双侧小脑梗死模式的探讨

摘要

Objective To evaluate the lesion patterns and stroke mechanism in patients with acute bilateral cerebellar infarcts .Methods Patients who were admitted at Xiangyang hospital over a 2-year period with acute cerebellar infarcts , proven by diffusion-weighted imaging , were studied .Cerebellar infarcts were topographically classified and divided into 2 groups:unilateral cerebellar infarct ( UCI) and bilateral cerebellar infarcts ( BCI ) .The demographics , involved territories , concomitant lesions outside the cerebellum (CLOC), and mechanisms were analyzed.Results Among 56 patients with acute cerebellar infarcts, 35.7%( n=20) were BCI.Baseline demographics were not significantly different between UCI and BCI , except for previous stroke (P=0.002), fibrinogen (P=0.036) and NIH Stroke Scale (P=0.001).Posterior inferior cerebellar artery ( PICA) infarcts were the most common in UCI ( P=0.006) , whereas PICA+superior cerebellar artery( SCA) infarcts were significantly higher in BCI ( P=0.004) .80%of patients with BCI infarcts had concomitant lesions outside the cerebellum (CLOC)(P=0.002), which were primarily restricted to the brainstem (P=0.022). Large-artery atherosclerosis was significantly higher in BCI ( P=0.041) , vertebral V 4 were the commonest artery stenosis sites followed by vertebrobasilar junction.Conclusions BCI was involved frequently in the PICA+SCA territory .Our results supports the fact that embolism resulted from large-artery atherosclerosis is the important stroke mechanism in the BCI .%目的：探寻双侧小脑梗死的模式和机制。方法经MRI弥散成像（ DWI）证实急性期小脑梗死的患者，根据梗死灶的分布将患者分为单侧小脑梗死组（ UCI ）和双侧小脑梗死组（ BCI ），并对两组的人口学特征、血管分布、小脑以外梗死灶以及病因进行了比较。结果因急性卒中入院的115例后循环脑梗死患者中，56例为小脑梗死或小脑合并其它部位梗死，其中单侧小脑梗死36例（64．3％），双侧小脑梗死20例（35．7％）。基线资料比较显示，脑卒中史（P＝0．002）、纤维蛋白元水平（P＝0．036）和入院时 NIHSS 评分（P＝0．001）在双侧小脑梗死组明显高于单侧小脑梗死组。按血管分布区划分，小脑后下动脉（PICA）供血区小脑梗死发生率最高，且更多发生单侧小脑梗死（ P＝0．006）；而双侧小脑梗死更常见于PICA＋小脑上动脉（SCA）供血区（P＝0．004）。双侧小脑梗死组合并小脑以外梗死灶的发生率明显高于单侧小脑梗死组（ P＝0．002），特别是合并幕下梗死灶常见（ P＝0．022）。在卒中机制上，双侧小脑梗死以大动脉粥样硬化性病变更多见（P＝0．041），责任动脉病变主要是在椎动脉V4段、V4段与BA接合处的重度狭窄或闭塞。结论双侧小脑梗死并不少见，常见于PICA＋SCA供血区；大动脉粥样硬化所致动脉源性栓塞是其卒中重要机制之一。