无定位体征的脑干腔隙性梗塞

Brainstemlacunawithoutsignsoflocalization

部分脑干腔隙性梗塞（腔梗）患者，因无定位体征而常常被误诊为椎基底动脉供血不足（Ｖ－ＢＡＩ）。为了对这些患者作出早期诊断，以利治疗及对预后的估计，对２１例无定位体征的脑干腔梗组（Ａ组）与３０例Ｖ－ＢＡＩ（Ｂ组）患者的临床表现、ＣＴ、ＭＲＩ、经颅多普勒超声（ＴＣＤ）及脑干听觉诱发电位（ＢＡＥＰ）进行比较分析。结果表明：Ａ组以持续症状为主，治疗效果较差，其ＴＣＤ改变不如Ｂ组明显，而ＢＡＥＰ的Ⅲ、Ⅴ波峰潜伏期（ＰＬ）及Ⅲ～Ⅴ波峰间潜伏期（ＩＰＬ）延长比Ｂ组明显。结论：凡症状持续、疗效较差、ＴＣＤ改变不显著而ＢＡＥＰ示听神经中枢段障碍明显者，要高度怀疑脑干腔梗。ＭＲＩ是脑干腔梗可靠而敏感的检查手段。

Somecasesofbrainstemlacunabecauseofwithoutsignsoflocalizationareoftenmis-diagnosedasvertebrobasilararteryischemia(V-BAI).Forearlydiagnosisandtreatmentofbrain-stemlacunaandpredictionoftheirprognosis,21casesofbrainstemlacunawithoutsignsoflocaliza-tion(groupA)werecomparedto30casesdiagnosedwithV-BAI(groupB)intermsofclinicalfea-tures,CT,MRI,transcranicalDoppler(TCD)andbrainstemauditoryevokedpotential(BAEP).TheresultsdemonstratedthatbrainstemlacunashouldbehighlysuspectedinthepatientspresentingpersistentV-BAIwithunsatisfactorytherapeuticresults.IfpeakvalueofTCDisalmostnormal,thepeaklatencyofⅢ、Ⅴwavesor/andⅢ～ⅤwavesintervalpeaklatencyofBAEPmaybeprolonged.MRIexaminationisindicatedforthepatients.