Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Neurointerv Surg. 2010 Sep;2(3):195-7. doi: 10.1136/jnis.2009.002048. Epub 2010 Jun 4.
Acute basilar artery occlusion (ABAO) is a devastating disease that can produce significant brainstem injury. Pretreatment diffusion weighted imaging (DWI) demonstrating extensive brainstem involvement has been shown to predict a poor outcome regardless of reperfusion. This case report describes a patient presenting with coma secondary to ABAO. MRI at presentation demonstrated significant DWI abnormality in the majority of the bilateral pons. The basilar artery was endovascularly recanalized 8 h after stroke onset, and the patient had a marked clinical recovery with no deficit at 3 months. Follow-up imaging revealed significant reversal of the pontine lesion. This finding of brainstem DWI reversibility cautions against the use of DWI to select ABAO patients for intra-arterial stroke therapy. The degree of apparent diffusion coefficient reduction on pretreatment MRI may not adequately identify which DWI abnormal brainstem tissue is potentially reversible.
急性基底动脉闭塞（ABAO）是一种破坏性疾病，可导致严重的脑干损伤。预处理弥散加权成像（DWI）显示广泛的脑干受累，无论再灌注情况如何，均可预测不良预后。本病例报告描述了一例因 ABAO 导致昏迷的患者。发病时的 MRI 显示双侧脑桥大部分存在显著的 DWI 异常。发病后 8 小时，基底动脉通过血管内再通，患者在 3 个月时出现明显的临床恢复，无任何缺陷。随访影像学显示脑桥病变明显逆转。这一发现表明脑干 DWI 具有可逆性，这告诫我们不要使用 DWI 来选择 ABAO 患者进行动脉内卒中治疗。预处理 MRI 上表观弥散系数降低的程度可能不能充分识别潜在可逆转的 DWI 异常脑干组织。
