脑干腔隙性梗死的MRI、TCD、BAEP检查与临床

MRI,TCD,BAEP and Clinical Manifestations of Brainstem Lacunar Infartion

目的探讨MRI、TCD、BAEP联合检查脑干腔隙性梗死的价值。方法对28例脑干腔隙性梗死患者的头颅MRI、TCD、BAEP及临床特征作回顾性分析。结果本组患者中老年男性较多,71%有高血压史,临床表现多样,MRI扫描显示腔隙灶直径在0.2～1.5cm,桥脑腹侧居多;24例TCD异常:20例提示椎-基底动脉血流速度下降或增高,4例频谱显示典型的脑动脉硬化改变;22例BAEP异常,主要表现为Ⅲ、Ⅴ波PL及Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ的IPL延长,脑干下段(桥脑、延脑)多表现为Ⅲ波、Ⅰ～Ⅲ异常,脑干上段(桥脑、中脑)多表现为Ⅴ波、Ⅲ～Ⅴ、Ⅰ～Ⅴ异常。结论MRI是诊断脑干腔隙性梗死的最佳手段,TCD反映椎-基底动脉系统血管弹性及血流速度,对诊断有一定帮助,BAEP对病变的定位有较高的应用价值。

Objective To explore the value of joint check of MRI,TCD and BAEP in brainstem lacunar infartion.Methods MRI,TCD,BAEP and clinic characteristics of 28 patients with brainstem lacunar infartion was retrospectively analyzed.Results Among this group,the majority of the patients were old men,and 71% had histories of hypertension.Clinical manifestations of them were complex and varied.The MRI indicated that the patients’ lacunes ranged from 0.2 to 1.5 cm in diameter,and the lesions of lacune appeared mainly in the ventral region of the pons;the TCD of 24 cases were abnormal：20 cases showed that the velocities of blood flow of vertebro-basilar artery went down or up,in the other 4 cases,the frequency spectrum indicated the typical changes of cerebral arteriosclerosis;In 22 cases,BEAP was abnormal,the manifestation of which was the extension of Ⅲ,Ⅴwaves’ PL andⅠ-Ⅲ,Ⅲ-Ⅴ,Ⅰ-Ⅴ waves’ IPL.In the low brain stem（pons,medulla oblongata）the Ⅲ,Ⅰ-Ⅲ waves were abnormal;and in the upper brain stem（pons,midbrain） abnormal waves were mainly found in Ⅴ,Ⅲ-Ⅴ,Ⅰ-Ⅴ.Conclusion MRI was the best way to diagnose the brainstem lacunar infartion.TCD can reflect the changes of flow velocity of the vertebral-basilar arteries,thus it was of certain help to diagnosis.BAEP was of great value in localizing the lesion.