Pessin M S, Chimowitz M I, Levine S R, Kwan E S, Adelman L S, Earnest M P, Clark D M, Chason J, Ausman J I, Caplan L R
Department of Neurology, New England Medical Center, Boston, MA 02111.
Neurology. 1989 Jan;39(1):16-21. doi: 10.1212/wnl.39.1.16.
We studied seven patients with brainstem infarction and large fusiform vertebrobasilar (VB) aneurysms to clarify the clinical, radiologic, and pathologic features. All presented with pontine infarcts; one also had a cerebellar infarct. VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation. Four had intraluminal thrombi and one had severe basilar artery stenosis. Two distinct clinical pictures emerged: unilateral pontine infarcts with favorable outcome, presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery, and major fatal bilateral pontine infarcts from basilar artery occlusion. Two patients came to autopsy. One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction; the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage. Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus, local embolism, atherostenosis, and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication.
我们研究了7例患有脑干梗死和大型梭形椎基底动脉（VB）动脉瘤的患者，以明确其临床、影像学和病理学特征。所有患者均表现为脑桥梗死；1例还伴有小脑梗死。4例患者在脑干梗死之前出现了VB短暂性脑缺血发作（TIA）。血管造影和CT显示了VB梭形动脉瘤样扩张。4例有腔内血栓形成，1例有严重的基底动脉狭窄。出现了两种不同的临床情况：单侧脑桥梗死且预后良好，推测与动脉瘤样基底动脉后壁发出的脑桥穿通动脉起始处阻塞有关；以及因基底动脉闭塞导致的严重致命性双侧脑桥梗死。2例患者进行了尸检。1例在扩张的基底动脉中有血栓形成，并有大脑后动脉分支栓子伴枕叶出血性梗死；另1例有基底动脉血栓形成伴动脉瘤破裂和蛛网膜下腔出血。梭形VB动脉瘤通过腔内血栓形成、局部栓塞、动脉粥样硬化性狭窄和旁正中穿通动脉阻塞导致脑干卒中。蛛网膜下腔出血是一种罕见的并发症。
