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目的研究基底动脉(BA)严重狭窄或闭塞所致脑梗死的临床表现,并评估其预后,分析与预后不良的相关因素。方法收集168例后循环缺血脑梗死患者病例,经全脑动脉造影筛选出29例BA严重狭窄或闭塞病变患者,MRI证实存在BA供血区新鲜脑梗死;随访1年,分析与预后不良相关的临床及血管病变特点。结果21例患者病前有以眩晕发作为主要表现的短暂性脑缺血发作(TIA);发病72h内出现意识障碍者9例,其中4例死亡,5例严重残障。1年病死率为44.8%(14例),严重残障率为13.8%(3例);狭窄位于BA近1/3段6例,中1/3段11例,远1/3段4例;9例入院时NIHSS≥14分的患者3例死亡,6例严重残障。结论BA严重病变所致脑梗死临床预后较差。频繁出现且持续时间逐渐延长的眩晕、早期出现意识障碍可能提示预后不良。NIHSS评分有助于判断预后。
Objective To study the clinical manifestations of cerebral infarction caused by severe stenosis or occlusion of basilar artery (BA) and assess its prognosis and analyze the related factors of poor prognosis. Methods A total of 168 patients with posterior circulation ischemic cerebral infarction were enrolled and 29 patients with severe stenosis or occlusion of BA were screened by whole cerebral arteriography. MRI confirmed the presence of fresh cerebral infarction in the BA donor area. The patients were followed up for 1 year and analyzed for poor prognosis Clinical and vascular lesions. Results Twenty-one patients had transient ischemic attack (TIA) with dizziness as the main symptom before the onset of disease. There were 9 patients with disturbance of consciousness in 72 hours after onset, of which 4 died and 5 were severely disabled. The 1-year mortality rate was 44.8% (14 cases) and severe disability rate was 13.8% (3 cases). The stenosis was located in nearly 1/3 of the BA in 6 cases, 11 of the 1/3 cases and 4 of the far 1/3 cases in the 1 / Three patients died of NIHSS ≥14 at admission, and six were severely disabled. Conclusions The prognosis of cerebral infarction caused by severe BA is poor. Frequent and prolonged duration of dizziness, early disturbance of consciousness may indicate poor prognosis. The NIHSS score helps determine prognosis.