貌似大脑半球病变的脑干梗死临床和影像分析  

An analysis for clinical and imaging features of brainstem infarctions seemed to cerebral hemisphere infarctions in some clinical findings

作　　者：朱良付[1] 曾进胜[1] 洪华[1] 杨智云[2] 盛文利[1] 黄如训[1] 

机构地区：[1]中山大学附属第一医院神经科脑血管专科,广州510080 [2]中山大学附属第一医院放射科,广州510080

出　　处：《中国神经精神疾病杂志》2005年第1期24-28,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金 (编号 :3 9940 0 12 ;3 0 2 714 85 );美国CMB基金(编号 :0 0 73 0 );教育部归国人员启动基金 (编号 :19993 63 )资助项目

摘　　要：目的　分析貌似大脑半球病变的脑干梗死的临床和影像学特点及临床定位错误的原因。方法　连续1年观察发病 6h内收治的首发脑梗死 118例 ,先行OCSP(theOxfordshirecommunitystrokeproject)分型、NIHSS评分 (thenationalinstitutesofhealthstrokescale)和超早期头颅CT平扫 ,再结合 72h内的头颅MR筛出貌似大脑半球病变的脑干梗死。结果　 118例中首诊分型 5 0例为腔隙梗死 ,其中 4 4例行MR复查并证实貌似大脑半球病变的脑干梗死 12例。头颅CT均未检出脑干病灶 ,MR准确检出了脑干责任灶。病灶多在脑桥的三叉神经根平面、脑桥旁正中动脉的血供分布区。 11例病灶小于 2 0mm ,呈纵向条状、片状。结论　早期行MR有助于明确诊断貌似大脑半球病变的脑干梗死。对有糖尿病病史、起病有头晕、临床呈单纯运动性轻偏瘫或单纯性偏瘫的LACI,要注意其病灶有可能在脑干。Objective To investigate clinical and imaging features of brainstem infarctions seemed to cerebral hemisphere infarctions in some clinical findings, and to analyse the causes of bias in localization diagnosis. Methods A total of 118 patients with the first attack of ischemic stroke within 6 hours after onset were assessed on admission by the Oxfordshire Community Stroke Project (OCSP) classification, the national institutes of health stroke scale and noncontrast computed tomographic(CT) brain scan; Then magnetic resonance imaging was performed within 72 hours of onset to identify brainstem infarction. Results Among 118 patients with brain infarction, 50 cases were diagnosed as lacunar infarction in cerebral hemisphere with OCSP criteria but without CT findings, in which 44 cases were undertaken MR and 12 cases were confirmed to have a brainstem infarction. The loci distributed predominantly in the fields of the paramedian arteries and on the level of radix trigeminus, and were less than 20 mm in size, manifesting as the shapes of longitudinal strip and patch. Conclusions MR performed at early stage may confirm the diagnosis for brainstem infarctions seemed to cerebral hemisphere in some clinical findings. The patients with history of diabetes mellitus, onset symptom of dizziness and pure motor hemiparesis or hemipleia have more possibility to suffer from this kind of brainstem infarction.

关 键 词：脑干 分型 脑梗死 磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]