基底動脈尖綜合征50例臨床分析
發(fā)布時間：2018-11-18 18:55
【摘要】：目的:基底動脈尖綜合征(Top of the Basilar Syndrome TOBS)是由Caplan在1980年提出的,是指基底動脈尖端部位急性缺血或閉塞所導(dǎo)致的相應(yīng)供血區(qū)的血液循環(huán)障礙,臨床上以丘腦、中腦、小腦、枕葉、顳葉內(nèi)側(cè)面梗死為表現(xiàn)的一組綜合征。TOBS發(fā)病率較低,但病情兇險,預(yù)后差,死亡率高。本研究通過對TOBS患者危險因素、臨床表現(xiàn)、影像學(xué)特點、并發(fā)癥、預(yù)后等方面的分析,以提高臨床醫(yī)生對TOBS的認識,做到早期診斷,早期治療,改善預(yù)后。方法:收集2015年6月到2016年10月在河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科住院的50例TOBS患者。所有入選患者均符合1995年全國第四屆腦血管病學(xué)術(shù)會議制定的腦梗死的診斷標準,并經(jīng)頭顱CT或MRI檢查診斷為TOBS。統(tǒng)計TOBS患者發(fā)病的危險因素、病因、臨床癥狀和體征、影像學(xué)特點、并發(fā)癥和預(yù)后等相關(guān)臨床資料,進行統(tǒng)計學(xué)分析。結(jié)果:1 TOBS的危險因素從高到低依次為高血壓、吸煙或飲酒、高脂血癥、高同型半胱氨酸血癥、糖尿病、心臟病、腦梗死及TIA病史。TOBS病因最多見為腦栓塞。2臨床表現(xiàn)最多見的為意識障礙,其次依次為眼球運動障礙,瞳孔異常,運動障礙,行為和認知障礙,言語障礙,偏盲或皮質(zhì)盲,眩暈,感覺障礙。3各解剖部位按發(fā)病頻率由高到低依次為:丘腦、小腦、中腦、枕葉、顳葉、橋腦。4 TOBS患者主要的并發(fā)癥為感染,原因主要為肺部感染和泌尿系感染,其次依次為低蛋白血癥、電解質(zhì)、酸堿平衡紊亂,應(yīng)激性潰瘍,下肢靜脈血栓。5 50例患者中21例預(yù)后較好,29例預(yù)后差,其中8例死亡。結(jié)論:1 TOBS最常見的危險因素是高血壓,腦栓塞為本病的最主要的病因。2 TOBS的臨床表現(xiàn)復(fù)雜多樣,不同的部位受累,會出現(xiàn)不同的臨床表現(xiàn),其中最常見者為意識障礙和眼球運動障礙,但以上并非診斷本病的必要條件。3臨床醫(yī)生應(yīng)注重全面查體,并盡早行MRI、DWI、MRA或CT、CTA檢查,做到早期診斷,以免漏診。4基底動脈尖綜合征預(yù)后差,死亡率和致殘率均較高,并發(fā)癥的出現(xiàn)會加重病情,影響預(yù)后。
[Abstract]:Objective: basilar artery apex syndrome (Top of the Basilar Syndrome TOBS) was proposed by Caplan in 1980. It refers to the disturbance of blood circulation in the corresponding blood supply area caused by acute ischemia or occlusion at the tip of the basilar artery. It is clinically characterized by thalamus, midbrain and cerebellum. Occipital and temporal medial infarction is a group of syndrome. The incidence of TOBS is low, but the disease is dangerous, the prognosis is poor, and the mortality is high. In this study, the risk factors, clinical manifestations, imaging features, complications and prognosis of TOBS patients were analyzed in order to improve clinicians' understanding of TOBS, early diagnosis, early treatment and improvement of prognosis. Methods: 50 patients with TOBS were collected from June 2015 to October 2016 in Department of Neurology, second Hospital of Hebei Medical University. All the selected patients were in accordance with the criteria for the diagnosis of cerebral infarction established by the fourth National Symposium on Cerebrovascular Disease in 1995, and were diagnosed as TOBS. by CT or MRI. The risk factors, etiology, clinical symptoms and signs, imaging features, complications and prognosis of TOBS patients were analyzed statistically. Results: 1 the risk factors of TOBS from high to low were hypertension, smoking or drinking, hyperlipidemia, hyperhomocysteinemia, diabetes, heart disease. Cerebral infarction and history of TIA. Cerebral embolism was the most common cause of TOBS. 2 the most common clinical manifestation was consciousness disorder, followed by eye movement disorder, pupil abnormality, motor disorder, behavioral and cognitive disorder, speech disorder, hemianopsia or cortical blindness. The main complications of the patients with vertigo, sensory disturbance and pontine were: thalamus, cerebellum, midbrain, occipital lobe, temporal lobe and pons. 4 the main complications were infection, mainly caused by pulmonary infection and urinary tract infection. Hypoproteinemia, electrolyte, acid-base balance disorder, stress ulcer, venous thrombosis of lower extremity were followed by hypoproteinemia. 21 of 550 patients had good prognosis, 29 had poor prognosis, 8 of them died. Conclusion: 1 the most common risk factor for TOBS is hypertension, and cerebral embolism is the main etiology of the disease. 2 the clinical manifestations of TOBS are complex and diverse, and different sites will be involved, and different clinical manifestations will occur. The most common of them are consciousness disorder and ocular movement disorder, but these are not necessary conditions for diagnosis of this disease. 3 clinicians should pay attention to comprehensive physical examination, and do MRI,DWI,MRA or CT,CTA examination as soon as possible, so as to make early diagnosis. 4 the prognosis of basilar artery apex syndrome was poor, the mortality and disability rate were higher, and the occurrence of complications would aggravate the condition and affect the prognosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
