小脑梗死的临床诊断

小脑梗死的临床表现缺少特异性 ,若不及时作ＣＴ、ＭＲＩ检查 ,常有误诊、漏诊 ,有必要对其临床特点进行探讨。1　临床资料1.1　一般资料　 1996年 1月～ 2 0 0 1年 1月住我院的 44 0例脑梗死患者中小脑梗死 18例 (4 .1% ) ,男 13例 ,女 5例 ,年龄41～ 82岁 ,平均 6 2 .6± 12 .6岁。有高血压病史 9例 ,眼底动脉硬化 7例 ,冠心病史 3例 ,椎基底动脉ＴＩＡ史 3例 ,糖尿病史 2例。入院后初诊为小脑梗死 10例 ,椎基底动脉供血不足 4例 ,美尼尔病 2例 ,小脑占位、前庭神经元炎各 1例。1.2　临床表现　急性起病 16例 ,亚急性起病 2例。 14例首发…     

以眩晕为首发症状脑梗死19例临床分析

目的探讨以眩晕为首发症状脑梗死的临床及影像学特点。方法收集2011年1月至2012年10月我院神经内科收治的以眩晕为首发症状脑梗死的临床资料,与同时期无眩晕症状脑梗死对照,前者称眩晕组,后者为对照组,比较两组人口统计学、血管危险因素、临床和影像学特征。结果眩晕组脑梗死患者年龄、性别、血管危险因素与无眩晕组脑梗死差异无统计学意义(P>0.05)。眩晕组脑梗死部位多位于后循环,常伴随多种神经受损的症状和体征(P<0.05)。结论以眩晕颅首发症状的脑梗死多为后循环脑梗死,常伴随多种神经受损的症状和体征,单纯眩晕患者应早期完善头颅MRI或DSA检查。     

以头痛为首发症状的小脑后下动脉梗死

1　病　例患者 ,男 ,4 5岁 ,头痛 10余天 ,加重伴吞咽困难 2天入院。 10余天前于安静状态下出现头痛 ,以右枕颞部明显 ,严重时伴恶心呕吐 ,无发热 ,2天前出现头痛加剧 ,伴吞咽困难 ,饮水呛咳 ,言语不清、头晕 ,左侧肢体活动不灵。既往体健。体检 :ＢＰ 170 / 110ｍｍＨｇ ,神志清 ,言语不清 ,左侧眼裂小 ,左侧瞳孔较右侧小 ,吞咽困难 ,饮水打呛 ,咽反射消失 ,余颅神经 (- )。左侧共济运动失调。双侧肌力、肌张力正常 ,病理征 (- )。左侧面部 ,右侧半身痛觉减退 ,颈项强直 ,克氏征 ,布氏征阴性。颅脑ＭＲＩ示左侧小脑半球及蚓部脑梗死 ,并累…     

以眩晕为首发症状的神经梅毒三例

近年来我国的神经梅毒发病不断增多,神经梅毒发病隐袭,临床表现多样,极易造成误诊、漏诊,应引起临床的重视.以眩晕为临床表现的神经梅毒病例报道罕见,现报道3例以眩晕为首发症状的神经梅毒患者.     

以孤立性眩晕为首发症状的急性脑梗死患者10例

目的探讨以孤立性眩晕为首发症状的急性脑梗死(ACI)的特点及溶栓治疗预后。方法对10例以孤立性眩晕起病,诊断为ACI并进行溶栓治疗患者,分析包括临床表现、影像学特征、病因分型、预后等临床资料。结果所有患者均有孤立性眩晕出现,时间长短不一。超早期给予溶栓治疗,有9例预后较好,1例因急性心肌梗死死亡。结论孤立性眩晕患者要警惕后循环卒中,早期发现其他神经功能缺损体征并给予溶栓治疗,效果较好。     

前庭自旋转实验在小脑梗死中的应用研究

目的探讨前庭自旋转试验(VAT)对以眩晕为症状的小脑梗死患者前庭功能评判的价值。方法比较21例小脑梗死患者康复治疗前后VAT结果变化。结果 21例VAT中水平增益增高11例;水平增益增高合并水平增益降低10例。康复治疗后,患者眩晕、平衡障碍、VAT增益完全改善12例;眩晕、平衡障碍、VAT增益明显改善9例。结论 VAT不仅可以提示小脑梗死患者前庭系统损害的部位及程度,而且为小脑梗死的康复治疗方案的选择和疗效评判提供了客观依据。     

