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目的探讨椎-基底动脉延长扩张症(VBD)并脑干梗死的临床特点。方法对3例椎-基底动脉延长扩张症并脑干梗死的临床资料进行回顾性分析,总结经颅多普勒(TCD)、CT动脉造影(CTA)及MRI观察其后循环血流动力学和影像学特征。结果 (1)3例患者椎-基底动脉高度、位置偏移度及最宽直径的测量值均符合VBD的诊断标准;(2)TCD检查显示3例患者椎-基底动脉收缩期、舒张期峰值血流速度及平均血流速度降低;(3)头颈CTA显示椎-基底动脉不同程度的扩张、延长及迂曲,形成“S”形或“C”形;(4)头MRI显示急性脑梗死病变在延髓或中脑部位;(5)3例患者经抗血小板聚集、降脂等治疗后好转。结论 VBD合并脑干梗死可能存在椎-基底动脉形态和结构的变异及后循环血流动力学障碍。VBD常并发脑干梗死,对脑干梗死的治疗应依据患者临床表现和影像学特点采取个体化的治疗方案。
Objective To investigate the clinical features of vertebrobasilar prolongation (VBD) and infarction of brainstem. Methods The clinical data of 3 patients with prolonged dilatation of vertebrobasilar artery and infarction of the brainstem were retrospectively analyzed. TCD, CT angiography (CTA) and MRI were performed to observe the postoperative hemodynamics and Imaging features. Results (1) The measured values of vertebrobasilar artery height, position deviation and the broadest diameter in 3 patients all met the diagnostic criteria of VBD. (2) TCD showed that the vertebrobasilar artery systolic and diastolic peak (3) head and neck CTA showed vertebrobasilar artery to varying degrees of expansion, prolongation and tortuosity, the formation of “S” shape or “C” shape; (4) the head MRI display Acute cerebral infarction in the medulla oblongata or midbrain lesions; (5) 3 patients after anti-platelet aggregation, lipid-lowering therapy improved. Conclusions There may be variations in morphology and structure of vertebral-basilar artery and posterior circulation hemodynamic disorder in patients with VBD complicated with cerebral infarction. VBD often complicated by infarction of the brainstem, the treatment of infarction of the brainstem should be based on clinical manifestations and imaging characteristics of patients to take individualized treatment.