基底動脈頂端症候群("Top of the Basilar" syndrome)

"Top of the Basilar" Syndrome

王宗仁(Tsung-Jen Wang) ； 周介仁(Jieh-Ren Jou) ； 翁林仲(Lin-Chung Woung) ； 施永豐(Yung-Feng Shih) ； 林隆光(Luke L-K Lin)

《中華民國眼科醫學會雜誌》 42卷2期 (2003/06) Pp. 127-131

https://doi.org/10.30048/ACTASOS.200306.0004

摘要

目的：檢視過去五年內台大醫院基底動脈頂端症候群病人在眼部臨床病徵的表現，同時回顧過去的相關文獻。
方法：基底動脈頂端症候群被歸屬為一種脊椎腦底動脈循環不良(vertebro-basilar insufficiency)，我們檢視了由1997年7月至2002年7月之間，屬於脊椎腦底動脈循環不良這個診斷在本院神經科住院的78個病人，藉由核磁共振血管攝影或傳統腦血管攝影來確定基底動脈頂端症候群的診斷。我們檢查這些病人在該症候群發生時的眼部病徵表現，同時追蹤檢查這些病人的預後情形。
結果：我們發現有四個基底動脈頂端症候群的病人，都是經由神經科醫師及影像檢查而確定診斷的。男女比率是三比一。有兩個病人的起初表現為雙眼眼盲，三個病人有意識混亂的情形，病人皆有明顯視野缺損的情形，兩個病人有垂直性眼球運動麻痺的情形，一個病人有左側偏癱的運動功能失調，追蹤檢查發現有持續性的視野缺損及眼球垂直運動的異常。
結論：和其他型的脊椎腦底動脈循環不良比較，基底動脈頂端症候群的預後較佳。早期診斷必須依據有大腦皮質盲的臨床表現及後續的影像學檢查之證實。核磁共振血管攝影比傳統腦血管攝影是較不具侵襲性的檢查，其對於診斷是有價值的。

並列摘要

Objective: To review the ophthalmic manifestations of top of the basilar syndrome (TOB) in the past five years at NTUH.
Summary Background: Top of the basilar syndrome (TOB) is caused by a disturbance in circulation at the top of the basilar artery. Clinical signs include an array of visual, oculomotor, and behavioral disturbances. The unique symptoms and signs usually lead the patient to visit the ophthalmologists. As an ophthalmologist, it is important to realize the special presentation of TOB syndrome. We here report four patients who had TOB syndrome definitely in the past five years at NTUH.
Methods: TOB syndrome is classified into a kind of vertebrobasilar insufficiency (VBI) (ICD-10 code 435.0). We reviewed 78 cases who had VBI on admission in the past five years (1997 July to 2002 July). The diagnosis of TOB syndrome was confirmed by image studies, such as MRA and angiography. We reviewd the ophthalmic manifestation of these patients. Follow-up examination was also performed if possible.
Results: We found four cases who had TOB syndrome. The diagnoses of these four patients were con-finned by neurologists and image studies. Three were male and one was female. Binocular blindness was noted as the initial presentation in two patients. Three patients had conscious disturbance. Obvious visual field defects were noted either by confrontation test or by visual field examination. Vertical gaze palsy was noted in two cases. The motor dysfunction with left hemiplegia was noted only in one case. Follow-up examination revealed persistent visual field defects and vertical motility impairment. The prognosis is relative good compared to other kind of vertebro-basilar insufficiency.

並列關鍵字

top of the basilar syndrome ； vertebro-basilar insufficiency ； vertical gaze palsy