基底动脉尖缺血性卒中的昏迷：是不可逆性昏迷吗
Coma from “Top of the Basilar Artery” Ischemic Stroke: Is Irreversible Coma?

DOI: 10.12677/acm.2011.11004, PP. 17-20

Keywords: 基底动脉尖；缺血性卒中；昏迷；预后；溶栓治疗
Top of the Basilar Artery, Ischemic Stroke, Coma, Outcome, Thrombolytic Therapy

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Abstract:

摘 要：尽管基底动脉尖急性缺血性梗塞预后不良，然而，基底动脉尖缺血性卒中患者的昏迷有不同的模式，对其不同的昏迷类型及预后尚研究不足。现在我们描述二例基底动脉尖急性缺血性卒中昏迷病人。这二例患者入院时都有高血压，并有长期高血压病史。病例1是以突发短暂昏迷为表现的基底动脉动脉尖短暂性缺血发作(TIA)，T1和T2加权MR图像和脑CT扫描结果正常，有很好的预后。病例2脑MR 影像T2加权在双侧中脑和小脑可见高信号强度，临床诊断为基底动脉尖梗塞并长期昏迷，3个月进入持续性植物状态，最终乃至死亡。我们发现，昏迷在基底动脉尖缺血性卒中有不同的类型，可逆或不可逆直接与血流能否再通有关。我们建议，及时对基底动脉尖梗塞的昏迷病人溶栓治疗应该是一种明智的选择。
Abstract: Although top of the basilar artery occlusion has a poor prognosis, the different patterns and out-come of coma in top of the basilar artery ischemic stroke patients have not been adequately investigated. We report two cases with top of the basilar artery ischemic stroke and acute coma. In this study we demonstrate in two patients with an elevated hypertention on admission and a long history of hypertention. One patient, with top of the basilar artery transient ischemic attack and transient coma (normal T1- and T2-weighted MR images), had a good outcome. The other, with top of the basilar artery infarction and coma (high signal inten-sities on T2-weighted MR images in the bilateral midbrain and cerebellum), made a survived in a persistent vegetative state and eventual death. We find that the coma in top of the basilar artery ischemic stroke has a different pattern, and reversible or irreversible is directly related to whether blood flow can be recanalization. We suggest that thrombolysis therapy for unconscious patients with top of the basilar artery infarction should be a wise choice.

References

[1]	N. Sanossian, B. Ovbiagele. Prevention and management of stroke in very elderly patients. Lancet Neurol, 2009, 8(11): 1031-1041.
[2]	K. Winbeck, K. Bruckmaier, T. Etgen, et al. Transient ischemic attack and stroke can be differentiated by analyzing early diffusion-weighted imaging signal intensity changes. Stroke, 2004, 35(5): 1095-1099.
[3]	C. Oppenheim, C. Lamy, E. Touze, et al. Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions?. American Journal of Neuroradiology, 2006, 27(8): 1782-1787.
[4]	J. J. Wang, M. L. Baker, P. J. Hand, et al. Transient ischemic attack and acute ischemic stroke: Associations with retinal microvascular signs. Stroke, 2011, 42(2): 404-408.
[5]	S. Prabhakaran, J. Y. Chong, and R. L. Sacco. Impact of abnormal diffusion-weighted imaging results on short-term outcome following transient ischemic attack. Arch Neurol, 2007, 64(8): 1105-1109.
[6]	D. Collen. On the regulation and control of fibrinolysis. Edward Kowalski memoeial lecture. Thromb. Haemost, 1980, 43(2): 77-79.
[7]	B. Carson, K. Lam, T. Yoo et al. Embolus extravasation is an alternative mechanism for cerebral microvascular recanalization. Nature, 2010, 465(7297): 478-482.
[8]	J. J. Fins. Constructing an ethical stereotaxy for severe brain injury: Balancing risks, benefits and access. Nature Reviews Neuroscience, 2003, 4(4): 323-327.
[9]	S. Laureys, M. Boly, and P. Maque. Tracking the recovery of consciousness from coma. The Journal of Clinical Investigation, 2006, 116(7): 1823-1825.
[10]	M. C. Zurru, G. Orzuza. Epidemiological aspects of stroke in very old patients. Cardiovasc Hematol Disord Drug Targets. 2011 Mar 11. [Epub ahead of print] PMID: 21446898 [PubMed- as supplied by publisher].
[11]	N. K. Mishra, H. C. Diener, P. D. Lyden, et al. VISTA Collaborators. Influence of age on outcome from thrombolysis in acute stroke: A controlled comparison in patients from the Virtual International Stroke Trials Archive (VISTA). Stroke, 2010, 41(12): 2840-2848.

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