Ha Sang Hee, Kim Hyug-Gi, Kim Bum Joon
Department of Neurology.
Department of Radiology, Kyung Hee University Hospital.
Medicine (Baltimore). 2020 Aug 7;99(32):e21530. doi: 10.1097/MD.0000000000021530.
Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration.
Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only.
Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography.
High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration.
No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration.
A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.
基底动脉开窗是一种先天性异常，表现为基底动脉重复，可导致缺血性卒中。然而，基底动脉开窗患者的卒中机制尚未得到明确证实。
在此，我们报告一例64岁男性患者，患有控制良好的高血压，仅因构音障碍入院。
弥散加权成像显示双侧对称性脑桥梗死，未累及中线。磁共振血管造影观察到基底动脉开窗。
进行高分辨率磁共振成像（MRI）和4D流动MRI以验证与基底动脉开窗相关的卒中机制。
高分辨率MRI在基底动脉开窗区域未观察到斑块。4D流动MRI显示基底动脉开窗区域有分叉血流，流速高且剪切应力低。
基底动脉开窗区域的高流速和低剪切应力的湍流可能影响了通过双侧穿支动脉的血流，导致双侧对称性脑桥梗死，未累及基底动脉中隔所在的中线。4D流动动力学研究可能有助于验证卒中机制。
