Sakai Kyoji, Kameda Masahiro, Tanimoto Takaho, Terasaka Kaoru, Sugatani Hiroshi, Higashi Toru
Department of Neurosurgery, Himeji Central Hospital, Himeji, Hyogo, Japan.
Neurol Med Chir (Tokyo). 2003 Jun;43(6):298-300. doi: 10.2176/nmc.43.298.
A 63-year-old hypertensive man presented with vertebral artery (VA) dissection manifesting as subarachnoid hemorrhage located mainly in the posterior fossa. Left vertebral angiography on the day of hemorrhage showed complete occlusion of the left VA. Right vertebral angiography showed retrograde filling of the distal portion of the left VA and the left posterior inferior cerebellar artery, and a "double lumen"-like finding in the left VA. He was managed conservatively. Follow-up angiography on Day 29 showed spontaneous recanalization of the occlusive lesion and an almost normal arterial configuration. T2-weighted magnetic resonance (MR) imaging on Day 45 revealed multiple infarctions in the brainstem. T1-weighted MR imaging showed a high intensity area, suggestive of intramural hematoma, in the left VA. He was transferred to another hospital in a persistent vegetative state.
一名63岁的高血压男性因椎动脉（VA）夹层破裂导致蛛网膜下腔出血入院，出血主要位于后颅窝。出血当天的左侧椎动脉血管造影显示左侧椎动脉完全闭塞。右侧椎动脉血管造影显示左侧椎动脉远端及左侧小脑后下动脉逆行充盈，左侧椎动脉呈“双腔”样表现。患者接受了保守治疗。第29天的随访血管造影显示闭塞病变自发再通，动脉形态基本正常。第45天的T2加权磁共振（MR）成像显示脑干多发梗死。T1加权MR成像显示左侧椎动脉内有一个高强度区域，提示壁内血肿。患者以持续性植物状态转至另一家医院。
