旋转性椎动脉闭塞综合征致反复后循环梗死一例  

A case report of recurrent posterior circulation infarction caused by bow hunter syndrome

作　　者：薛素芳[1] 石海艳 杜祥颖[2] 马欣[1] Xue Sufang;Shi Haiyan;Du Xiangying;Ma Xin(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院影像科,北京100053

出　　处：《中国脑血管病杂志》2019年第8期423-425,共3页Chinese Journal of Cerebrovascular Diseases

摘　　要：旋转性椎动脉闭塞综合征又称弓猎人综合征(BHS),指在头颈旋转或伸展过程中导致椎动脉机械性闭塞或狭窄的一种罕见临床综合征,其后循环缺血症状多在头部旋转时发生,并在中立位置时迅速改善。在少数情况下,BHS可因椎动脉反复挤压内膜受损继发血栓形成致动脉-动脉栓塞性梗死。作者报道了1例弓猎人综合征致反复后循环梗死的青年女性病例,该患者以突发反应迟钝、记忆力下降、右侧肢体活动不利起病,既往无明确血管危险因素,临床症状与转颈活动无相关性。颈动脉超声转颈试验示左侧椎动脉颈部右转时出现血流减弱逆转,头颈部CT血管成像(CTA)和DSA检查示左侧椎动脉V3、V4交界处局部突起,考虑为夹层或假性动脉瘤;转颈CTA示右侧转头时左侧椎动脉出枢椎横突孔之后未见显影;高分辨率MR示左侧椎动脉V3、V4交界区血管内一膜样结构突入管腔。提示BHS临床症状可以与转颈无关,仅表现为后循环区域梗死,可以合并同侧椎动脉范围非常局限的夹层或假性动脉瘤损害表现。临床医师如果缺乏相应的认识,可能会造成漏诊和误诊。因此遇到隐源性后循环青年卒中患者,应仔细分析后循环血管形态改变,必要时行颈动脉超声转颈试验或动态DAS明确有无合并BHS。Rotational vertebral artery occlusion syndrome,also known as Bow Hunter Syndrome(BHS),is a rare clinical syndrome that causes mechanical occlusion or stenosis of the vertebral artery during head and neck rotation or extension.Ischemia symptoms of the vertebral-basilar artery system often occur during head rotation and could rapidly improve with neutral position.In a few cases,BHS may result in arterio-arterial embolic infarction due to secondary thrombosis from intimal injury caused by repeated compression of the vertebral artery.The author reported a case of a young female patient with repeated posterior circulatory infarction caused by BHS.The patient suffered from sudden unresponsiveness,memory decline,and right limb inflexibility.There were no vascular risk factors in her past history,and no correlation between clinical symptoms and neck rotation.Neck rotation test by carotid ultrasound showed the blood flow of left vertebral artery was decreased and reversed when the neck rotated to the right.Head and neck CT angiography(CTA)and DSA examination showed left vertebral artery local protrusion at the junction of V3 and V4,which was considered as dissection or pseudoaneurysm.Left vertebral artery segment after axial transverse foramen was not visible on CTA during right head rotation.High resolution MR showed a membranous structure protruding into the lumen at the V3-V4 junction of the left vertebral artery.It is suggested that the clinical symptoms of BHS may be unrelated to neck rotation,but could only present as posterior circulation area infarction combined with ipsilateral vertebral artery imaging characteristics of limited range of dissection or pseudoaneurysm.Missed diagnosis and misdiagnosis may occur if the clinicians lack the corresponding understandings and knowledge.Therefore,in young patients with posterior circulation cryptogenic stroke,morphological changes of posterior circulation vessels should be carefully analyzed.If necessary,carotid ultrasound neck rotation test or dynamic DAS should be condu

关 键 词：弓猎人综合征 后循环梗死 动脉-动脉栓塞性梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]