新发孤立脑干梗死患者的病因和影像特点研究

The study of etiology and imaging characteristics of patients with new isolated brainstem infarction

目的:探讨不同病因的新发孤立脑干梗死(Brainstem infarction,BSI)患者的临床和影像特点。方法:连续选取302例发病7天以内的非心源性新发孤立BSI患者;收集患者的临床相关信息;分析患者的头颅MRI特点,包括BSI的具体部位,BSI是否位于旁正中穿支动脉供血区、梗死的大小和体积、病因亚型等。结果:按照SSS-TOAST分型,150例(49.7%)BSI患者为小血管病变(SAD)病因分型,152例(50.3%)为大动脉病变(LAD)病因分型。BSI以桥脑病变最多,284例(94.0%)位于脑桥,139例(46.0%)为旁中央支动脉受累。旁正中动脉供血组Fazekas评分≥3分者81例,Fazekas评分平均3分,非旁正中动脉供血组Fazekas评分≥3分者73例,Fazekas评分平均2分,差异均有显著意义(P值分别为0.028、0.013)。陈旧性腔隙性梗死的数量,旁正中动脉供血组较多,两组差异具有显著性(P值为0.037)。而关于梗死大小,梗死的最大长径、最大横径、最大高度和体积,非旁正中动脉供血组均大于旁正中动脉供血组,差异具有极显著意义(P值<0.000 1)。结论:不同病因的BSI患者的影像特点存在差异,临床工作中要注意评估而采取不同的治疗措施。

Objective: To investigate the clinical and imaging characteristics of new isolated brainstem infarction(BSI) patients with different etiologies. Methods: A total of 302 consecutive patients with non-cardiac isolated BSI within 7 days of onset were enrolled. We collect relevant clinical information of patients and evaluate the characteristics of patient ’s head MRI,including the lesion sites, whether the lesion is located in the territory of the paramedian perforating artery, size and volume of the focus and the etiological subtypes of infarcts. Results: According to SSS-TOAST classification, 150 patients(49.7%) with BSI were classified as small artery disease(SAD). One hundred and fifty-two patients(50.3%) with BSI were classified large artery disease(LAD). Pontine infarcts were the most common type of BSI and 284(94.0%) cases were located in the pons. In 139 patients(46.0%) the paramedian artery regions were involved. There were 81 cases with Fazekas score ≥3 in the paramedian group. Fazekas score was 3 points in median group, while Fazekas score ≥3 in 73 cases, and the average score was 2 points in the non-simple paramedian group. The differences were significant(P=0.028, 0.013, respectively). The number of old lacunar infarcts was more in paramedian group(P=0.037). As for the size of infarction, the maximum length diameter, maximum transverse diameter, maximum height and volume of infarction in the non paramedian group were larger than those in the paramedian group, with significant difference(P<0.000 1). Conclusion: The imaging characteristics of BSI patients with different etiologies are different. We should pay attention to the evaluation and take different treatment measures in clinical work.