Palazzo Paola, Ruff Michael, Lyerly Michael J, Alexandrov Andrei V
Department of Neurology, School of Medicine, University of Alabama Hospital, Birmingham, AL.
Department of Neurology, Campus Bio-Medico University, Rome, Italy.
J Neuroimaging. 2014 Nov-Dec;24(6):607-609. doi: 10.1111/jon.12069. Epub 2013 Nov 19.
We present a case of a man presenting with vertigo and nausea who was found to have multifocal infarcts in the posterior circulation on magnetic resonance imaging (MRI). An magnetic resonance angiography (MRA) demonstrated focal widening and central signal dropout in the distal vertebral artery consistent with arterial fenestration. Transcranial Doppler ultrasonography showed turbulent flow and a spike waveform suggestive of an intra-luminal thrombus. This was confirmed by computed tomography (CT) angiography. Following the initiation of dual antiplatelet therapy, the signal abnormalities on transcranial doppler (TCD) resolved suggesting dissolution of the thrombus. This case highlights the diagnostic pitfalls that may arise when relying on only one modality for assessing intracranial vasculature and the importance of clarifying the diagnosis of basilar thrombosis or fenestration.
我们报告一例以眩晕和恶心为表现的男性病例，其磁共振成像（MRI）显示后循环存在多灶性梗死。磁共振血管造影（MRA）显示椎动脉远端局灶性增宽及中心信号缺失，符合动脉开窗表现。经颅多普勒超声显示血流紊乱及尖峰波形，提示管腔内血栓形成。计算机断层扫描（CT）血管造影证实了这一点。在启动双联抗血小板治疗后，经颅多普勒（TCD）上的信号异常消失，提示血栓溶解。该病例凸显了仅依靠单一方式评估颅内血管时可能出现的诊断陷阱，以及明确基底动脉血栓形成或开窗诊断的重要性。
