磁共振弥散加权像阴性的急性后循环脑梗死九例  

Case analysis of posterior circulation infarction with negative diffusion weighted imaging

作　　者：刘荧 刘欣 王红霞 王丽娟 崔世磊[2] Liu Ying;Liu Xin;Wang Hongxia;Wang Lijuan;Cui Shilei(Department of Neurology,the Zhongguancun Hospital,Beijing100190,China)

机构地区：[1]北京市中关村医院神经内科,北京100190 [2]首都医科大学附属北京同仁医院神经内科

出　　处：《脑与神经疾病杂志》2018年第12期739-743,共5页Journal of Brain and Nervous Diseases

摘　　要：目的探讨头颅磁共振弥散加权像(DWI)阴性的急性后循环脑梗死(PCI)患者的临床特征。方法 2015年6月-2017年3月就诊于首都医科大学附属北京同仁医院神经内科和北京市中关村医院神经内科的发病72h内DWI阴性的急性PCI 9例患者,分析其症状、体征及影像学检查特点,进行临床特征分析和病因学分类。结果 DWI阴性的急性PCI 9例,男性4例,女性5例,发病年龄为47～82岁。责任病灶分别位于脑桥(4例)、小脑(3例)、延髓(1例、)和丘脑(1例)。NIHSS评分1.33±1.12(0～3)分,6个月后随访NIHSS评分均值为0.44±0.73(0～2)分,与发病时比较明显好转(P=0.009)。根据急性卒中治疗低分子肝素试验病因分型法(TOAST)的分型标准,小动脉闭塞5例、大动脉粥样硬化4例。结论头颅MRI DWI阴性的急性PCI多为轻型卒中,预后较好。由于DWI在急性PCI早期诊断中存在假阴性,应重视详细的神经系统检查以期早期诊断。Objective To investigate the clinical characteristic of acute posterior circulation cerebral infarction（PCI） with negative diffusion weighted imaging（DWI）. Method9 patients with acute PCI whose DWI within 72 hours of onset were negative presented to neurological department of the Beijing Tongren hospital and Beijing Zhongguancun hospital, from June 2015 to March 2017. Data of clinical presentations, physical sign and imaging were collected, clinical feature analysis and etiology classification were carried out. Results 9（16.1%） patients with acute PCI were DWI negative, there were 4 males and 5 females. The age was （47-82）. The focal lesions were located in pons （4 cases）, cerebellum （3 cases） medulla（1 case） and thalamus （1 case）. The NHISS score was 0.44±0.73（0-2）and 0.44±0.73（0-2）after 6 months follow-up which had the obvious improvement（P=0.009）. According to the classification standard of TOAST in the acute stroke, there were 5 cases of small-vessel occlusion and 4 cases of large-artery atherosclerosis. Conclusion DWI-negative acute PCI are mostly minor stroke and have a relatively good prognosis.Due to the false negative of DWI in early diagnosis of acute PCI, attention should be given to the detailed nervous system examination in order to recognize PCI in the early stage.

关 键 词：磁共振弥散加权像 假阴性 急性后循环脑梗死 

分 类 号：R743.32[医药卫生—神经病学与精神病学]