孤立中脑梗死患者的临床症状及病因分型

摘要

Objective To investigate the clinical manifestations,imaging features,and etiological classification in patients with isolated midbrain infarction. Methods From December 2013 to January 2017,40 consecutive patients with isolated midbrain infarction admitted to the Department of Neurology, General Hospital of Shenyang Military Command were enrolled retrospectively. The general data,clinical and imaging data of the patients were analyzed retrospectively. According to the vascular control range and MRI characteristics,the midbrain infarcts were divided into anteromedial,anterolateral,lateral and dorsal infarcts . The differences of baseline data,clinical manifestation and etiological typing of various types of patients were analyzed. Results In the 40 patients,23 were anteriomedial infarction,14 were anterolateral infarction, 1 was lateral infarction,and 2 were mixed location infarction,0 was dorsal infarction. The common signs were dysarthria in 23 cases (57. 5%),limb and／or gait ataxia in 18 cases (45. 0%),oculomotor disturbances and／or ptosis in 15 cases (37. 5%),and limb movement disorders in 14 cases (35. 0%). The differences were statistically significant in central facial paralysis and／or lingual paralysis (3／23 vs. 8／17 ),oculomotor disturbances (15／23 vs. 0 ),and etiological types between the patients with anterior medial infarction and those infarction at other sites (all P＜0. 05). Of the 40 patients,38 had a short-term good prognosis (95. 0%)and 2 had poor prognosis (5. 0%). Conclusions Isolated midbrain infarcts mainly manifested as dysarthria,ataxia,and oculomotor disturbances. Oculomotor disturbances occurred in anteromedial infarction. The common causes of anteromedial infarction are large atherosclerosis and small vascular lesions,while the cause of infarction in other sites is often large atherosclerosis.%目的 探讨孤立中脑梗死患者的临床表现、影像学特点及病因分型.方法 连续回顾性纳入2013年12月至2017年1月间沈阳军区总医院收治的40例孤立中脑梗死患者,并对患者的一般资料及临床、影像资料进行回顾性分析.根据动脉供血范围及MRI影像学特点,将中脑梗死分为前内侧、前外侧、外侧及背侧梗死,分析各型患者的基线资料、临床表现、病因分型等的差异.结果 40例患者中,前内侧区梗死患者23例,前外侧区14例,外侧区1例,混合部位梗死2例.常见体征为构音障碍23例(57. 5%),肢体和(或)步态共济失调18例(45. 0%),眼球活动障碍和(或)上睑下垂15例(37. 5%),肢体运动障碍14例(35. 0%).前内侧区梗死患者与其他部位梗死患者中枢性面(或)舌瘫(3／23比8／17)、眼球活动障碍(15／23比0)及病因分型差异均有统计学意义(均P＜0. 05).40例患者中,短期预后良好38例(95. 0%),预后不良2例(5. 0%).结论 孤立中脑梗死主要表现为构音障碍、共济失调及眼球活动障碍.眼球活动障碍发生于前内侧区梗死.前内侧区梗死常见病因为大动脉粥样硬化、小血管病变,而其他部位梗死病因常为大动脉粥样硬化.