Percheron动脉闭塞致中线旁双侧丘脑梗死11例临床特点及影像学分析  

Bilateral paramedian thalamic infarction induced by occlusion of artery of percheron:Clinical and imaging characteristics of 11 cases

作　　者：康健捷 刘雁 项薇 吴志军 王显悦 张本 邓兵梅 KANG Jianjie;LIU Yan;XIANG Wei;WU Zhijun;WANG Xianyue;ZHANG Ben;DENG Bingmei(Department of Neurology,Southern Theater General Hospital of PLA,Guangzhou 510010,Guangdong Province,China;Department of Neurology,Qianhai Life Insurance Guangzhou General Hospital,Guangzhou 511325,Guangdong Province,China;Department of Neurology,FoGang People's Hospital,Qingyuan 511699,Guangdong Province,China;Department of Cardiac Surgery,Southern Theater General Hospital of PLA,Guangzhou 510010,Guangdong Province,China)

机构地区：[1]南部战区总医院神经内科,广东广州510010 [2]前海人寿广州总医院神经内科,广东广州511325 [3]清远市佛冈县人民医院神经内科,广东清远511699 [4]南部战区总医院心脏外科,广东广州510010

出　　处：《解放军医学院学报》2023年第8期845-850,867,共7页Academic Journal of Chinese PLA Medical School

基　　金：广州市科技计划项目(202102080514)。

摘　　要：背景 Percheron动脉(artery of percheron,AOP)闭塞所致的中线旁双侧丘脑梗死临床罕见,早期诊断困难,病因学构成及长期预后的分析研究极少。目的 分析Percheron动脉闭塞所致中线旁双侧丘脑梗死的临床表现和影像学特点,提高对该病的认识和诊治水平。方法 回顾性分析2009年3月-2021年8月南部战区总医院11例AOP梗死的住院患者临床表现、影像学特点、病因、治疗及预后,其中包括1例少见的急性期静脉溶栓治疗患者。结果 11例患者,男性5例,女性6例,年龄2~87岁。均急性起病,首发症状表现为突发意识障碍9例、肢体抽搐和精神行为异常1例、记忆力下降1例。临床症状还包括淡漠少语、记忆力下降(7/11),肢体肌力轻度下降(7/11),眼球上下视受限(5/11)。10例患者颅脑MRI显示双侧丘脑旁正中长T1长T2信号,弥散加权成像(diffusion weighted imaging,DWI)呈高信号;1例颅脑CT显示双侧丘脑旁正中蝶形低密度影;8例患者合并中脑导水管周围部分灰质梗死,其中5例为“V”形梗死灶。病因包括心源性栓塞(4/11)、动脉粥样硬化(3/11)、不明原因(4/11)。11例均接受抗血小板聚集或抗凝、降血脂、脑保护以及改善脑循环治疗;其中1例接受了尿激酶溶栓治疗,未遗留后遗症。9例以意识障碍起病的患者中,8例神志转为清醒,1例死于肺部感染。治疗后临床症状均有所改善,随访3个月~13年,部分患者遗留记忆力障碍。结论 AOP梗死以脑卒中样形式起病,有典型的突发意识障碍、认知功能障碍及垂直凝视障碍等临床表现,MRI显示双侧丘脑旁正中长T1长T2信号,Flair高信号,可有中脑病变;早期诊断及治疗,尤其是溶栓治疗,对改善预后至关重要。Background Bilateral paramedian thalamic infarction due to occlusion of the artery of percheron(AOP)is rare in clinical practice,and it is difficult to make early diagnosis.There are few studies on the etiology and the long-term prognosis of this disease.Objective To analyze the clinical manifestations and imaging characteristics of bilateral paramedian thalamic infarction induced by occlusion of AOP,so as to improve the understanding of the disease and diagnosis capabilities.Methods From March 2009 to August 2021,the clinical features,imagines,etiology,treatment and prognosis of 11 cases who were admitted to Southern Theater General Hospital of PLA were analyzed.Among them,there was one case who received intravenous thrombolytic therapy.Results There were 5 male patients and 6 female patients,aged 2-87 years.All the 11 cases had acute onset,9 cases had sudden disturbance of consciousness,1 case had seizures and gibberish,and 1 case had memory loss.Reticent and impairment of memory occurred in 7 cases,slight decrease in limb muscle strength in 7 cases,and limited upper and lower movement of eyeball in 5 cases.The brain MRI of 10 patients showed hypointensity T1W1 and hyperintensity T1W2 signals in the median of bilateral thalamus,and the diffusion weighted imaging(DWI)showed hyperintensity.The brain CT of 1 case showed phialiform low density shadow in the paramedian of bilateral thalamus. Eight patients were complicated with partial periaqueductal gray matter infarction in the midbrain,5 of which were V-shaped infarction. There were 4 cases of cardiogenic embolism, 3 cases of atherosclerosis and 4 cases ofunknown cause. All patients were treated with antiplatelet aggregation or anticoagulation, lowering blood lipids, brain protection andimproving cerebral circulation, of which 1 case received urokinase thrombolytic therapy, without any sequelae. Of the 9 cases withonset of consciousness disorder, except 1 case died of pulmonary infection, 8 cases had improved clinical symptoms. The clinicalsymptoms were improved

关 键 词：Percheron动脉 双侧丘脑梗死 缺血性脑卒中 磁共振 

分 类 号：R743.3[医药卫生—神经病学与精神病学]