以頭暈為首發(fā)癥狀的腦干梗死的臨床特點

楊穎　張擁波

[摘要] 目的 探討以頭暈為首發(fā)癥狀的腦干梗死的臨床特點及影像特點。 方法 選取2013年3月～2016年8月在北京友誼醫(yī)院神經內科住院的87例以頭暈為首發(fā)癥狀的腦干梗死患者，均行MRI+DWI及頭頸CT血管造影（CTA）檢查，按梗死部位分為中腦、橋腦和延髓梗死三組，對其臨床特點進行分析。 結果 以頭暈為首發(fā)癥狀的腦干梗死，主要發(fā)生在橋腦，占68.97%;其次是延髓，占24.14%。所有患者均以頭暈起病，其中僅表現為孤立性頭暈（無其他伴隨癥狀）的患者18例（占20.69%），最常見的伴隨癥狀為單側肢體無力占（51.72%）;中腦梗死病變血管主要分布于大腦后動脈，橋腦梗死病變血管主要分布于基底動脈、以輕、中度狹窄為主，延髓梗死病變血管主要分布于椎動脈、以重度、閉塞為主。 結論 以頭暈為首發(fā)癥狀的腦干梗死患者，最好發(fā)部位為橋腦，單側肢體無力為最常見的伴隨癥狀，病變血管中腦梗死主要分布于大腦后動脈，橋腦梗死以基底動脈的輕-中度狹窄為主，延髓梗死以椎動脈的重-閉塞為主。

[關鍵詞] 頭暈;腦干梗死;臨床特點;CT血管造影

[中圖分類號] R741? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0129-04

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

YANG Ying1? ?ZHANG Yongbo2

1.Internal Medicine， Beijing Shuili Hospital， Beijing? ?100036， China; 2.Department of Neurology， Beijing Friendship Hospital Affiliated to Capital Medical University， Beijing? ?100050， China

[Abstract] 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.

[Key words] Dizziness; Brainstem infarctions; Clinical manifestation; CT angiogrophy

腦干梗死是指椎基底動脈及其分支血管狹窄或閉塞引起的中腦、腦橋或延髓缺血性壞死，出現相應的神經系統癥狀和體征，腦干梗死占所有腦梗死的9%～21%[1]。腦干梗死發(fā)病急、進展快，網狀結構受累可出現意識障礙，其病死率和致殘率高于前循環(huán)梗死。腦干梗死的病因及部位不同，臨床表現復雜多樣，給預后判斷帶來困難。……