本文編號：2340879
[Abstract]:Objective: basilar artery apex syndrome (Top of the Basilar Syndrome TOBS) was proposed by Caplan in 1980. It refers to the disturbance of blood circulation in the corresponding blood supply area caused by acute ischemia or occlusion at the tip of the basilar artery. It is clinically characterized by thalamus, midbrain and cerebellum. Occipital and temporal medial infarction is a group of syndrome. The incidence of TOBS is low, but the disease is dangerous, the prognosis is poor, and the mortality is high. In this study, the risk factors, clinical manifestations, imaging features, complications and prognosis of TOBS patients were analyzed in order to improve clinicians' understanding of TOBS, early diagnosis, early treatment and improvement of prognosis. Methods: 50 patients with TOBS were collected from June 2015 to October 2016 in Department of Neurology, second Hospital of Hebei Medical University. All the selected patients were in accordance with the criteria for the diagnosis of cerebral infarction established by the fourth National Symposium on Cerebrovascular Disease in 1995, and were diagnosed as TOBS. by CT or MRI. The risk factors, etiology, clinical symptoms and signs, imaging features, complications and prognosis of TOBS patients were analyzed statistically. Results: 1 the risk factors of TOBS from high to low were hypertension, smoking or drinking, hyperlipidemia, hyperhomocysteinemia, diabetes, heart disease. Cerebral infarction and history of TIA. Cerebral embolism was the most common cause of TOBS. 2 the most common clinical manifestation was consciousness disorder, followed by eye movement disorder, pupil abnormality, motor disorder, behavioral and cognitive disorder, speech disorder, hemianopsia or cortical blindness. The main complications of the patients with vertigo, sensory disturbance and pontine were: thalamus, cerebellum, midbrain, occipital lobe, temporal lobe and pons. 4 the main complications were infection, mainly caused by pulmonary infection and urinary tract infection. Hypoproteinemia, electrolyte, acid-base balance disorder, stress ulcer, venous thrombosis of lower extremity were followed by hypoproteinemia. 21 of 550 patients had good prognosis, 29 had poor prognosis, 8 of them died. Conclusion: 1 the most common risk factor for TOBS is hypertension, and cerebral embolism is the main etiology of the disease. 2 the clinical manifestations of TOBS are complex and diverse, and different sites will be involved, and different clinical manifestations will occur. The most common of them are consciousness disorder and ocular movement disorder, but these are not necessary conditions for diagnosis of this disease. 3 clinicians should pay attention to comprehensive physical examination, and do MRI,DWI,MRA or CT,CTA examination as soon as possible, so as to make early diagnosis. 4 the prognosis of basilar artery apex syndrome was poor, the mortality and disability rate were higher, and the occurrence of complications would aggravate the condition and affect the prognosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
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