小脑型分水岭梗死的临床表现和影像学特点  

Clinical manifestation and image features of cerebellar watershed infarction

作　　者：李秋菊[1,2] 李淑嫒[3] 赵仁亮[3] 

机构地区：[1]青岛市城阳人民医院神经内科,山东省266109 [2]青岛大学医学院 [3]青岛大学医学院附属医院神经内科

出　　处：《中华脑科疾病与康复杂志（电子版）》2013年第3期15-18,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的分析小脑型分水岭梗死的临床表现和影像学特点,以提高对小脑型分水岭梗死的认识。方法回顾性分析2008年1月至2010年12月青岛大学医学院附属医院神经内科住院患者,66例诊断为小脑梗死,均行颅脑磁共振成像(MRI)和计算机断层摄影血管造影(CTA)检查。根据引起小脑梗死的血管分布将患者分为两组:小脑区域性梗死组50例,小脑型分水岭(非区域性)梗死组16例,对比分析两组患者的危险因素、临床及影像学特点。应用t检验和卡方检验进行统计分析。结果 (1)小脑区域性梗死和小脑型分水岭梗死组在年龄、性别、高血压、糖尿病、高脂血症、吸烟及心房纤颤方面差异无统计学意义。(2)两组小脑梗死最常见的临床表现是眩晕。小脑型分水岭梗死组与小脑区域性梗死组相比,前者短暂的意识丧失较多见(25%vs.2%,χ2=6.167,P=0.013),无体征者较多见(56%vs.4%,χ2=20.212,P=0.000),后者恶心呕吐症状多见(19%vs.52%,χ2=20.417,P=0.041),言语不清症状多见(0%vs.26%,χ2=3.697,P=0.046)。(3)两组小脑梗死患者在大血管病变方面无统计学差异(62%vs.50%,χ2=0.525,P=0.469),提示即使很小的梗死灶也可能存在大血管病变。结论小脑区域性梗死和小脑型分水岭梗死有相同的血管危险因素和病因,其中高血压是最常见的危险因素。小脑梗死临床表现各异。直径≤2 cm的小脑型分水岭梗死可能存在后循环大血管病变,应予积极的治疗和干预。Objective To analyze the clinical manifestation and image features of cerebellar watershed infarction. Methods Data from Neurology Department of the Affiliated Hospital of Medical College,Qingdao University from January 2008 to December 2010 were reviewed, 66 cases were diagnosed cerebellar infarction. All patients received detections of brain magnetic resonance imaging （MRI）and computed tomographic angiography（CTA）. According to the distribution of cerebral arteries, 16 cases were diagnosed with cerebeUar watershed infarcts and 50 cases were diagnosed with cerebellar territorial infarcts. Risk factors, clinical manifestation and image features of them were analyzed, t-test and chi-square test were used as statistic method. Results （ 1 ） There was no significant difference between the two groups in the age, gender, hypertension history, diabetes mellitus history, hyperlipidemia history, smoking history, history of atrial fibrillation. （2） Vertigo was the most frequent symptom in both groups. Transient loss of consciousness occurred more frequently in patients with watershed infarcts （25% vs. 2%, ~2 = 6. 167, P = 0. 013 ）, whereas vomiting, dysarthria occurred more frequently in patients with territorial infarcts. Neurological examination was normal in 56% of patients with watershed infarcts but in 0nly 4% of those with territorial infarcts （ ~2 = 20. 212, P = O. 000）. （3）There was no significant difference between watershed infarct group and territorial infarct group in regard to the presence of large-artery occlusive disease （ 62% vs. 50% , X2 = 0. 525, P = 0. 469）. Conclusions No significant differences were found in regard to etiology, risk factors and large artery disease between patients with cerebellar watershed and territorial infarcts in this study. Hypertension is the most common risk factor. Patients with cerebellar infarction has various clinical manifestations. Cerebellar watershed infarction patients may have large artery disease, thus, they should be treated positivel

关 键 词：脑梗死 小脑 病因 临床特点 

分 类 号：R743.3[医药卫生—神经病学与精神病学]