Shioya Hitoshi, Kikuchi Kenji, Suda Yoshitaka, Shindo Kenjiro
Department of Neurosurgery, Yuri Kumiai General Hospital, 38 Kawaguchi-aza-yago, Honjo-shi, Akita 015-8511, Japan.
No To Shinkei. 2004 Jun;56(6):519-24.
We report here a case of atypical Wallenberg's syndrome due to spontaneous vertebral artery (VA) dissection. A 52-year-old woman was admitted to our department because of a sudden onset of left orbital pain. Emergency CT scan disclosed no evidence of intracranial hemorrhage. Neurological examination at the time of the current admission, showed dysphagia, left soft palate palsy, hoarseness, left Horner syndrome, hypalgesia with thermohypesthesia on the right side of her face, however, hypalgesia with thermohypesthesia on the right side of her body. The diagnosis of atypical Wallenberg's syndrome was based on the above findings. MR images disclosed the infarcted lesion at the left lateral medulla depicted as high-intensity on T2-weighted & FLAIR images. We carried out conservative treatment with antiplatelet & hemodilution therapies and the blood pressure control. Left vertebral angiograms obtained 18 days after the onset, showed the segmental severe stenosis of the VA between the ramification of the posterior inferior cerebellar artery (PICA) and the union of the VAs. In the venous phase, retention of contrast medium in the VA and the PICA was observed. The flow rate of the parent artery was decreased. We strongly suspected that her initial symptom of left orbital pain was due to dissection of the VA itself. Three-dimensional CT angiograms obtained 30 days after the onset, demonstrated the defect of the left VA between the ramification of the left PICA and the union of the VAs. Left vertebral angiograms obtained 36 days after the onset, showed the occlusion of the VA between the ramification of the PICA and the union of the VAs. The neurological findings gradually improved and the patient was discharged. Follow up left vertebral angiograms obtained 4 months & 16 months after the onset, revealed almost no changes of left VA occlusion.
我们在此报告一例因自发性椎动脉（VA）夹层导致的非典型延髓背外侧综合征。一名52岁女性因突发左眼眶疼痛入住我科。急诊CT扫描未发现颅内出血证据。本次入院时的神经系统检查显示吞咽困难、左侧软腭麻痹、声音嘶哑、左侧霍纳综合征、右侧面部痛温觉减退，然而，右侧身体痛温觉减退。基于上述发现诊断为非典型延髓背外侧综合征。MR图像显示左侧延髓梗死灶在T2加权像和液体衰减反转恢复（FLAIR）像上呈高信号。我们采用抗血小板和血液稀释疗法以及血压控制进行保守治疗。发病18天后进行的左侧椎动脉血管造影显示，在小脑后下动脉（PICA）分支与椎动脉汇合处之间的椎动脉节段性严重狭窄。在静脉期，观察到椎动脉和PICA内有造影剂滞留。供血动脉的血流速度降低。我们强烈怀疑她最初的左眼眶疼痛症状是由于椎动脉本身夹层所致。发病30天后进行的三维CT血管造影显示，在左侧PICA分支与椎动脉汇合处之间的左侧椎动脉有缺损。发病36天后进行的左侧椎动脉血管造影显示，在PICA分支与椎动脉汇合处之间的椎动脉闭塞。神经系统检查结果逐渐改善，患者出院。发病4个月和发病16个月后进行的随访左侧椎动脉血管造影显示，左侧椎动脉闭塞几乎没有变化。
