脑干腹侧中线旁对称性脑梗死的临床及影像学分析

摘要

Objective To study the clinical and imaging characteristics of bilateral ischemic stroke on ventral median line of brain stem.Methods The clinical and imaging data of 11 patients with ischemic stroke on ventral median line of brain stem were retrospectively analyzed.The clinical data of 7 isolated brain stem ischemic stroke patients and 4 posterior circulation ischemic stroke patients,6 elderly and 5 middle-aged and young ischemic stroke patients were compared.Results The patients were mainly manifested as acute onset of disease,disorder of consciousness,disorder of eye movement,and quadriplegia.Of the 11 patients included in this study,1 was diagnosed with ischemic stroke in medulla,1 with ischemic stroke in pontomedullary junction,3 with ischemic stroke in pons,4 with ischemic stroke both in pons and midbrain,2 with ischemic stroke in midbrain.Of the 11 patients included in this study,3 died,3 had persistent disorder of consciousness,and 5 were improved.The history of hyperlipidemia and smoking was significantly longer,the NIHSS score on admission and the rate of poor outcome were significantly higher in isolated brain stem ischemic stroke patients with posterior circulation ischemic stroke (P＜0.05,P＜0.01).The rate of disorder of consciousness,lung infection,poor coutcome was significantly higher in elderly ischemic stroke patients than in middle-aged and young ischemic stroke patients (P＜0.05,P＜0.01).Conclusion Bilateral ischemic stroke on ventral median line of brain stem is a special type of vertebrobasilar infarction.Its most common cause is basilar artery perforater occlusion.Its clinical symptoms are complicated and various.The outcome is poorer in elderly ischemic stroke patients than in middle-aged and young ischemic stroke patients.%目的 探讨脑干腹侧部中线旁对称性脑梗死综合征的临床特点.方法 对11例脑干腹侧部中线旁对称性脑梗死患者的临床资料及影像学检查进行回顾性分析.比较7例孤立性脑干病灶与4例合并后循环其他部位病灶患者,6例老年与5例中青年患者的临床资料.结果 患者均为急性起病,以不同程度的意识障碍、眼球运动障碍及四肢瘫痪为主要特点;病灶累及延髓1例,延髓脑桥交界区1例,单纯累及脑桥3例,同时累及中脑和脑桥4例,单纯累及中脑2例;3例死亡,3例持续性意识障碍,5例好转.孤立性脑干病灶与后循环多发病灶患者高脂血症、吸烟史和出院改良的Rankin量表≥4分比较,差异有统计学意义(P＜0.05,P＜0.01);老年患者意识障碍、合并肺感染、死亡或未愈比例较中青年患者高(P＜0.05,P＜0.01).结论 脑干腹侧部中线旁对称性脑梗死是椎基底动脉梗死的一种特殊类型,常见病因为椎基底动脉穿支闭塞,临床症状复杂多样,老年患者预后更差.