急性双侧小脑梗死

Acute bilateral cerebellar infarction

目的探讨急性小脑梗死的临床和影像学表现特点和相互关系,病因和发生机制以及预后。方法选择我科住院的15例双侧小脑多发性梗死患者,对其血管危险因素、临床表现、MRI病变形态、分布和临床的关系,可能的病因性发病机制以及预后进行分析。结果本组双侧小脑梗死占全部小脑梗死患者的23.8%。急性双侧小脑梗死以双侧PICA供血区的多发性梗死最多见(66.7%)。主要临床表现为头晕/眩晕(93.3%)、恶心、呕吐(93.3%)、共济失调(60%)和构音障碍(58.7%)。双侧小脑梗死多表现为大病变侧的单侧体征如共济失调。除上述小脑症状外,双侧PICA供血区梗死,特别是内侧支分布区受累(6例)时,突出的临床表现为眩晕,其中4例表现为孤立性假性眩晕;AICA梗死患者的特征表现为双侧耳聋;而SCA供血区梗死的临床表现特点是构音障碍、单侧共济失调,偶可出现大病变对侧的耳聋。Rankin评分均在3分或3分以下,死亡1例。结论急性小脑多发性梗死主要发生于双侧PICA供血区,主要临床症状和体征为头晕/眩晕、恶心呕吐、共济失调等体征多数限局于单侧肢体,出现于小脑梗死较大的一侧。病因多数为心源性栓塞或主动脉粥样硬化性栓塞所致,预后较好。

Objective To investigate the clinical spectrum and MRI features of acute bilateral cerebellar infarction, and its possible pathophysiology and prognosis. Methods 15 cases with bilateral cerebellar infartion were diagnosed by MRI. The size, number and distribution of MRI lesions, the correlation between MRI findings and clinical features, possible pathophysiology and prognosis were analyzed and discussed. Result This study demonstrated that bilateral cerebellar infarction accounted for 23.8% in all cerebellar infarction, and the concurrence multiple infarctions in bilateral PICA territory predominate （ 66.7 % ） in bilateral cerebellar infarction. The cardinal symptoms included dizziness/vertigo （ 93.3 % ）, nausea/vomiting（ 93.3 % ） , ataxia（ 60% ）and dysarthria（ 58.7 % ）. Although bilateral cerebellar hemispheres were involved by ischemic lesions, only the large lesion of dominating side manifested itself the unilateral sign such as ataxia. Apart from the cerebellar symptoms as above, patients with PICA infarction, the prominent and characteristic symptom was isolated vertigo in PICA infarction, sudden deafness in AICA and incidental deafness in SCA. Conclusion Acute bilateral infarction always occurs in bilateral PICA territory. The common clinical symptoms are dlzziness/vertigo, nausea/vomiting, ataxia, which only manifested to unilateral limb, ipsilaterally to the side of large lesion. The highly associated cardiovascular risk factors, positive Urinalysis, and the findings of DWI that detecting bilateral multiple ischemic lesions in more than one artery territories indicate the cardiogenic or aorta atherosclerotic embolism being as the most etiology in this study. The prognosis is better than expected.