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...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.展开更多
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 w...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.展开更多
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...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.展开更多
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 occlus...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.展开更多
目的：分析椎动脉夹层动脉瘤的血管内介入治疗中支架置入和双导管技术保护小脑后下动脉（PICA）的方法及其影像和临床随访结果。方法回顾性纳入首都医科大学宣武医院神经外科2012年1月至2014年12月收治的4例累及PICA的椎动脉夹层动脉瘤...目的：分析椎动脉夹层动脉瘤的血管内介入治疗中支架置入和双导管技术保护小脑后下动脉（PICA）的方法及其影像和临床随访结果。方法回顾性纳入首都医科大学宣武医院神经外科2012年1月至2014年12月收治的4例累及PICA的椎动脉夹层动脉瘤并经血管内治疗患者的临床资料。术后6个月复查全脑DSA，临床随访12～24个月。结果4例患者中，3例采用PICA-椎动脉支架置入技术，1例采用双向双导管技术保护PICA。对4例患者介入治疗技术方面均获成功，术后即刻造影显示PICA通畅，无缺血症状；6个月造影显示动脉瘤无复发，PICA通畅，无狭窄；12～24个月随访无新发神经功能缺损症状。结论在累及PICA的椎动脉夹层动脉瘤介入治疗中，使用P I C A-椎动脉支架置入技术和双向双导管技术能够安全、有效地保护P I C A。展开更多
基金Youth Innovation Project of Medical Research in Sichuan Province,No.Q18012.
文摘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.
文摘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.
文摘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.
基金Jiangsu Province Cadre Health Research Project(No.BJ17010)Suzhou Science and Technology Development Project(No.SS201714,No.SS201859)135 major projects of the Ministry of Science and Technology:Digital Diagnosis and Treatment Demonstration Application and Clinical Solution for Stroke(No.2017YFC0114302).
文摘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.
文摘目的：分析椎动脉夹层动脉瘤的血管内介入治疗中支架置入和双导管技术保护小脑后下动脉（PICA）的方法及其影像和临床随访结果。方法回顾性纳入首都医科大学宣武医院神经外科2012年1月至2014年12月收治的4例累及PICA的椎动脉夹层动脉瘤并经血管内治疗患者的临床资料。术后6个月复查全脑DSA，临床随访12～24个月。结果4例患者中，3例采用PICA-椎动脉支架置入技术，1例采用双向双导管技术保护PICA。对4例患者介入治疗技术方面均获成功，术后即刻造影显示PICA通畅，无缺血症状；6个月造影显示动脉瘤无复发，PICA通畅，无狭窄；12～24个月随访无新发神经功能缺损症状。结论在累及PICA的椎动脉夹层动脉瘤介入治疗中，使用P I C A-椎动脉支架置入技术和双向双导管技术能够安全、有效地保护P I C A。
