椎-基底动脉系统结构异常误诊二例  

Two misdiagnosed cases of abnormal structure of vertebra-basalartery system and literature review

作　　者：刘琦[1] 董惠[1] 刘亚玲[1] Liu Qi;Dong Hui;Liu Yaling(Department of Neurology,the Second Hospital of Hebei Medical School,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《脑与神经疾病杂志》2021年第3期178-182,共5页Journal of Brain and Nervous Diseases

基　　金：河北省重点研发计划项目(192777090)。

摘　　要：目的 椎-基底动脉系统结构异常目前被认为是脑卒中发生的原因之一,少见的因椎基底动脉压迫所致的临床症状可以被误诊为多种神经系统疾病,包括运动神经元病、炎性脱髓鞘及周围神经病等.方法 通过对我科近期收住的两例椎-基底动脉系统结构异常压迫延髓和舌下神经被误诊为运动神经元病及其他疾病患者进行分析,了解椎-基底动脉系统结构异常的临床表现、影像学特点、诊断标准、治疗和预后.结果 缺乏正确的影像学评估通常是导致椎-基底动脉系统结构异常被误诊的主要原因.头颅MRI\MRA\CTA是诊断椎-基底动脉系统结构异常的主要检查方法.针对此病,目前尚无有效的治疗方法,针对缺血性脑卒中为主要临床表现的患者主要以抗血小板聚集、调脂固斑、治疗脑血管病危险因素为主要治疗手段;针对以压迫为主要临床表现的患者,则可以通过充分的评估后进行手术治疗.结论 椎-基底动脉结构异常的临床表现多样,正确的影像学评估有利于早期诊断,调整治疗方案,减轻患者焦虑情绪.Objective The abnormality of the vertebral-basal artery system is currently considered to be one of the causes of stroke.Rare clinical symptoms caused by compression of the vertebrobasilar artery can be misdiagnosed as a variety of neurological diseases,including motor neuron disease,inflammatory demyelination,and peripheral neuropathy.Methods Recently,two patients with vertebral-basal artery system structural abnormalities were admitted and misdiagnosed as motor neuron disease and other disease,for oppressing the medulla oblongata and hypoglossal nerves.We make the analyze to understand the clinical manifestations and images of abnormal vertebral-basal artery system structures characteristics,diagnostic criteria,treatment and prognosis.Results Lacking correct imaging evaluation is usually the primary cause of the misdiagnosis.Brain MRI\MRA\CTA are the main examination methods for diagnosing structural abnormalities of the vertebral-basal artery system.At present,there is no effective treatment for the disease.For patients with ischemic stroke as the main clinical manifestation,anti-platelet aggregation,lipid fixation,and treatment of cerebrovascular disease risk factors are the main treatment methods;for those with compression as the main clinical manifestation,patients can undergo surgery after adequate evaluation.Conclusion The clinical manifestations of vertebrobasilar structure abnormalities are diverse,and correct imaging evaluation is conducive to early diagnosis,adjust therapy methods,and extenuate anxiety.

关 键 词：椎-基底动脉系统结构异常 舌下神经麻痹 炎性脱髓鞘 运动神经元病 延髓压迫 

分 类 号：R742.5[医药卫生—神经病学与精神病学]