| Cerebral vascular disease has long been considered as a kind of serious disease affecting human health and quality of life, with the improvement of living standards and trend of population aging, its incidence, morbidity, and mortality increases year after year, and combine with heart disease and cancer, constitute the three main causes of death of human, and makes the disease more and more popular in researching and being attentioned in recent years. Cerebral vascular diseases by their nature can be divided into hemorrhagic cerebral vascular disease and ischemic cerebral vascular diseases, among which the ischemic cerebral vascular disease is more common. in recent years. With the development in fields of cerebrovascular disease-related pathology, pathophysiology, imaging diagnostics, therapeutics measures, it has been made more fruitful results in the clinical diagnosis and treatment.Hypertension, diabetes, dyslipidemia, obesity and chronic smoking, and drinking is still the main risk factors for cerebral vascular disease. These risk factors make the long-term chronic effects to the vessels and can cause series damage to them. First, increased permeability of endothelial cells leading the monocytes in blood into the subendothelial and become foam cell through the phagocytosis of lipid, which finally cause the formation of subcutaneous lipid-rich plaques and fibrous plaques, and later convex to the lacuna of vessels, and it will cause blood vessels gradually hardening, elastic degeneration and progressive luminal narrowing or occlusion. On the other hand the result of these stimulus make the vascular endothelial cells damaged and lost, exposuring subendothelial collagen, making the blood material components such as platelets, fibrins and red blood cells aggregate to the collagen surface of the blood vessels, and eventually caused the gradual formation of thrombosis which ultimately lead to vessel stenosis or occlusion. Cerebrovascular atherosclerosis occurs mainly in the carotid artery, vertebral basilar artery and willis ring, etc, and the thrombosis occurs mainly in the blood vessel bifurcation which suffers from lash of the blood stream, and it make the cerebral vessels more susceptible to the atherosclerosis and thrombosis.Top of the basilar syndrome refers to a kind of clinical syndrome presented as ischemic infarctions in midbrain, thalamus, temporal and occipital lobes, cerebellum and even upper pontine which is caused by 5 arteries including the bilateral posterior cerebral artery(PCA), bilateral superior cerebellar artery(SCA) and the basilar artery(BA), and these arteries are originated from the top of the basilar artery within the region of 2cm diameter. In order to study the correlation between the clinical and imaging manifestation of this disease further, we collected 55 patients with top of basilar syndrome and carried out retrospective analysis to the relevant primary data.The result shows that top of the basilar syndrome is mainly seen in the elderly people and onset of the TOBs has the tendency of getting yonger and yonger. And the patients who suffered from the disease before the age of 60s account for more than half of the total patients. High risk factors including hypertension, diabetes, hyperlipidemia and atrial fibrillation, of which the long-term high blood pressure with small artery atherosclerotic plaque formation is the main risk factors of this disease. Disorders of ocular and pupil movement always be the main clinical manifestation in the patient with TOBs, and besides this there may be one or both pyramid sign, ataxia, different level of the consciousness disturbance, visual defect, and of which the disorders of ocular and pupil movement are presented most frequently. Imaging findings such as brain CT and MRI mostly shows the unilateral or bilateral infarctions in the midbrain and thalamus, accompanied by the different number of ranges in different parts of the cerebellum, occipital lobe, temporal lobe and the upper pontine. Improving the circulation and lowering the intracranial pressure as a primary treatment combined with anti-infection, gastric protecting and other symptomatic and supportive treatment, patients have relatively good prognosis, the total effective rate is significantly higher than the foreign reports, and the mortality is only 7.2%. So the early diagnosis, positive and effective comprehensive treatment and prevention of complications, plays an important role to the prognosis of top of the basilar syndrome, and can reduce the relapse rate and mortality. Besides this, early systemic rehabilitation is also an important project to reducing the disability.Conclusions: As the specificity and complexity of the anatomical structures of the rostral basilar artery, clinical and imaging manifestations varied from patient to patient. But as the deeper clinical recognization to the TOBs and continuous development of the laboratory and accessory examinations and the treatment, it has much improved the accuracy rate of the diagnosis and effective rate of the treatment. It can provide following information to the clinical diagnosis and treatment of the disease: (1) Elderly patients with hypertension, diabetes, atrial fibrillation and long-term smoking, drinking and other high risk factors for cerebrovascular disease. (2) There are main clinical manifestations such as vertigo, nausea, vomiting and disorders of ocular and pupil movement, with varying degrees of consciousness disturbance, ataxia and visual defect. (3) Accessory examinations such as CT and MRI are the most frequently used examinations besides TCD, MRA, CTA and DSA. We can find that the midbrain and thalamus are the most common positions of the TOBs and combine with the infarctions of cerebellum, occipital lobe, temporal lobe or the upper pontine with multiple lesions, and we can also find different level of the stenosis or the obstruction with the basilar artery(BA), unilateral or bilateral posterior cerebral artery(PCA) and the superior cerebellar artery(SCA). (4) Treatment consists mainly of thrombolysis, anti-platelet aggregation, scavenging free radicals, improving the circulation, lowering the intracranial pressure and other symptomatic and supportive treatment like oxygen uptaking, anti-infection and protection of gastric mucosa. (5) Prognosis mainly depends on the position, number, the range of the infarction, and the establishment of collateral circulation, and the timeliness of the treatment is also very important. Usually the smaller position, the fewer lesion and the more collateral circulation development and promptly the patient receive the treatment, the better prognosis the patient will be.This clinical statistical analysis mainly focuses on the epidemiological features of top of the basilar artery syndrome, and also study the clinical manifestations and corresponding imaging features of the distribution and frequency of the lesions, and analyze the differences between clinical manifestations and imaging findings comparatively. In order to further understand the characteristics of clinical onset of the disease, as far as to make timely and correct diagnosis and related treatment, and predict the prognosis of this disease effectively, it provides some quantitative indicators. |
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