孤立性脑桥梗死的临床及头部磁共振特点分析  

Analysis of clinical and MRI features of isolated pontine infarction

作　　者：翟志永[1] 冯娟[1] ZHAI Zhiyong;FENG Juan(Department of Neurology,Sheng Jing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院神经内科,辽宁沈阳110004

出　　处：《中风与神经疾病杂志》2018年第9期787-790,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨孤立性脑桥梗死的头部磁共振特点,并进行临床分析。方法回顾性分析48例临床确诊为脑桥梗死患者的症状、体征及头部磁共振资料,总结分析其临床特点以及与梗死灶分布的关系。结果脑桥前内侧区梗死最为常见(56.3%),其次为前外侧区梗死(14.6%),分水岭梗死(10.4%),侧部(8.3%),混合型梗死(8.3%)及后部梗死(2.1%)。临床表现主要有偏瘫(72.9%)、构音障碍(68.8%)、感觉障碍(68.8%)、共济失调(37.5%)、头晕(22.9%)、复视(18.8%)、外展神经麻痹(16.7%)、双眼凝视(12.5%)、周围性面瘫(12.5%)等。梗死前有反复短暂性脑缺血发作多为脑桥分水岭区梗死。脑桥混合型梗死及分水岭区梗死患者的基底动脉狭窄比例高,双侧脑桥梗死的椎动脉狭窄比例高。结论脑桥梗死以前内侧区梗死最为常见,机制主要为旁正中小动脉闭塞。而脑桥分水岭区梗死常提示基底动脉主干狭窄,混合型梗死多为基底动脉斑块同时堵塞多支穿支动脉开口,双侧脑桥梗死一般为基底动脉或椎动脉斑块脱落所致。而合并有核间性眼肌麻痹、两眼向病灶对侧偏视、病灶侧展神经麻痹及周围性面神经麻痹具有特异性,最能提示梗死部位在脑桥。Objective To investigate the clinical and MR imaging features of isolated pontine infarction,and carry on the clinical analysis to it.Methods Clinical characteristics and MR imaging documents in 48 patients with pontine infarction were analyzed retrospectively.The relation of clinical manifestations of different types of pontine infarction was analyzed further.Results Various anatomical locations of isolated pontine infarction ranged from a frequency from high to low as follows:anteromedial territory(56.3%),anterolateral territory(14.6%),watershed area(10.4%),lateral territory(8.3%),mixed zone(8.3%)and posterior territory(2.1%).The main clinical manifestations were hemiplegic paralysis(72.9%),dysarthria(68.8%),paresthesia(68.8%),ataxia(37.5%),vertigo(22.9%),diplopia disorder(18.8%),abducent paralysis(16.7%),gaze palsy(12.5%)and peripheral facial paralysis(12.5%).Repeated transient ischemic attack before infarction mostly occurred in watershed area of pontine infarction.The incidence of basilar artery sclerosis or stenosis was more higher in patients with pontine infarction in watershed area and mixed zone than other areas.And the incidence of vertebral artery sclerosis or stenosis was more higher in patients with bilateral pontine infarction.Conclusions Pontine infarction was mainly occurred in anteromedial territory by the result of paramedian artery infarction.Watershed area of pontine infarction often indicates basilar artery stenosis.One-sided mixed zone infarction of pons often indicates a basal artery plaque clogging multiple perforating arteries.The plaques of basilar artery or vertebral artery sclerosis are probably one of the main causes of bilateral pontine infarction.If brain symptoms are accompanied by nuclear ophthalmoplegia,abducent paralysis,gaze palsy or peripheral facial paralysis,they often indicate a pontine infarction.

关 键 词：脑梗死 脑桥 基底动脉 磁共振成像 

分 类 号：R743[医药卫生—神经病学与精神病学]