A Discussion In The Relationship Between The Clinical Manifestation And Prognosis Of Top Of The Basilar Syndrome

BackgroundSince the conception of Top of the Basilar Syndrome(TOBS) was named by Caplan in 1980, the internal and external scholars have done a large quantity of researches. As a special type of cerebrovascular disease, TOBS has a low disease incidence and dangerous condition. Studies national and abroad tend to report a small number of infrequent cases, discuss the complicated and changeable clinical manifestation, image changes and the diagnosis with the purpose to raise the accuracy rate of early diagnosis. Some researchers did retrospective studies to risk factors, and found that the risk factors of cerebrovascular disease which were publicly known by internationality were not particular to TOBS. The studies to the prognosis were rare. Our research comprehensively analysis the gender, past diseases, clinical manifestation, complication, image changes and so on, assess and forecast the prognosis of TOBS objectively and accurtely.MethodWe studied a cohort of 48 cases of TOBS patients from China-Japan Union Hospital of Jilin University between October 2006 to March 2010. All the TOBS patients were confirmed by CT or MRI. We use The Nation Institutes of Health Stroke Scale(NIHSS) to assess the neurologic impairments within 72 hours after fell ill. We divided the patients into two groups, one with NIHSS lower than 25,the other more than or equal to 25. The denouement after 30 days were assessed by modified Rankin scale(MRS) to recovery after therapy. We also divided into two groups, one included 0~3, the other included 4~6(death mark 6). We also counted the numbers of the focus on image changes. According to the image changes, we divided the patients into three groups, one with supratentorial focuses, one with subtentorial focuses, the last one with both supratentorial and subtentorial focuses. We used SPSS 13.0 statistical software package to sort and analyze the data of 48 cases of TOBS patients, to assess the relationship between prognosis and gender, past diseases, clinical manifestation, complication, NIHSS, image changes and so on. We quantified these and usedχ2 to test the count data of clinical indicators, taking P <0.05 as statistical significant and P <0.01 as conspicuous significant statistical. Then we used Logistic regression analysis to assess the relationship between prognosis and NIHSS, image change groups and complication.ResultsThis study involved 48 cases of TOBS patients, including 36 male, 12 female with male female ratio of 3:1. The average of age is 61±12.1. There are 40 patients combining with hypertension, 10 patients with diabetes, 20 patients with coronary heart disease, within 3 patients suffering from atrial fibrillation, 22 patients with hyperlipaemia, 4 patients with repeatedly TIA, 10 patients with cerebral infarction, 24 patients with smoking and drinking. The mortality rate is 14.6%。We found that the risk factors to TOBS are no significant differences from the other cerebrovascular diseases. In our study, as the first symptom of TOBS, disturbance of consciousness, dizziness and dyskinesia were common. But the clinical manifestation of TOBS with a high incidence were eye movement hyperactivity disorder(70.8%), abnormal pupil(45.8%), disturbance of consciousness(54.4%), dyskinesia(50.0%) and pathologic signs(83.3%). The most common complication is pulmonary infection. The patients who suffered from disturbance of consciousness and behavioral and cognitive disorder often had a poor prognosis. When we analyzed image changes, we found that the prognosis was often bad with the focuses on mesencephalon, thalamus and pons. But the number of focuses had nothing to with the prognosis. NIHSS, mage change groups, hypertension, hyperlipaemia, diabetes, and smoking and drinking have pertinency with prognosis(P<0.05). Besides these factors, NIHSS and mage change groups have conspicuous positive correlation with prognosis(P<0.01). The results showed that the patients with NIHSS>25 had a poor prognosis as well as the ones with focuses which were subtentorial , or both supratentorial and subtentorial. We unioned NIHSS and infectant, then we found that the forecast accuracy of good prognosis raised to 87.5%, the one of bad prognosis to 93.8%, the average 91.7%.Conclusion1. Top of the Basilar Syndrome has poor prognosis, high mortality and disability rate, especially in the patients with disturbance of consciousness, behavioral and cognitive disorder, as well as the ones with the focuses on mesencephalon, thalamus and pons.2.It is objective and accurate to judge the prognosis of top of the Basilar Syndrome by NIHSS, image change group and the occurrence of complications.