旁正中动脉入口部梗死82例临床分析

Clinical Analysis of Acute Paramedian Pontine Infarctions Owing to Branch Atheromatous Disease in 82 Cases

目的探讨急性桥脑旁正中动脉入口部梗死(branch atheromatous disease,BAD)的临床特点。方法回顾性分析1997～2003年本院神经内科收治的82例桥脑BAD的临床表现、MRI影像特点、脑干听觉诱发电位(BAEP)表现、危险因素。结果本组病例的临床特点是:平均发病年龄69.2岁,男性/女性=46/36,56/82病情呈进行性发展,75/82有构音障碍,72/82有肢体偏瘫,29/82为高度肢体瘫痪,27/82有轻度意识障碍,6/82伴有不全Homer征,49/82出现面部或(和)偏侧肢体感觉减退,25/82出现周围性面瘫,42/82有非旋转性头晕;13/82有眼球运动障碍。MRI表现有:梗死灶位于桥脑中上部、达桥脑表面,楔形,内侧位于桥脑旁正中、呈类似直线,可显示出基底动脉壁不整;危险因素方面除高血压外还与糖尿病、脂质代谢异常有关。结论根据临床特点及MRI表现正确诊断出桥脑BAD,以指导进一步的病因治疗及预防。

Objective To investigate the clinical characteristics of acute paramedian pontine infarctions owing to branch atheromatous dis ease. Methods Data of brainstem auditory evoked potentials and magnetic resonance imaging of 82 cases with acute paramedian pontine infarction were analyzed retrospectively as well as clinical findings and risk factors. Results The average age of onset was 69.2 in this group, in (?) there was no significant difference between male and female. Most patients developed with chronic progression. The clinical findings include dysarthria (n=75)、hemiplegia (n = 72, 29 with severe hemiplegia)、sensory dysfunction (n=49)、peripheral facial paralysis (n=25) nonrotary dizziness (n=42) and ocular movement disturbance (n=13). Besides, mild unconsciousness (n=27) and Homer sign (n=6) could be also found. MRI showed wedge - shaped lesions in the upper pons extending to the pontine surface, the base edge was located in (?) median pontine. Diabetes and abnormal lipid metabolism were the most common risk factors as well as hypertension. Conclusion It is premise (?) proper diagnose to grasp the clinical characteristics and MRI findings of paramedian pontine infarctions owing to branch atheromatous disease which could be usefull in etiology therapy and prevention.