以急性眩晕为主要表现的小脑下后动脉小脑支梗死三例临床及影像学分析

Clinical and imaging analysis of three cases of cerebellar branch infarction of posterior inferior cerebellar artery with acute vertigo

目的探讨以急性眩晕为主要表现的小脑下后动脉(posterior inferior cerebellar artery,PICA)小脑支梗死3例患者的临床表现及影像学特点。方法收集2013年11月至2017年9月解放军总医院第三医学中心疑似前庭神经炎等急性外周性前庭疾病收入耳鼻咽喉科眩晕病房的3例PICA小脑支梗死患者的临床资料,分析发病时的主要症状、体征、既往病史、家族史、神经系统检查阳性体征、前庭功能检查、影像学特征、治疗及预后等。结果3例PICA小脑支梗死患者均以急性持续性眩晕、伴恶心呕吐、行走不稳起病。神经系统查体发现眼球震颤3例,站立不稳或侧倾3例,患侧肢体共济失调1例,龙贝格征(Romberg sign)阳性3例。头颅MRI可见小脑下蚓部及底部小脑半球(内侧区为主)的急性梗死灶3例,其中1例梗死灶波及延髓后部。3例患者均按照急性脑梗死治疗,其中1例行血管内治疗,预后良好。结论PICA小脑支梗死极易误诊为前庭神经炎等外周性前庭疾病。对于急性眩晕患者一定要仔细检查相关体征,必要时行头颅MRI以明确诊断,血管影像学检查可以避免因夹层动脉瘤或血管畸形破裂出血而危及生命。

Objective To explore the clinical and imaging characteristic of three cases of cerebellar branch infarction of posterior inferior cerebellar artery(PICA)with acute vertigo.Methods Clinical data of three patients with PICA cerebellar branch infarction who were suspected as vestibular neuritis and admitted to the Department of Otolaryngology in the Third Medical Center of PLA General Hospital was collected from November 2013 to September 2017.The main symptoms and signs,medical history,family history,positive signs of nervous system examination,vestibular function examination,imaging features,treatment and prognosis of the patients were analyzed.Results All three patients suffered from infarction in cerebellar branch of PICA had acute persistent vertigo with nausea and vomiting,associated with unsteadily walking.Neurological examination results showed nystagmus in three cases,axial lateropulsion in three cases,ataxia in limb in one case and positive Romberg sign in three cases.MRI showed acute infarction in the inferior cerebellar vermis and the basal cerebellar hemisphere(mainly in medial raphe area)in three cases,of which one case affected the posterior medulla infarction oblongata.The three patients were all treated with acute cerebral infarction therapy,and one patient underwent endovascular therapy.The prognosis was good.Conclusions The infarction in the cerebellum territory of PICA is easily misdiagnosed with peripheral vertigo such as vestibular neuronitis.For the patients with acute vertigo,the examination of the associated signs should be concerned,and the cranial MRI should be performed to make a definite diagnosis if necessary.Angiographic examination can avoid life-threatening bleeding caused by dissecting aneurysm or vascular malformation.