累及脑桥表面的孤立单侧脑桥梗死与进展性运动障碍的关系  

Progressive motor deficit caused by isolated unilateral pontine infarction extending to the pontine surface

作　　者：陈珂楠[1] 郭舜源[1] 陈桂花[1] 耿昱[1] 

机构地区：[1]浙江省人民医院神经内科,杭州310014

出　　处：《中华神经科杂志》2013年第3期172-175,共4页Chinese Journal of Neurology

摘　　要：目的对比分析急性期进展性和无进展性孤立单侧脑桥梗死患者的病因、影像学和临床表现，并探讨累及脑桥表面的梗死与进展性运动障碍的关系。方法回顾性分析经磁共振成像证实的新发孤立单侧脑桥梗死患者58例，其中31例入院1周内完成头、颈部CT血管造影成像。根据卒中发生后5d内动态的美国国立卫生研究院卒中评分（NIHSS）情况，58例患者分为两组。组1：有进展性运动障碍（23例）；组2：无进展性运动障碍（35例）。比较两组的危险因素、神经功能缺损程度、临床表现、梗死灶分布以及大小和形态、基底动脉病变情况。结果组1和组2主要病因均为基底动脉分支病变。组1[21／23（91．3％）]中病灶累及脑桥腹侧表面的比例高于组2[20／35（57．1％），Х^2=7．817，P=0．005]。组1患者平均入院时NIHSS评分（6．7±2．9）高于组2（4．5±2．4，t=3．121，P=0．003）。组1患者卒中发生1个月时的平均改良Rankin量表（mRS）评分[（2．2±1．1）分]高于组2[（1．5±0．8）分，t=2．909，P=0．004]。经Logistic回归分析发现，累及脑桥表面的梗死与进展性运动障碍的发生呈正相关（OR=9．670，95％CI1．171—79．856，P=0．035）。结论进展性孤立单侧脑桥梗死的病因主要为基底动脉分支病，其初始症状较无进展的孤立单侧脑桥梗死重，前者短期残障程度也较高，累及脑桥表面的梗死可作为进展性卒中的预测指标。Objective To analyze the causes, neuroimaging and clinical manifestations of isolated unilateral pontine infarction and to discuss its relationship to progressive motor deficit （PMD）. Methods All 58 patients with isolated acute unilateral pontine infarction confirmed by magnetic resonance imaging （MRI） were recruited in this study for retrospective review. Thirty-one patients of them had brain and neck multi-slice spiral CT angiography（CTA） within 1 week after admission. PMD severity was accessed using the dynamic National Institutes of Health Stroke Scale （ NIHSS ） within 5 days after onset. All 58 patients were divided into two groups ： patients with PMD （ 23 cases ） in group 1 and patients without PMD （ 35 cases ） in group 2. Two groups were compared for the risk factors, initial NIHSS scores, modified Rankin Scale （mRS） scores at 1 month after onset, clinical manifestations, infarction distribution, size and morphology of infarctions and basilar artery lesions. Results The major cause was pathologic changes in basilar artery branch in both groups（6/12 in group 1 and 10/19 in group 2）. The proportion of patients with infarction extending to the pontine surface in group 1 was higher than that in group 2 （21/23, 91.3% vs 20/35, 57.1%, Х^2 =7. 817, P =0. 005）. Initial NIHSS score in group 1 was higher than that in group 2（6.7 ±2. 9 vs 4. 5 ±2.4, t = 3. 121 ,P = 0. 003 ）. mRS score at 1 month after onset in group 1 was higher than that in group 2 （ 2. 2 ±1.1 vs 1.5 ±0. 8, t = 2. 909, P = 0. 004 ）. The Logistic regression analysis showed that isolated unilateral pontine infarction extending to the pontine surface was positively related to PMD （odds ratio 9. 670, 95% confidence interval 1. 171-79. 856, P = 0. 035 ）. Conclusions Progressive isolated unilateral pontine infarction is mostly caused by pathologic changes in basilar artery branch. Patients with PMD have a more severe initial clinical manifest and they have a worse short-term prognosis than patients wi

关 键 词：脑梗死 脑桥 运动障碍 椎底动脉供血不足 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]