Wang Yu, Zhang Yao, Wang Yang, Liu He, Liu Yunpeng
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
Int J Surg Case Rep. 2023 Nov;112:108948. doi: 10.1016/j.ijscr.2023.108948. Epub 2023 Oct 10.
Vertebral artery dissection is a rare but serious condition that can lead to neurological deficits and even death. It is commonly associated with trauma or underlying vascular diseases. Top of basilar syndrome (TOBS) is a neurological condition that can result from vertebral artery dissection, either by direct ischemia or secondary occlusion due to distal embolization of injured inner vascular tissue. We here present a patient who was initially suffering from seizure then had TOBS due to a progressive vertebral artery dissection, with emphasis of high-resolution MRI imaging and immunohistochemistry study of the thrombus.
A young male presented to the emergency department with sudden onset of seizure. A history of recent neck exercise was reported. The patient had gaze palsy, adduction disability, and dysarthria. High-resolution MRI showed a vertebral artery dissection with evidence of occlusion of the top of basilar artery. After the thrombectomy, a pathologic study revealed CD31[+] tissue in the thrombus, indicating an origin from dissected vertebral artery.
It's important to recognize and treat vertebral artery dissection promptly due to its varying symptoms. Using high-resolution MRI at early stage and conducting pathologic analysis of CD31 on the thrombus can assist in the diagnosis, potentially leading to more precise treatment plans and better outcomes for patients.
椎动脉夹层是一种罕见但严重的疾病，可导致神经功能缺损甚至死亡。它通常与创伤或潜在的血管疾病有关。基底动脉尖综合征（TOBS）是一种可由椎动脉夹层引起的神经疾病，其原因要么是直接缺血，要么是由于受损血管内组织的远端栓塞导致继发性闭塞。我们在此报告一名患者，该患者最初患有癫痫发作，随后因进行性椎动脉夹层而出现TOBS，并重点介绍了血栓的高分辨率MRI成像和免疫组织化学研究。
一名年轻男性因突然发作癫痫被送往急诊科。据报告有近期颈部运动史。患者有凝视麻痹、内收障碍和构音障碍。高分辨率MRI显示椎动脉夹层，有基底动脉尖闭塞的证据。取栓术后，病理研究显示血栓中有CD31[+]组织，表明起源于夹层的椎动脉。
由于椎动脉夹层症状多样，及时识别和治疗非常重要。早期使用高分辨率MRI并对血栓进行CD31病理分析有助于诊断，可能为患者带来更精确的治疗方案和更好的治疗效果。
