双侧脑干梗死患者临床影像学的特征和病因分析

Radiologic characteristics and etiology of bilateral brainstem infarction

目的比较单侧和双侧脑干梗死患者临床影像学特征和病因,并重点分析双侧脑干梗死灶的分布模式及其可能的脑卒中机制。方法选择头颅弥散加权成像所证实的急性梗死灶累及脑干的患者338例,其中单侧脑干梗死组286例,双侧脑干梗死组52例。结果与单侧脑干梗死组比较,双侧脑干梗死组患者临床症状较重和短期预后较差,且多发脑干梗死灶(73.1%vs 5.6%)、合并小脑梗死(53.8%vs 5.6%)和合并大脑后动脉梗死(26.9%vs2.8%)更为多见(P<0.01)。大血管粥样硬化是双侧脑干梗死患者最常见的脑卒中病因(基底动脉粥样硬化19例;椎动脉粥样硬化21例)。基底动脉粥样硬化患者所致双侧脑干大梗死(47.4%vs 14.3%)、单发脑干大梗死(31.6%vs 4.8%)和脑干大梗死横跨脑干中线(47.4%vs 4.8%)较椎动脉粥样硬化患者所致双侧更多见(P<0.05,P<0.01);而椎动脉粥样硬化患者所致双侧多发脑干内部小梗死较基底动脉粥样硬化患者所致双侧更多见(52.4%vs 10.5%,P<0.01)。结论基底动脉和椎动脉粥样硬化所致双侧脑干梗死的梗死灶分布模式存在不同之处,提示上述两种情况下的脑卒中机制也存在差异。

Objective To compare the clinical-radiological features and etiology between unilateral and bilateral brainstem infarction （BSI）, and analyze the distribution pattern of bilateral brainstem infarction （BBSI） and its mechanism. Methods Three hundred and thirty-eight acute isehemic stroke patients were divided into unilateral BSI （UBSI） group （n=286） and BBSI group （n=52）. Results The clinical symptoms were severer and the short-term prognosis was poorer in BBSI group than in UBSI group. The incidence of multiple BSI, cerebellar infarction and posterior cerebral artery infarction was significantly higher in BBSI group than in UBSI group （73. 1% vs 5.6%,53.8% vs 5.6%,26.9% vs 2.8% ,P〈0. 01）. Large artery atherosclrosis was a common risk factor for ischemic stroke in BSI patients （basilar artery atherosclerosis in 19 and vertebral artery atherosclerosis in 21）. The incidence of large BBSI,large BSI crossing the median line of brainstem,and single large brainstem infarction induced by basilar artery atherosclerosis was sig- nificantly higher than that induced by vertebral artery atherosclerosis （47. 4% vs 14. 3%, 47.4% vs 4.8%,31.6% vs 4.8% ,P〈0.05,P〈0.01）. The incidence of multiple small brainstem infarctions induced by vertebral artery atherosclerosis was significantly higher than that induced by basilar artery atherosclerosis in BBSI patients （P〈0.01）. Conclusion The distribution pat- tern of BBSI induced by vertebral artery atherosclerosis differs from that induced by basilar artery atherosclerosis,indicating that their mechanism is different.