不同疾病伴发的小脑中脚病变的临床与影像学分析  

Clinical and imaging analysis of middle cerebellar peduncle lesions associated with different diseases

作　　者：周晓影 付胜奇[2] 张津 任雅芳[2] 宋良 张淑玲[2] ZHOU Xiaoying;FU Shengqi;ZHANG Jin(Department of Neurology,Zhengzou People’s Hospital,Xinxiang Medical University,Zhengzhou 450003,China)

机构地区：[1]新乡医学院附属郑州人民医院神经内科,河南郑州450003 [2]郑州人民医院神经内科,河南中医药大学第五临床医学院神经内科,河南郑州450003

出　　处：《中风与神经疾病杂志》2022年第4期328-332,共5页Journal of Apoplexy and Nervous Diseases

基　　金：河南省医学科技攻关省部共建项目(SB201903029);河南省医学科技攻关项目(LHGJ20200683)。

摘　　要：目的探讨不同疾病导致小脑中脚病变的病因、临床表现和神经影像学特征。方法回顾性分析2016年5月-2021年10月就诊我院的9例小脑中脚病变患者一般临床资料,分析不同疾病的临床表现及影像学特点。结果9例患者小脑中脚均可见异常信号影,其中:例1:言语不清、左侧肢体无力3 m,头晕、行走不稳10 d,既往有脑桥梗死,诊断为华勒变性;例2:脑桥出血后头晕、行走不稳1 y,诊断为桥脑出血并桥臂华勒变性;例3:头晕、行走不稳1 y,加重3 m,诊断为多系统萎缩;例4:记忆力减退2 m,加重10 d,既往患有类风湿性关节炎,诊断为狼疮性脑病;例5:发作性四肢抽搐、意识丧失3 d,既往患有慢性肾功能不全,诊断为肾性脑病;例6:左下肢无力4 m,头晕、言语不利2 d,诊断为视神经脊髓炎谱系疾病;例7:头晕、行走不稳15 d,HIV阳性,诊断为HIV脑病;例8:双手持物笨拙4 y,不自主抖动2 d,诊断为肝豆状核变性;例9:头晕、行走不稳3 m,既往有霍奇金淋巴瘤病史,诊断为霍奇金淋巴瘤合并中枢神经系统损害。结论小脑中脚病变病因复杂,应根据病史、临床表现、影像学表现、实验室检查综合分析,以减少临床误诊、漏诊。Objective To investigate the etiology,clinical manifestations and neuroimaging features of the lesions of the middle cerebellar foot caused by different diseases.Methods The general clinical data of 9 patients with bilateral middle cerebellar peduncle lesions admitted to our hospital from May 2016 to October 2021 were retrospectively analyzed,and the clinical manifestations and imaging characteristics of different diseases were analyzed.Results Abnormal lesions were seen in 9 patients with middle cerebellar feet,including case 1:Speech slurred,left limb weakness for 3 months,dizziness,walking instability for 10 days previous pontine infarction,diagnosed as Walle’s degeneration.Case 2:Dizziness and unstable walking for 1 year after pontine hemorrhage,diagnosed as pontine hemorrhage and Waller’s degeneration of the bridge arm.Case 3:Presented with dizziness and walking instability for 2 years and was diagnosed with mu-ltiple system atrophy.Case 4:Memory loss for 2 months,aggravation for 10 days,previous rheumatoid arthritis,diagnosed as lupus encephalopathy.Case 5:Seizures of limbs,loss of consciousness for 3 days,chronic renal insufficiency in the past,diagnosed as renal encephalopathy.Case 6:Left lower limb weakness for 4 months,dizziness,seppch impairment for 2 days,diagnosed as neuromyelitis optic specturum disease.Case 7:Dizziness,walking instability for 15 days,HIV positive,diagnosed as HIV encephalopathy.Case 8:Clumsy handholding for 4 years,involuntary shaking for 2 days,diagnosis of Wilsonl’s disease.Case 9:Dizziness,unstable walking for 3 months,previous history of Hodgkin’s lymphoma,diagnosed as Hodgkin’s lymphoma with central nervous system damage.Conclusion The etiology of the lesions of middle cerebellar foot is complex,attentions are needed in order to reduce clinical misdiagnosis and missed diagnosis.

关 键 词：小脑中脚病变 临床表现 影像学表现 

分 类 号：R742.8[医药卫生—神经病学与精神病学]