小脑梗死的分型与后循环血管病变

The Subtypes of Cerebellar Infarctions and Angiopathy of Posterior Circulation

目的研究有无大血管病变患者小脑梗死灶的特征,探讨小脑梗死分型与后循环血管病变的关系。方法收集我科自2006年1月～2008年3月期间住院的小脑梗死患者共35例,所有患者均同时具备颅脑磁共振成像(magnetic resonance imaging,MRI)和血管造影检查,包括计算机断层摄影血管造影(computed tomographic angiography,CTA)、磁共振血管造影(magnetic resonance angiography,MRA)和数字减影血管造影(digital subtraction angiography,DSA)检查。根据血管造影检查的结果将入组患者分为两组:大血管病变组20例,小血管病变组15例,分析两组小脑梗死的分型和后循环血管病变(包括狭窄或闭塞)的关系。结果⑴大血管病变组20例中,颅内血管(椎动脉颅内段或基底动脉)病变最多见(10例,50%),梗死类型多为分水岭梗死(7例,70%);其次为颅外血管合并颅内血管(椎动脉颅外段合并颅内段或基底动脉)病变(8例,40%),梗死灶多为小脑后下动脉(PICA)供血区的区域性梗死(7例,87.5%);单独颅外血管(椎动脉颅外段)病变最少见(2例,10%),梗死分布无明显倾向性。⑵小血管病变组15例中,梗死灶亦多位于分水岭区(9例,60%)。结论由于小脑血液供应特点,小脑梗死中分水岭梗死和腔隙性梗死较区域性梗死更为常见。小梗死灶(直径≤2cm)可能存在后循环大血管的狭窄或闭塞,应予积极的治疗和干预,以防病情加重。

Objective To investigate the characteristics of cerebellar infarction with or without occlusive diseases of large arteries, and the relationship between subtypes of cerebellar infarctions and arteries occlusive disease in the posterior circulation. Methods Thirty-five patients with cerebellar infarctions underwent both brain MR imaging and angiography（computed tomographic angiography, or magnetic resonance angiography, or digital subtraction angiography） in Beijing Friendship Hospital from Jan. 2006 to Mar. 2008. The infarction subtype on MRI and angiography features were analyzed. Results （1）The occlusive disease of large arteries were detected in 20 cases（57.1%）, in which the intracranial segment of vertebral or basilar arteries were more common（10 cases, 50%） and among those the watershed infarctions appeared in 7 cases（70%）. The next were extracranial segment of vertebral artery coexistent with the intracranial vertebral segment or basilar artery（8 cases, 40%） that most commonly with cerebellar infarction in territory supplied by posterior inferior cerebellar artery（PICA）（7 cases, 87.5%）. Isolated occlusive disease of extracranial segment of vertebral arteries was detected only in 2 cases（10%） which showed no predilection for certain cerebellar subtypes. （2）In 15 patients（42.9%） with small artery disease, 9 patients（60%） showed watershed infarctions on MRI studies. Conclusion Because of the feature of peculiar blood-supply in the cerebellum, watershed and lacuna infarctions are more common than large territorial infarctions. There is no distinct difference in the subtype of cerebellar infarctions between patients with large artery disease and with small arterial occlusive disease.