139例脑桥梗死患者的临床分析

目的根据脑桥梗死患者的症状、体征,结合脑桥的解剖学特点和头颅MRI检查对患者病灶定位,随之探讨脑桥梗死与椎基底动脉病变的相关关系。方法连续入选2003年6月～2007年12月收住益阳医专附属医院神经内科的急性脑桥梗死患者139例,所有患者均行头颅MRI检查,将病例分为A(腹内侧梗死组--脑桥旁中央动脉分布区)、B(腹外侧梗死组-脑桥短旋动脉分布区)、C(被盖部梗死组-脑桥长旋动脉分布区)、D(混合组-可能累及A、B、C多条动脉分布区),并对其病灶位置分布、神经系统体征、神经功能缺损程度(改良Rankin评分)等指标进行分析。结果 139例患者中A、B、C、D组各占66(47.5%)、44(31.6%)、17(12.2%)、12(8.7%)。在临床表现特点上,腹内、外侧梗死多,表现为病灶对侧肢体偏瘫、中枢性面瘫以及构音障碍,同时伴或不伴肢体共济失调;脑桥被盖部梗死主要表现为脑神经瘫痪及感觉障碍;双侧脑桥梗死则往往表现为假性延髓性麻痹、双侧肢体运动障碍。结论脑桥梗死病灶多位于腹内、外侧,且多表现为病灶对侧肢体瘫痪、中枢性面瘫以及构音障碍;不同梗死部位影响神经功能缺失程度不同,不同部位的梗死与椎基底动脉的狭窄或闭塞关系密切。

Objective According to the patients with pontine infarction symptoms, signs, combined with pontine anatomical features and head MRI examination in patients with pontine infarction lesion localization, exploration and vertebrobasilar lesions related. Methods Of successive selected 2003.6- 2007.12 admitted to Yiyang Medical College Affiliated Hospital Department of Neurology of the acute pontine infarction patients 139 cases, all patients underwent head MRI examination, the patients were divided into A （ ventral pontine infarction group - arteria paracentralis distribution ）, B （ ventrolateral pontine infarction group - short circumflex artery distribution area C （ covered ） part of the pontine infarction group - long circumflex artery distribution area ） D （ mixed group - may involve the A, B, C many arterial distribution ）, and the location of the lesion distribution, neurological symptoms, severity of neurological deficits （ modified Rankin scoring ） were analyzed. Results 139 patients with A, B, C, D group each accounted for 66 （ 47.5% ）, 44 （31.6%）, 17 （12.2%）, 12 （8.7%）. In the clinical manifestation, intra-abdominal, lateral infarction, manifested as focus contralateral hemiplegia, central facial palsy and dysarthria, simultaneously with or without limb ataxia; pontine tegmental infarction mainly for Department of cranial nerve paralysis and zensory disorders; bilateral pontine infarction is often manifested as pseudobulbar palsy, bilateral limb movement disorder. Conclusion Pontine infarction lesions located in the intra-abdominal, lateral, and more performance for the lesions in the contralateral limb paralysis, central facial palsy and dysarthria; different infarction affect nerve function deficiency of different levels, different parts of the infarction associated with vertebral basilar artery stenosis or occlusion relationship.