双侧小脑中脚梗死10例临床特点和病因学初步研究  

Clinical features and stroke etiology in 10 patients with bilateral middle cerebellar peduncle infarctions:a preliminary study

作　　者：姜季委 刘亚欧 龚浠平[1] 王琳琳[1] 李汶逸 邹昕颖[1] 李俊杰[1] 徐俊 Jiang Jiwei;Liu Ya'ou;Gong Xiping;Wang Linlin;Li Wenyi;Zou Xinying;Li Junjie;Xu Jun(Center of Neurology,Beijing Tiantan Hospital,Capital Medical University,China National Clinical Research Center for Neurological Diseases,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,国家神经系统疾病临床医学研究中心,北京100070

出　　处：《中华神经科杂志》2023年第6期654-660,共7页Chinese Journal of Neurology

基　　金：国家重点研发计划(2021YFC2500100,2021YFC2500103);国家自然科学基金(82071187,81870821)。

摘　　要：目的探索双侧小脑中脚梗死的临床和影像学特征、病因和潜在机制,以提高临床认识。方法回顾性连续性收集首都医科大学附属北京天坛医院2020年1月1日至2022年4月30日诊断为急性双侧小脑中脚梗死患者的临床资料,记录其入院时社会人口学数据、脑卒中危险因素、临床症状和体征以及入院时美国国立卫生研究院卒中量表(NIHSS)评分。根据头颅磁共振弥散成像评估其脑梗死的部位和特点,头颅磁共振血管造影或计算机断层血管造影成像评估其椎-基底动脉颅外段和颅内段血管情况。采用中国缺血性卒中病因分型评估脑梗死病因学分型和发病机制。结果本研究共纳入10例双侧小脑中脚急性梗死患者,其中男性8例,女性2例,发病年龄51.0~86.0(64.8±11.4)岁,入院时NIHSS评分为2.0~12.0(4.9±2.9)分。所有患者均有脑卒中危险因素,最常见的是高血压(10例)和脂蛋白代谢异常(8例)。最常见的临床表现为眩晕(10例),其次是共济失调(9例)和构音障碍(8例)。10例中4例为孤立性双侧小脑中脚梗死,6例合并其他椎-基底动脉供血脑区梗死,其中4例为合并小脑半球梗死,与临床症状相一致。所有患者脑梗死病因均为大动脉粥样硬化性,椎动脉V4段和小脑前下动脉狭窄或闭塞为最常见受累血管(9例);5例发病机制为低灌注/微栓子清除障碍,4例为动脉-动脉栓塞,1例载体动脉斑块阻塞穿支。结论双侧小脑中脚梗死是一类以眩晕、共济失调和构音障碍为主要表现的,罕见且呈高度异质性的脑血管病。梗死病因多为椎动脉V4段和小脑前下动脉狭窄或闭塞。因责任血管的解剖变异性,发病机制涉及低灌注/微栓子清除障碍、动脉-动脉栓塞和载体动脉阻塞穿支,也使得梗死部位在影像学上呈现孤立性或合并小脑半球、脑干梗死等多样性。Objective To characterize clinical and neuroimaging features,etiologies,and mechanisms of bilateral middle cerebellar peduncle(MCP)infarctions.Methods Consecutive patients with bilateral MCP infarctions treated in the Beijing Tiantan Hospital,Capital Medical University between January 1,2020 and April 30,2022 were enrolled in this retrospective study.The demographic data,vascular risk factors,clincial manifestations and the National Institutes of Health Stroke Scale(NIHSS)scores were collected.Brain diffusion-weighted imaging was used to assess the regions of cerebral infarction,and the extracranial and intracranial segments of the vertebrobasilar artery were evaluated using magnetic resonance angiography,or computed tomography angiography.The stroke etiology and underlying mechanism were evaluated according to the Chinese Ischemic Stroke Subclassification.Results Ten patients with bilateral MCP infarctions(8 men and 2 women)were analyzed ultimately.The onset age were 51.0-86.0(64.8±11.4)years.NIHSS scores were 2.0-12.0(4.9±2.9)points at admission.All patients had vascular risk factors,most of which were hypertension(10 cases)and dyslipoproteinemia(8 cases).The most common clinical manifestations were vertigo(10 cases),followed by ataxia(9 cases)and dysarthria(8 cases).Four cases were isolated bilateral MCP infarctions,while 6 patients were combined with other vertebrobasilar artery infarctions,4 of which were combined with cerebellar hemisphere infarctions,consistent with the clinical symptoms.The etiology in all patients was large atherosclerosis(severe stenosis or occlusion of V4 segment of vertebral artery and anterior inferior cerebellar artery;9 cases).Five patients were classified as hypoperfusion/impaired emboli clearance,while 4 patients were considered as artery-to-artery embolism,and 1 was considered as the parent artery(plaque or thrombosis)occluding penetrating artery.Conclusions Bilateral MCP infarctions are an extremely rare cerebrovascular disease characterized by vertigo,ataxia,and dysarthria.C

关 键 词：脑梗死 磁共振成像 小脑中脚 病因学 小脑前下动脉 椎动脉 

分 类 号：R743.33[医药卫生—神经病学与精神病学]