以头晕为首发症状的脑干梗死的临床特点

Clinical characteristics of the brainstem infarction with dizziness as the first symptom

目的探讨以头晕为首发症状的脑干梗死的临床特点及影像特点。方法选取2013年3月~2016年8月在北京友谊医院神经内科住院的87例以头晕为首发症状的脑干梗死患者,均行MRI+DWI及头颈CT血管造影(CTA)检查,按梗死部位分为中脑、桥脑和延髓梗死三组,对其临床特点进行分析。结果以头晕为首发症状的脑干梗死,主要发生在桥脑,占68.97%;其次是延髓,占24.14%。所有患者均以头晕起病,其中仅表现为孤立性头晕(无其他伴随症状)的患者18例(占20.69%),最常见的伴随症状为单侧肢体无力占(51.72%);中脑梗死病变血管主要分布于大脑后动脉,桥脑梗死病变血管主要分布于基底动脉、以轻、中度狭窄为主,延髓梗死病变血管主要分布于椎动脉、以重度、闭塞为主。结论以头晕为首发症状的脑干梗死患者,最好发部位为桥脑,单侧肢体无力为最常见的伴随症状,病变血管中脑梗死主要分布于大脑后动脉,桥脑梗死以基底动脉的轻-中度狭窄为主,延髓梗死以椎动脉的重-闭塞为主。

To investigate the clinical and imaging features of brainstem infarction with dizziness as the first symptom. Methods Eighty-seven brainstem infarction patients who had dizziness as the primary symptom in Department of Neurology in Beijing Friendship Hospital from March 2013 to August 2016 were recruited, and underwent MRI+DWI and CT angiography (CTA) examination. They were divided into three groups according to the distribution of affected lesions, the midbrain group, the pons group, and the medulla oblongata group, and their clinical characteristics were analyzed. Results Brainstem infarction with dizziness as the primary symptom mainly occurred in the pons, accounting for 68.97%, and the medulla oblongata accounted for 24.14% secondly. All patients were observed with dizzinessin, 18 cases (accounting for 20.69%) showed isolated dizziness(no other accompanying symptoms) among them, the most common associated symptom was unilateral limb weakness (accounting for 51.72%);the responsible vessel of midbrain infarction were mainly distributed in the posterior cerebral artery, and the pons were mainly distributed in the in basilar artery with mild-to-moderate narrow, the medulla oblongata were mainly distributed in the in vertebral artery with heavy-to-occlusive narrow. Conclusion Brainstem infarction with dizziness as the primary symptom mainly occurred in the pons. The most common associated symptom is unilateral limb weakness. Pathological vessels, the midbrain are mainly distributed in the posterior cerebral artery, and the pons mainly in basilar artery with mild-to-moderate narrow, the medulla oblongata mainly in vertebral artery with heavy-to-occlusive narrow.