后循环急性多发脑梗死36例临床分析

Clinical analysis of 36 patients with acute multiple cerebral infarction in posterior circulation

目的：研究后循环多发脑梗死病因、发病机制、影像学特点、临床表现。方法：收集2007年5月~2009年8月大连三院神经内科住院的后循环多发脑梗死患者的临床资料,分析其病因、影像学特点、临床表现。结果：病因为动脉粥样硬化、血管狭窄者29例（81%）,其中高血压23例、糖尿病18例、高脂血症25例、吸烟15例、饮酒13例、病因为心脏病者7例,其中房颤5例、陈旧性心肌梗死2例、临床表现按症状和体征发生频率依次为眩晕19例、肢体瘫痪17例（偏瘫13例,四肢瘫痪4例）、构音不清16例、偏盲12例、共济失调8例、颅神经麻痹7例、意识障碍3例;按不同责任病变血管分类,以大脑后动脉病变最常见（46%）,其次为基底动脉（31%）,椎动脉病变者（23%）。结论：动脉粥样硬化是急性后循环脑梗死的最常见原因,动脉粥样硬化至动脉栓塞是其主要发病机制。眩晕、偏瘫、构音障碍是其常见临床表现,血管受累以大脑后动脉最常见,后循环多发脑梗死病灶大小相对较小,临床转归较好。

Objective To investigate the etiopathogenisis,pathogenesis,imageological features and clinical manifiestations of acute multiple infarcts in posterior circulations.Method The clinical data of 36 patients with acute multiple cerebral infarction in posterior circulation who were admitted to hospital between May 2007 and August 2009 were collected,and the etiopathogenisis,imageological features and clinical manifiestations were restrospectively analyzed.Results About 81% had artherosclerosis and posterior circulation artery stenosis among the patients with acute posterior infarcts.Hypertention,diabetes,coronary artery disease,hyperlipidemic and smoking were the risk factors.Vertigo was most common（53%）,extremeties paresis（47%）,with hemiplegia of 36%,tetraplegia of 11%,dysarthria（44%）,hemiopia（33%）,ataxia（22%）,cranial nerve palsy（19%） and consciousness disturbances（8%）.According the features of imageology,the multiple infarcts of the patients with PCA were most frequent with verteral artery（46%）,with basilar artery took second place（31%）,vertebral artery had 23%.Conclusion Artherosclerosis is the main etiology,and cerebral embolism is the main pathogenesis of acute multiple infarcts in posterior circulations.Vertigo,hemiplegia and dysarthria are the common clinical symptoms,and posterior cerebral artery is the main affected artery.