which provides a reliable basis of timely clinical treatment and evaluation.

头颈CT血管造影联合磁敏感加权成像在小脑后下动脉供血区急性脑梗死责任血管判断中的价值分析

目的 探讨头颈CT血管造影(computed tomography angiography, CTA)联合磁敏感加权成像(susceptibilityweighted imaging, SWI)在小脑后下动脉(posterior inferior cerebellar artery, PICA)供血区急性脑梗死责任血管病变检出中的价值。方法 选取2021年8月至2022年10月首都医科大学附属北京友谊医院PICA供血区急性脑梗死患者50例,诊疗期间接受MRI常规平扫+SWI及头颈CTA检查。按梗死大小分为区域性梗死(37例)和小梗死(13例),基于头颈CTA及SWI观察责任血管改变;头颈CTA观察梗死侧责任血管有无斑块及狭窄,头颈CTA联合SWI观察梗死侧责任血管有无磁敏感血管征(susceptibility vessel sign, SVS);比较头颈CTA及头颈CTA联合SWI对不同类型PICA供血区急性脑梗死患者责任血管病变的检出率。结果 50例患者中,男40例,女10例,年龄43~79岁,中位年龄62.5岁。37例区域性梗死患者中,针对梗死侧椎动脉V4段,头颈CTA检出13例管腔重度狭窄/闭塞,头颈CTA联合SWI其中4例SVS阳性;针对梗死侧PICA,头颈CTA共检出12例管腔重度狭窄/闭塞,头颈CTA联合SWI 12例SVS均为阳性,另检出9例PICA SVS阳性患者。13例小梗死患者中,针对梗死侧椎动脉V4段,头颈CTA检出6例管腔病变,头颈CTA联合SWI其中4例SVS阳性;针对梗死侧PICA,头颈CTA检出6例管腔病变,头颈CTA联合SWI其中5例SVS阳性,另检出1例PICA SVS阳性患者。结论 头颈CTA联合SWI有助于提高PICA供血区急性脑梗死患者责任血管病变的检出率,椎动脉V4段狭窄时帮助判断有无血栓形成及血栓形成位置,有助于提高PICA病变尤其是椎动脉V4段无异常改变时PICA病变的检出率。

超声评估踝关节骨折患者距腓前韧带及下胫腓前韧带远侧束损伤的价值

目的:探讨超声在评估踝关节骨折患者距腓前韧带(ATFL)及下胫腓前韧带远侧束(ATiFL-DF)损伤中的应用价值。方法:收集2019年4月至2023年3月在浙江大学医学院附属邵逸夫医院因踝关节骨折就诊,临床怀疑韧带损伤,术前行踝关节超声检查,并予以踝关节镜探查的患者。以踝关节镜下检查结果为诊断金标准,评估韧带损伤分级,统计分析超声诊断ATFL及ATiFL-DF损伤的敏感度、特异度、阳性预测值和阴性预测值,并行Kappa一致性检验。结果:共收集病例51例。超声诊断ATFL损伤的敏感度和特异度分别为100.0%和92.3%,阳性预测值为92.6%,阴性预测值为100.0%,超声与踝关节镜检查结果一致性佳(kappa=0.849)。超声诊断ATiFL-DF损伤的敏感度和特异度分别为86.7%和33.3%,阳性预测值为90.7%,阴性预测值为25.0%,超声与踝关节镜检查结果一致性差(kappa=0.168)。结论:超声检查是评价踝关节骨折患者ATFL损伤的可靠的检查方式,但对ATiFL-DF损伤的评估特异性较差,因此ATiFL-DF损伤超声检查阴性的踝关节骨折患者仍有必要行踝关节镜检查。

小脑后下动脉动脉瘤的治疗进展

小脑后下动脉(PICA)动脉瘤是导致蛛网膜下腔出血及后循环缺血的原因之一,由于解剖结构较复杂,故该动脉瘤治疗难度较大,预后较差。根据动脉瘤位置的不同、性质的不同,可选用的治疗方案也各不相同。该文在复习文献的基础上就累及PICA动脉瘤的最新治疗进展进行综述。

1例小脑后下动脉瘤术后并发气道塌陷患者的护理

小脑后下动脉瘤属于后循环动脉瘤之一,包括从小脑后下动脉和椎动脉交界处发出的动脉所产生的动脉瘤,位置毗邻脑干和后组颅神经,瘤体多为非囊状。小脑后下动脉瘤的发生率低,由于特殊的解剖位置及瘤体形态,导致手术治疗难度较大,术后易产生多种严重并发症。临床上常见的手术治疗方式有开颅动脉瘤夹闭术、单纯血管内介入栓塞治疗、血管搭桥术。文章总结1例小脑后下动脉瘤介入栓塞术后并发气道塌陷患者的护理,主要包括气道塌陷高风险识别、气道塌陷的疾病观察及紧急抢救、气道置管期间集束化气道管理、术后拔除气管插管前的评估及护理、气管插管拔管后预见性护理及观察。患者经过积极的抢救和护理,病情好转,转康复医院继续治疗。