以眩晕/头晕伴耳鸣耳聋为主要表现的小脑前下动脉梗死四例分析并文献复习

Analysis of 4 cases suffered from infarction in the territory of anterior inferior cerebellar artery manifesting as vertigo/dizziness with hearing loss and tinnitus,and literature review

目的探讨小脑前下动脉(anterior inferior cerebellar artery,AICA)梗死的临床表现及影像学特点。方法报告4例曾疑诊为周围性眩晕疾病,经头颅磁共振成像(magnetic resonance imaging,MRI)证实诊断的AICA梗死患者,分析其临床、影像学表现及治疗预后情况,并复习相关文献。结果4例AICA梗死患者中,多以急性眩晕/头晕(4例),伴恶心呕吐(2例),耳鸣(4例)、耳聋(3例)和步态不稳(4例)起病。神经科查体发现患侧面部感觉障碍(3例)、面瘫复视(1例)、患侧肢体或步态共济失调(4例),但未见眼球震颤等体征。头颅MRI表现为脑桥下外侧(4例)、桥臂(3例)、小脑前下部(3例)急性梗死(任一部位发生即可确诊AICA梗死)。结论AICA梗死很易误诊为前庭周围性疾病。对急性眩晕伴耳鸣、耳聋的患者需警惕AICA梗死,应注意检查患侧有否面部麻木、感觉障碍和肢体共济失调等体征,必要时行头颅MRI以确诊。

Objective To explore the clinical manifestation and the magnetic resonance imaging(MRI)characteristics of infarction in the territory of anterior inferior cerebellar artery(AICA).Methods We reported 4 patients who were suspected peripheral vertigo,but were diagnosed as AICA infarction by MRI.And we reviewed some recently associated papers.Results The AICA infarction patients mostly had acute prolonged vertigo/dizziness(n=4)with nausea and vomiting(n=2),usually associated with tinnitus(n=4)and hearing loss(n=3),and unstead walking(n=4).In neurological examination,facial sensory loss(n=3),facial palsy(n=1),ataxia(n=4)of limbs and/or gait could be found,but without nystagmus.The diagnosis of the AICA infarction was made when the acute infarction lesions involved at least one of the following anatomic structures:lateral inferior pontine area(n=4),middle cerebellar peduncle(n=3),or anterior cerebellar hemisphere(n=3)in cranial MRI.Conclusions The AICA infarctions were easily misdiagnosed with peripheral vertigo.For a patient of acute vertigo with tinnitus or hearing loss,we must pay attention to the examination of the facial numbness or sensory loss,and limb ataxia.The cranial MRI is very important for the diagnosis of AICA infarction.