以突聋为首发症状的脑梗死患者临床特点

目的探讨以突聋为首发症状的脑梗死患者的临床特点,提高对该类情况的认识,尽早做出正确诊断。方法报道我院2014年收治的2例以突聋为首发症状的脑梗死病例,均完善头颅MRI、HR-MRI、DSA、颈动脉超声、TCD检查,结合文献复习,总结临床特点。结果该2例患者首发症状表现为突聋合并头晕,DSA均发现基底动脉近段狭窄。病例1头颅MRI示双侧桥脑及左侧小脑新发梗死灶,予急诊动脉溶栓治疗,后续双联抗血小板聚集及他汀治疗,听力好转。病例2头颅MRI示右侧桥脑新发梗死灶,予双联抗血小板聚集及他汀治疗,遗留听力下降。结论以突聋为首发症状的脑梗死并不罕见,突聋患者应尽快完善脑血管检查,突聋患者具有以下临床特点时需要高度警惕脑梗死:伴随头晕症状、合并多种动脉粥样硬化危险因素、基底动脉狭窄。     

以眩晕为首发症状的老年蛛网膜下腔出血临床分析

我院2006年以来收治以眩晕为首发症状的老年人蛛网膜下腔出血(SAH)患者70例,现分析如下。1资料与方法1.1一般资料我院自2006年收治老年蛛网膜下腔出血患者70例,所有患者均以眩晕为首发症状。男40例,女30例;年龄45～75岁,平均65岁。眩晕发作至就诊时间30     

以位置性眩晕及水平眼震为首发表现的小脑占位病变(附1例报告及文献复习)

目的探讨主要症状为位置性眩晕及水平眼震的小脑占位病变患者的临床及病灶分布特征,以提高临床医生对该少见病的认识。方法回顾性分析2016年12月诊治的1例以位置性眩晕及位置性眼震为首发症状的小脑占位病变患者的临床资料及疾病诊治经过,并结合文献复习进行总结。结果患者男性,75岁,以反复眩晕、恶心、呕吐、活动后加重2个月就诊,查体发现水平翻滚试验可见水平背地眼震,首次查头颅CT平扫未见明显异常,诊断右侧水平半规管帽石症,给予Gufoni手法复位治疗无明显效果。4周后患者出现意识淡漠,复查头颅CT显示梗阻性脑积水,头颅CT增强示右侧小脑小结占位病变,先后行侧脑室外引流及小脑肿瘤切除术,术后病理为弥漫大B细胞淋巴瘤。结合既往报道的文献13例和本研究的1例共计14例小脑占位引起的位置性眩晕及水平眼震患者中,有9例初诊为良性阵发性位置性眩晕;肿瘤主要位于小脑小结、舌叶及四脑室底部等小脑中线部位。结论小脑中线部位的占位病变可以表现为位置性眩晕/眼震,临床医生需注意识别,以免漏诊。     

Repetitive Episodic Isolated Vertigo in a Patient with Cerebellar Infarction

Isolated vertigo is an important symptom of posterior circulation stroke. It has been reported that 11.3% of patients with isolated vertigo have a stroke and that most lesions are located in the cerebellum, particularly in the posterior inferior cerebellar artery. We report the case of a 63-year-old man with multiple atherosclerotic risk factors and atrial fibrillation who showed repeated episodes of isolated vertigo. His repeated vertigo was short-lasting and was often triggered by body position, mimicking benign paroxysmal positional vertigo. Cranial computed tomography on the third hospital day showed left cerebellar infarction within the territory of the posterior inferior cerebellar artery. The vertigo was ameliorated on the fifth hospital day and warfarin was prescribed for secondary prevention. Clinicians should pay special attention to cases in which a patient presents isolated vertigo, even if it shows transient recurrence or is triggered by a positional change, especially in patients with multiple cerebrovascular risk factors.     

Positional Vertigo After Isolated Cerebellar Nodulus Stroke: A Report of 3 Cases

We report 3 cases (69-year-old man, 71-year-old man, and 82-year-old woman) of isolated cerebellar nodulus stroke patients, who presented with positional vertigo alone that lasted only for 2-4 days. Brain magnetic resonance imaging helped diagnosing these cases. Although rare, clinicians should be aware of isolated cerebellar nodulus stroke, when facing with patients with paroxysmal vertigo of acute onset.     

