孤立性脑桥梗死继发双侧小脑中脚华勒变性的临床及影像学特征  

Clinical and imaging features of bilateral Wallerian degeneration of the middle cerebellar peduncles secondary to isolated pontine infarction

作　　者：徐辉[1] 姚燕雯 白宏英[1] Xu Hui;Yao Yanwen;Bai Hongying(Department of Neurology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014 China)

机构地区：[1]郑州大学第二附属医院神经内科,郑州450014

出　　处：《国际脑血管病杂志》2022年第10期745-751,共7页International Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划项目(LHGJ20190314)。

摘　　要：目的探讨孤立性脑桥梗死继发双侧小脑中脚华勒变性的临床和影像学特征。方法回顾性纳入2017年6月至2021年12月郑州大学第二附属医院收治的诊断为孤立性脑桥梗死后双侧小脑中脚华勒变性患者,并通过检索中英文数据库收集在2001年1月至2021年12月期间报道的孤立性脑桥梗死后双侧小脑中脚华勒变性患者,总结其临床及影像学特征。结果共纳入孤立性脑桥梗死后双侧小脑中脚华勒变性患者48例,其中郑州大学第二附属医院收治的患者14例,通过检索中英文数据库收集34例。男性33例(68.75%),女性15例(31.25%),年龄(65.8±10.7)岁(范围37~88岁)。大多数患者有血管危险因素,以高血压最为常见。入院时以构音障碍和肢体无力为主要临床症状。全部48例患者的梗死部位均位于脑桥旁正中动脉供血区,其中单侧37例(77.08%)(左侧18例,右侧19例),双侧6例(12.50%),5例(10.42%)资料不全。诊断华勒变性时,8例(16.67%)出现头晕或共济失调,6例(12.50%)原有症状加重,其余34例(70.83%)无新发症状或原有症状加重。所有患者双侧小脑中脚均呈对称性异常信号,以T2或弥散加权成像(diffusion-weighted imaging,DWI)高信号明显。1例患者在梗死发病次日即出现双侧小脑中脚T2高信号,这是目前孤立性脑桥梗死后出现继发华勒变性发现时间最早的病例。结论孤立性脑桥梗死后出现双侧小脑中脚对称性病变时,应考虑到华勒变性的可能。华勒变性可在孤立性脑桥梗死后早期出现,大多数病例无新发症状或原有症状加重,常规MRI可早期识别。Objective To investigate the clinical and imaging features of bilateral Wallerian degeneration of the middle cerebellar peduncles secondary to isolated pontine infarction.Methods Patients diagnosed as bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction admitted to the Second Affiliated Hospital of Zhengzhou University from June 2017 to December 2021 were retrospectively included.Patients with bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction reported between January 2001 and December 2021 were collected by searching Chinese and English databases,and their clinical and imaging characteristics were summarized.Results A total of 48 patients with bilateral Wallerian degeneration of cerebellar middle peduncle after isolated pontine infarction were included,including 14 patients admitted to the Second Affiliated Hospital of Zhengzhou University,and 34 patients collected by searching the Chinese and English databases.Thirty-three patients were males(68.75%)and 15 were females(31.25%).Their age was 65.8±10.7 years old(range,37-88 years).Most patients had vascular risk factors,and hypertension was the most common.Dysarthria and limb weakness were the main clinical symptoms at admission.The infarct sites of all 48 patients were located in the blood supply area of paramedian pontine arteries,of which 37(77.08%)were unilateral(18 on the left and 19 on the right),6(12.50%)were bilateral sides,and 5(10.42%)had incomplete data.When Wallerian degeneration was diagnosed,8 patients(16.67%)had dizziness or ataxia,6(12.50%)had aggravated original symptoms,and the remaining 34(70.83%)had no new symptoms or aggravated original symptoms.All patients showed symmetrical abnormal signals in bilateral middle cerebellar peduncles,with obvious hyperintensity on T2 or diffusion-weighted imaging(DWI).One patient showed T2 hyperintensity in bilateral middle cerebellar peduncle on the next day after the onset of the infarction,which was the earliest case

关 键 词：脑干梗死 脑桥 WALLER变性 磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]