脑梗死继发脑疝的临床与病理特点  

Clinical and pathological features of herniation secondary to cerebral infarction

作　　者：徐惠琴[1] 李晓秋[1] 王耀山[1] 

机构地区：[1]沈阳军区总医院神经内科,110016

出　　处：《临床神经病学杂志》2006年第1期12-14,共3页Journal of Clinical Neurology

摘　　要：目的探讨脑梗死继发脑疝的临床与病理特点。方法对50例死于脑梗死继发脑疝患者的资料进行分析。结果50例患者均表现有意识障碍、瞳孔异常、偏瘫或四肢瘫。发病至出现脑疝时间平均(3·36±1·12)d,脑疝至死亡时间20h^7d,平均(1·5±0·98)d。病理解剖见颈内动脉、大脑中动脉和/或椎-基底动脉闭塞致大面积脑梗死,其中脑栓塞致出血性脑梗死25例,脑血栓形成致缺血性脑梗死25例。梗死部位:大脑半球31例,脑干15例,幕上幕下并存4例。50例继发多种类型脑疝,其中海马回疝36例,小脑扁桃体疝36例,中心疝18例,扣带回疝17例,蝶骨嵴疝27例;35例(70%)患者有多种脑疝并存,其中2种11例,3种10例,4种9例,5种5例。结论脑梗死继发脑疝主要见于颈内动脉、大脑中动脉闭塞导致大面积脑梗死;脑疝多发生在疾病早期,且以海马回及小脑扁桃体疝多见,常多种并存。Objective To discuss the clinical and pathological features of herniation secondary to cerebral infarction. Method Clinical and pathologic characteristics of 50 cases died of herniation due to cerebral infarction were analysised. Results The clinical manifestations, such as consciousness disturbance, pupillary change, hemiplegia or tetraplegia were detected in all 50 cases, the average time from onset to herniation was （3.36 ±1. 12） d,the time herniation to death was 20 h -7 d,average about （1. 5 ± 0.98）d. The large size cerebral infarctions caused by internal carotid artery, middle cerebral artery and/or vertebral artery occlusion were pathologically confirmed, hemorrhagic cerebral infarctions caused by cerebral embolism were found in 25 cases and the ischenmic infarctions caused by cerebral thrombosis in 25 caese. Site of infarction were cerebral hemisphere （31 cases） , brain stem （15 cases）, supratentorial and infratentorial brain （4 cases）. Of the 50 cases,36 cases had hippocampal gyrus herniation ,36 cases with cerebellur throat-almond herniation, 18 cases with central herniation, 17 cases with cingulated gyrus herniation,and 27 cases with sphenoidal crest herniation. Usually there were several herniation existing in the same patient. Among 50 cases, 11 cases had two kinds of herniation, 10 cases with three kinds of herniation,9 cases with four kind of herniation, and 5 cases with five kinds of herniation. Conclusions Herniation secondary to cerebral infarction were mainly presented in the large size cerebral infarction caused by internal carotid artery or middle cerebral artery occlusion, the time of herniation was in early stage of disease. Most of patients were hippocampal gyrus herniation and cerebellur throat-almond herniation. Usually there were several herniation existing in the same patient.

关 键 词：脑梗死 脑疝 病理 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]