急性桥臂病变的临床特征及病因学分析  

Clinical characteristic and etiological analysis of acute middle cerebellar peduncles lesions

作　　者：王娟[1,2] 张美娇[1] 王剑锋[1] 刘世福[2] WANG Juan;ZHANG Meijiao;WANG Jianfeng(Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院神经内科,辽宁大连116033 [2]黄河三门峡医院神经内科,河南三门峡472000

出　　处：《中风与神经疾病杂志》2022年第7期637-643,共7页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析急性桥臂病变患者的临床表现及诊断,探讨其病因及相关机制,提高对可累及桥臂的相关疾病的认识。方法回顾性分析我院2010年1月至2020年12月期间核磁弥散成像(DWI)存在桥臂高信号的住院患者共82例,总结其临床特征,进一步行病因及相关机制探讨。结果①所有患者均急性起病,以头晕/眩晕为主要症状,共济失调为主要体征,可伴肢体无力或麻木、构音障碍、走路不稳等。②68例为(82.9%)单侧桥臂病变,14例(17.1%)为双侧桥臂病变。③72例(87.8%)诊断为急性脑梗死,7例(8.5%)诊断为华勒氏变性,1例(1.2%)诊断免疫相关中枢神经系统脱髓鞘疾病可能性大,1例(1.2%)诊断原发性中枢神经淋巴瘤可能性大,1例(1.2%)MOG抗体病。④72例急性脑梗死患者中,20例(27.8%)为孤立单侧桥臂梗死,其中11例(55.0%)为大动脉粥样硬化型,5例(25.0%)为小动脉闭塞型,4例(20.0%)为不明原因;45例(62.5%)单侧桥臂合并其他部位梗死,其中33例(73.3%)为大动脉粥样硬化型,4例(8.9%)为心源性栓塞,9例(20.0%)为未明原因型;2例孤立双侧桥臂梗死,5例双侧桥臂合并其他部位梗死,病因均为大动脉粥样硬化型。结论(1)急性桥臂病变临床症状以头晕/眩晕最多见,病因以脑梗死最多见。(2)桥臂梗死多合并其它部位梗死,孤立桥臂梗死及双侧桥臂梗死临床相对少见,病因分型以大动脉粥样硬化型为主,其次为不明原因型、小动脉闭塞型、心源性脑栓塞。(3)华勒氏变性、免疫相关中枢神经系统脱髓鞘疾病、MOG抗体病和中枢神经淋巴瘤也可出现桥臂受累。Objective To analyze the clinical characteristic and diagnosis of patients with acute middle cerebellar peduncles lesions,explore etiology and related mechanism,and improve the cognition of related diseases involving the middle cerebellar peduncles.Methods 82 inpatients with middle cerebellar peduncles high signal on DWI in our hospital were analyzed retrospectively from January 2010 to December 2020.The clinical characteristic and diagnosis were summarized,and the etiology and related mechanism were further discussed.Results①All the patients had acute onset,with dizziness/vertigo as the main symptom and ataxia as the main physical sign,accompanied by limb weakness or numbness,arrhythmia,walking instability,etc.②68 cases(82.9%)had unilateral middle cerebellar peduncles lesions,14 cases(17.1%)had bilateral middle cerebellar peduncles lesions,③72 cases(87.8%)were diagnosed with acute cerebral infarction;7 cases(8.5%)were diagnosed with Wallerian degeneration;1 case(1.2%)had high probability of diagnosis of immune-related demyelinating disease of central nervous system;1 case(1.2%)had high probability of diagnosis of primary lymphoma of the central nervous system and 1 case(1.2%)was diagnosed MOG antibody disease.④Among 72 patients with acute cerebral infarction,20 cases(27.8%)were isolated unilateral middle cerebellar peduncles infarction,11 cases(55.0%)were aortic large large-artery atherosclerosis,5 cases(25.0%)were small-artery occlusion,and 4 cases(20.0%)were undetermined etiology.45 patients(62.5%)had unilateral middle cerebellar peduncles accompanied by infarctions in other sites,of which 33 cases(73.3%)were large-artery atherosclerosis,4 cases(8.9%)were Cardioembolism,and 9 cases(20.0%)were undetermined etiology.The etiology of 2 cases of isolated bilateral middle cerebellar peduncles infarction and 5 cases of bilateral middle cerebellar peduncles combined by infarction in other sites is large-artery atherosclerosis.Conclusion(1)The most common clinical symptom of acute middle cerebellar peduncles le

关 键 词：桥臂 临床特征 病因学 

分 类 号：R742[医药卫生—神经病学与精神病学]