MRI显示的共轭性眼偏斜与表现为孤立性急性前庭综合征的后循环缺血性卒中  

Conjugate eye deviation on MRI and posterior circulation ischemic stroke presenting as isolated acute vestibular syndrome

作　　者：乔晓红 丛艳彬[1] 张栩[1] 郑福浩 Qiao Xiaohong;Cong Yanbin;Zhang Xu;Zheng Fuhao(Department of Neurology,Weihai Central Hospital Afiliated to Qingdao University,Weihai 264400,China;Department of Neurointervention,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China)

机构地区：[1]青岛大学附属威海市中心医院神经内科,威海264400 [2]青岛大学附属威海市中心医院神经介入内科,威海264400

出　　处：《国际脑血管病杂志》2024年第11期832-838,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨MRI显示的共轭性眼偏斜在表现为孤立性急性前庭综合征(acute vestibular syndrome,AVS)的后循环缺血性卒中(posterior circulation ischemic stroke,PCIS)患者中的分布特点及其与梗死病灶的关系。方法:回顾性连续纳入2022年1月至2024年6月期间青岛大学附属威海市中心医院收治的表现为孤立性AVS的PCIS患者。在入院3 d内通过MRI检测梗死分布以及眼偏斜现象。如果观察到双眼水平朝向同侧的注视偏斜现象,则定义为放射学共轭眼偏斜(radiological conjugate eye deviation,RCED);如果一只眼偏斜而另一只眼无偏斜,则定义为放射学非共轭眼偏斜(radiological disconjugate eye deviation,RDED)。应用多变量logistic回归分析确定RCED的独立影响因素。结果:共纳入82例表现为孤立性AVS的PCIS患者,其中男性61例(74.4%),年龄(66.20±12.50)岁。小脑梗死72例(87.8%),延髓梗死9例(11.0%),脑桥尾侧梗死2例(2.4%),1例同时存在小脑和延髓梗死。MRI显示RCED 42例(51.2%),RDED 22例(26.8%),无偏斜18例(22.0%)。在42例RCED患者中,小脑梗死32例,占所有小脑梗死患者的44.4%;脑桥尾侧梗死2例,延髓梗死9例。22例RDED患者均为小脑梗死。单变量分析显示,RCED组年龄以及病灶累及小脑半球和延髓梗死的患者构成比与非RCED组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,病灶累及小脑半球是RCED的独立影响因素(优势比0.169,95%置信区间0.033~0.876;P=0.034)。结论:在表现为孤立性AVS的PCIS患者中,小脑梗死最为常见。延髓和脑桥梗死患者均表现为RCED,而小脑梗死患者的RCED发生率为44.4%。RDED仅见于小脑梗死患者。与RCED相比,RDED在梗死灶累及小脑半球的患者中更为常见。Objective:To investigate the distribution characteristics of conjugate eye deviation on MRI in patients with posterior circulation ischemic stroke(PCIS)presenting as isolated acute vestibular syndrome(AVS),and its relationship with infarct lesions.Methods:Patients with PCIS presenting as isolated AVS admitted to Weihai Central Hospital Affiliated to Qingdao University from January 2022 to June 2024 were included retrospectively.The infarct distribution and eye deviation were detected by MRI within 3 days of admission.If the gaze deviation of both eyes horizontally towards the same side is observed,it was defined as radiological conjugate eye deviation(RCED);if one eye was deviated while the other eye was not;it was defined as radiological non-conjugate eye deviation(RDED).Multivariate logistic regression analysis was to determine the independent influencing factors of RCED.Results:A total of 82 patients with PCIS presenting with isolated AVS were included.Among them,there were 61 males(74.4%),mean aged 66.20±12.50(range,31-91)years.Seventy-two patients(87.8%)had cerebellar infarction,9(11.0%)had medullary infarction,2(2.4%)had caudal pontine infarction,1 had both cerebellar and medullary infarction.MRI revealed RCED in 42 cases(51.2%),RDED in 22 cases(26.8%),and no deviation in 18 cases(22.0%).Of the 42 patients with RCED,32 had cerebellar infarction,accounting for 44.4%of all patients with cerebellar infarction;there were 2 patients with caudal pontine infarction and 9 with medullary infarction.All 22 patients with RDED had cerebellar infarction.Univariate analysis showed that there was significant difference between the RCED group and the non-RCED group in age and the proportion of patients with lesions involving the cerebellar hemisphere and medullary infarction(all P<0.05).Multivariate logistic regression analysis showed that the lesion involvement in the cerebellar hemisphere was an independent influencing factor for RCED(odds ratio 0.169,95%confidence interval 0.033-0.876;P=0.034).Conclusions:Cerebellar in

关 键 词：缺血性卒中 椎底动脉供血不足 前庭疾病 眼球运动 小脑疾病 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]