脑桥梗死的临床与神经影像学特征

Clinical and neuroimaging features of pontine infarction

目的阐述脑桥梗死的临床-影像-解剖学关系。方法回顾性分析69例急性孤立性脑桥梗死患者的临床特征及其与神经影像学改变的对应关系。结果主要临床特征有病灶对侧的中枢性面瘫和肢瘫、眩晕、构音障碍、偏身麻木、饮水呛咳、眼球水平运动异常等。9例(13．04％)患者在发病早期呈现进展性过程;51例(73．91％) 梗死灶位于脑桥旁正中区域;59例(85．51％)患者病灶位于脑桥中上部水平;45例血管造影患者中,9人有椎-基底动脉狭窄。结论脑桥梗死多发生在脑桥中上部的旁正中区域,主要由椎基底动脉狭窄、高血压性基底动脉穿通支闭塞所致。偏瘫、眩晕、构音障碍、感觉异常及眼球水平运动障碍等为主要临床表现。经典的脑桥综合征少见。少数患者在病程初期呈现进展过程,大多数患者预后良好。

Objective To clarify the clinical imagingoanatomic correlation of pontine infarction. Methods We retrospectively studied the correlation between clinical manifestation and neuroimaging findings of 69 patients with acute isolated pontine infarction. Results The most important manifestations included eontralateral hemiplegia with supranuelear facial palsy,vertigo ,dysarthria ,hemianesthesia ,drinking choke and horizontal gaze abnormality. 9 patients had a progressive course in early stage. Foci located in paramedian pons in 51 and mid-upper levels of the pons in 59 of 69 patients. Angiography showed that 9 patients had vertebral or basilar artery stenoses in 45 patients. Conclusions Pontine infarctions, which mainly located in mid-upper paramedian pons,are usually due to vertebrobasilar artery stenosis and occlusion of pontine perforating arteries by hypertension. The common clinical features are hemiplegia with supranuelear facial palsy, vertigo ,dysarthria, hemianesthesia and horizontal gaze abnormality. The typical pontine syndromes are rarely found. Although a fraction of patients with pontine infarctions has progressive courses in early stage. The a majority of patients have a good prognosis.