小脑分水岭梗死患者临床及影像学特点分析

摘要

目的：分析小脑分水岭梗死患者的临床特点及影像学特征。方法收集房山区第一医院神经内科2011‐09－2014‐12住院的小脑梗死患者147例，均行头颅M RI、椎动脉彩超、经颅多普勒（T CD ）、颅内动脉核磁血管造影（MRA）检查，必要时进行计算机断层摄影血管造影（CTA）和／或数字减影血管造影（DSA）检查。根据小脑梗死部位将患者分为小脑区域性梗死组和小脑分水岭梗死组，比较两组患者的危险因素、临床及影像学特点。结果（1）小脑区域性脑梗死109例，小脑分水岭梗死38例（25.9％），两组在年龄、性别构成以及合并高血压、糖尿病、高脂血症、吸烟及心房纤颤比例比较无统计学差异。（2）与区域性脑梗死比较，小脑分水岭脑梗死组失水状态、晕厥等前驱症状发生率较高（21.1％比9.2％，P＝0.026），后循环多发病灶发生率较低（21.1％比38.5％，P＝0.002），NHISS评分低（2.7±1.9比6.1±2.5，P＝0.000）。（3）两组小脑梗死患者发生后循环大血管病变比例无统计学差异（52.6％比36.7％，P＝0.085）；分析非心源性脑梗死病例发现，分水岭梗死存在大动脉狭窄几率高于区域性脑梗死（47.4％比30.2％，P＝0.002）。结论小脑分水岭梗死与区域性脑梗死相比危险因素相同，病因略有不同。分水岭梗死患者临床症状轻，但前驱症状发生率高。%Objective To analyze the clinical and imaging features of patients with cerebellar watershed infarction .Methods One hundred and forty‐seven inpatients of the neurology department in the first hospital of Fangshan District with cerebellar infarction were collected from September 2010 to December 2014 .They were evaluated by MRI , transcranial Doppler (TCD ) , vertebral artery color Doppler , Magnetic Resonance angiography (MRA) ,and CTA or DSA were examined if necessary .According to the infarction lesions ,patients were divided into the cerebellar territory infarction group and cerebellar watershed infarction group .The risk factors ,clinical and imaging features were compared between the two groups .Results (1) There were 109 cases with cerebellar territory infarction and 38 cases with cerebellar watershed infarction (25.9% ) .There were no statistical differences between the two groups in age ,gender ,hypertension ,diabetes mellitus ,dyslipidemia , smoking and atrial fibrillation .(2) In the cerebellar watershed infarction group ,there was a higher incidence of general hypoperfusion/dehydration and syncope (21.1% vs. 9.2% , P=0.026) ,lower NIHSS score (2.7 ± 1.9 vs. 6.1 ± 2.5 , P= 0.000) and lower frequency of multiple lesions (21.1% vs.38.5% , P= 0.002) than the territory infarction group .(3) There was no significant difference between two groups of patients with posterior circulation diseases (52.6% vs. 36.7% , P= 0.085) ,but in non‐cardiac stroke ,a higher incidence of artery stenosis in the watershed infarction group was found (47.4% vs.30.2% , P= 0.002) .Conclusions The risk factors are similar ,but the etiologies are different between the two groups .The clinical symptoms of the patients with watershed infarction are milder ,but the incidence rate of the precursory symptoms is higher than those of the patients with cerebellar territory infarction .