119例小脑梗死的临床分析

目的探讨小脑梗死的中国缺血性脑卒中分型诊断(CISS)、受累血管区域、合并小脑外梗死病灶以及临床表现。方法回顾性分析自2012年1月至2015年12月119例急性小脑梗死住院患者的头颅MRI影像、病因学检查以及临床表现等资料。结果 119例小脑梗死患者中,单侧小脑梗死78例(UCI组),双侧小脑梗死41例(BCI组)。两组的CISS分型无明显差异。UCI组以小脑后下动脉区梗死发生率最高(35.9%),与BCI组比较,差异有显著统计学意义(P0.01);BCI组中小脑后下动脉+小脑上动脉区梗死发生率最高(39.0%),但两组间比较差异无显著性;其余区域的梗死发生率在两组中差异无显著性。63/119例(52.9%)同时合并小脑外梗死灶。BCI组合并小脑外后循环梗死的发生率(53.7%)较单侧UCI组高(P0.05),而UCI组合并前循环梗死较BCI组更多(P0.05)。主要症状、体征包括:头晕/眩晕、眼球震颤、眼倾斜反应、听觉减退、小脑性构音障碍、共济失调,浅感觉障碍、锥体束征以及意识障碍等。意识障碍在BCI组的发生率高于UCI组(P0.01),其余各项两组间比较差异无显著性。结论小脑梗死的主要病因为大动脉粥样硬化;小脑后下动脉区梗死在UCI中最常见,BCI常合并小脑外的后循环供血区梗死;UCI和BCI的受累小脑动脉以及合并小脑外梗死的区域有一定差异,提示两者病因机制存在不同;意识障碍等严重神经功能缺损表现在BCI更为常见。     

Isolated Lateral Sinus Thrombosis Presenting as Cerebellar Infarction in a Patient with Iron Deficiency Anemia

As a rare cerebrovascular disease, cerebral venous thrombosis (CVT) is caused by various conditions including trauma, infection, oral contraceptive, cancer and hematologic disorders. However, iron deficiency anemia is not a common cause for CVT in adult. Posterior fossa infarction following CVT is not well demonstrated because posterior fossa has abundant collateral vessels. Here, we report a case of a 55-year-old man who was admitted with complaints of headache, nausea, and mild dizziness. The patient was diagnosed with isolated lateral sinus thrombosis presenting as cerebellar infarction. Laboratory findings revealed normocytic normochromic anemia due to iron deficiency, and the patient''s symptoms were improved after iron supplementation.     

German-Austrian Scape Occupying Cerebellar Infarction Study (GASCIS): study design,methods, patient characteristics

Summary An open prospective multicentric therapeutic trial to determine the timing and type of therapeutic intervention in patients presenting with secondary deterioration following cerebellar stroke is described. According to the results of retrospective studies a controlled approach comparing different therapies is ethically not feasible. Participants use the same scores and protocol for patient data collection but many choose different therapeutic procedures.     

A Computed Tomography Score for Assessment of Mass Effect in Space-Occupying Cerebellar Infarction

BACKGROUND AND PURPOSE: Patients with cerebellar infarction are threatened by infratentorial herniation and impaired circulation of cerebrospinal fluid if mass effect in posterior fossa develops. Clinical assessment is often impaired in patients with disturbances of consciousness. Therefore, computed tomography (CT) examination is essential in the diagnosis of complication and decision for operative treatment. METHODS: Mass effect of cerebellar infarction was quantitatively assessed using a 3-item CT score: width of fourth ventricle, compression of quadrigeminal cistern, and width of lateral ventricle. Retest and interrater reliability was determined. Validity of assessment of mass effect was examined using 185 CT scans from a cerebellar infarction study, and the effect of operative treatment on CT score was determined. RESULTS: The correlation coefficients for retest and interrater reliability were 0.94 and 0.75, respectively. The authors found a significant difference for the CT sum score and all CT items except "compression of the fourth ventricle" between patients with different levels of consciousness. Effect of operative treatment was documented by improvement of CT score. CONCLUSIONS: The proposed CT score is of high interrater and retest reliability, supplements the clinical assessment of the patient, and is able to monitor the efficacy of decompressive treatment.     

Bilateral Cerebellar Infarctions Caused by a Stenosis of a Congenitally Unpaired Posterior Inferior Cerebellar Artery

Bilateral symmetrical cerebellar infarcts in the territory supplied by the medial posterior inferior cerebellar artery (PICA) branches are extremely rare. In the few cases published, it has not been possible to clearly pinpoint the cause of this infarct pattern. The authors present the case history of a 58-year-old man who had acute headaches accompanied by pronounced rotatory vertigo with nausea and vomiting. The neurological examination revealed bilateral cerebellar signs. Cranial magnetic resonance imaging showed bilateral, nearly symmetrical infarcts in the territory of the medial branches of both PICAs. These bilateral PICA infarctions were caused by a stenosis of an unpaired PICA originating from the left vertebral artery supplying both cerebellar hemispheres.