Supplementing Qi and activating blood circulation method to treat vertebrobasilar dolichoectasia with posterior circulatory watershed infarction: a case report of two patients

doi:10.19852/j.cnki.jtcm.2023.04.006

Abstract

Abstract:

Vertebrobasilar dolichoectasia (VBD), a rare posterior circulation vascular variant disease, is an important risk factor for many acute cerebrovascular diseases. An insufficient understanding of VBD often leads to misdiagnose. Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here. Absence of common causes of stroke including hypoperfusion, blood system diseases, carotid and aortic dissection, and eosinophil elevation, the symptoms of the 2 patients met the diagnostic criteria of VBD. Both patients displayed symptoms that were in line with the Traditional Chinese Medicine (TCM) syndrome pattern of "Qi deficiency and blood stasis". Accordingly, they were comprehensively treated with Supplementing Qi and activating blood circulation method. The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up. A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD. TCM treatment based on syndrome identification might be a promising candidate for VBD management.

Key words: vertebrobasilar insufficiency, stroke, medicine, Supplementing Qi and activating blood circulation method, integrative medicine, case reports

LI He, SU Wenquan, LI Shanshan, JI Hanrui, CHENG Jiangyan, CUI Fangyuan, TANG Lu, ZHOU Li, GAO Ying, DONG Xinglu. Supplementing Qi and activating blood circulation method to treat vertebrobasilar dolichoectasia with posterior circulatory watershed infarction: a case report of two patients[J]. Journal of Traditional Chinese Medicine, 2023, 43(4): 824-828.

Figures/Tables 2

Figure 1 Cranial MRA showed dilation and extension of vertebrobasilar artery and MRI showed a new cerebral infarction in the left pons A: MRA showed that the maximum diameter of the right vertebral artery was 4.7 mm and the maximum diameter of the basilar artery was 5.5 mm. B: MRA showed that the distance from the beginning to the bifurcation of the basilar artery was 38.6 mm. C: MRA showed that the maximum diameter of basilar artery at pontine level was 5.7 mm. D: MRA showed that the maximum diameter of the right vertebral artery at the medulla oblongata level was 3.3mm and the maximum diameter of the left vertebral artery was 4.6 mm. E: DWI showed a wedge-shaped hyperintense lesion in the watershed area of left pontine, indicating a new watershed infarction in the left pontine. F: ADC showed a wedge-shaped low signal lesion in the watershed area of left pontine, indicating a new watershed infarction in the left pontine. MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; DWI: diffusion weighted imaging; ADC: apparent diffusion coefficient.

Figure 2 Cranial MRA showed dilation and extension of vertebrobasilar artery and Cranial MRI showed new cerebral infarction in the bilateral cerebellum A: MRA showed that the maximum diameter of the basilar artery was 5.3 mm. B: MRA showed that the distance from the beginning to the bifurcation of the basilar artery was 31.7 mm. C: DWI showed wedge-shaped hyperintense lesions in the watershed area of the right cerebellum, suggesting a new watershed infarction in the right cerebellum. D: DWI showed wedge-shaped high signal lesions in the watershed area of bilateral cerebellum, suggesting a new watershed infarction in bilateral cerebellum. MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; DWI: diffusion weighted imaging.

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