目的 探讨表现为后循环缺血性病变的小脑幕硬脑膜动静脉瘘(DAVF)的临床和影像学特点.方法 回顾性分析3例表现为后循环缺血性病变的小脑幕DAVF患者的临床和影像学资料.结果 本组患者起病形式多样,均表现头晕、恶心、呕吐,病变侧共济失调、水平眼震；1例患者出现交叉性感觉障碍、轻度延髓麻痹和不完全Horner征；头颅MRI均示小脑病变,其中1例合并延髓病变,病灶处均出现长T1、长T2及弥散加权成像高信号；2例MRI增强见小脑病灶强化及多条弯曲血管影；3例头部数字减影血管造影(DSA)检查均发现小脑幕DAVF瘘口.结论 小脑幕DAVF可引起小脑及脑干缺血表现,MRI增强扫描可见病灶强化及异常血管影,DSA检查可明确诊断.%Objective To investigate the clinical and imaging characteristics of tentorial dural arteriovenous fistulae (DAVF) which presented as ischemic damage in posterior circulation. Methods The clinical and imaging data of 3 tentorial DAVF patients presented as ischemic damage in posterior circulation were analyzed retrospectively. Results The onset in this group was various forms. The manifested symptoms of the 3 cases were vertigo, nausea, vomiting, pathological lateral ataxia and horizontal nystagmus. One case presented with crossed sensory disturbance, mild medulla oblongata paralysis and incomplete Horner's syndrome. Skull magnetic resonance imaging (MRI) was showed ischemic damage in cerebellum in 3 cases and brain stem in 1 cases. The lesions were long T1, long T2 changes and high signal on diffusion weighted imaging. MRI contrasted scan in 2 cases also found enhancement of lesions and multiple abnormal curved enhanced blood vessels. The 3 cases received digital subtraction angiography (DSA) examination and all found DAVF in tentorium of cerebellum. Conclusions Tentorial DAVF may cause ischemic damage in cerebellum and brain stem. MRI may show enhancement of lesions and abnormal blood vessels. Definite diagnosis can depends on DSA examination.
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