Dipartimento di Scienze Neurologiche, Psichiatriche ed Anestesiologiche, A.O.U. Policlinico G. Martino, Università di Messina, Messina, Italy.
J Stroke Cerebrovasc Dis. 2010 Jan;19(1):81-3. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.009.
We report a case of a 76-year-old woman admitted to our institution with sudden onset of dizziness and vertigo followed by vomiting and blurred vision. Her medical history was remarkable for hypertension, diabetes, and ischemic stroke in the territory of the left cerebral median artery. Her symptoms were suggestive of a cerebellar stroke. Computed tomography brain scan and neck vessel ultrasounds produced normal findings. A 24-hour blood pressure monitoring showed a reverse dipping pattern. Magnetic resonance imaging examination was performed, showing a hyperintense ischemic focus involving pons and left middle cerebellar peduncle, on T2-weighted images. On Time-of-flight (TOF)-3-dimensional magnetic resonance angiography, there was a marked reduction of basilar artery signal. The digital subtraction angiography showed a vertebrobasilar system anomaly. The right vertebral artery was hypoplastic with few thin terminal spinal branches. The left vertebral artery was vicarious to the right one in intracranial tract. V3 to V4 tract showed multiple atherosclerotic wall irregularities. The basilar common trunk was absent. An abnormal posterior inferior cerebellar artery replaced the anterior inferior cerebellar artery and superior cerebellar artery. Right posterior inferior cerebellar artery, anterior inferior cerebellar artery, and superior cerebellar artery arose from ipsilateral V4 tract. This case is the first description of pure basilar agenesia. The symptoms might be related to temporary decrement of the flow in the left vertebral artery. Furthermore, the reverse dipping pattern together with the aging, hypertension, and diabetes had probably contributed to a hemodynamic malfunction of the cerebral vascular system.
我们报告一例 76 岁女性，因突发头晕和眩晕，继之呕吐和视力模糊而入院。她的病史有高血压、糖尿病和左侧大脑中动脉区域的缺血性中风。她的症状提示小脑中风。头颅 CT 扫描和颈部血管超声未见异常。24 小时血压监测显示反向杓型模式。磁共振成像检查显示 T2 加权图像上有一个涉及脑桥和左侧小脑中脑脚的高信号缺血病灶。时飞（TOF）-3 维磁共振血管造影显示基底动脉信号明显减少。数字减影血管造影显示椎基底动脉系统异常。右侧椎动脉发育不良，仅有少数细终末脊髓分支。左侧椎动脉在颅内段替代右侧椎动脉。V3 至 V4 段有多个动脉粥样硬化壁不规则。基底动脉干缺如。异常的小脑后下动脉替代了小脑前下动脉和小脑上动脉。右侧小脑后下动脉、小脑前下动脉和小脑上动脉均发自同侧 V4 段。本例是纯基底动脉发育不全的首例描述。症状可能与左侧椎动脉血流暂时减少有关。此外，反向杓型模式加上年龄、高血压和糖尿病可能导致脑血管系统的血流动力学功能障碍。
