小脑梗塞

小脑梗塞的诊断及治疗较困难。本文综述小脑的血供、发病情况、病因、症状、进展类型、定位诊断及治疗的研究进展。     

小脑梗塞

小脑梗塞产生的症状有时象前庭疾病,腔隙综合征,常常又被同时损害的脑干症状所掩盖,所以临床诊断相当困难。本文分析我院自1988年～1994年的7年中小脑梗塞病例。 临床资料 一般资料:本组24例小脑梗塞(男17例,女7例),占我院同期脑梗塞(822例)的2.9％。年龄43～80岁(平均64.5岁)。既往     

小脑梗塞手术治疗体会

小脑梗塞是神经内科常见疾病,多采取保守治疗痊愈,但梗塞面积较大,症状严重者多预后不良.我们从1999年5月至2004年5月手术治疗小脑梗塞患者11例,效果满意,并总结如下.     

青年人大面积小脑梗塞的诊治经验(附2例报告)

小脑梗塞比较少见,约占全部脑梗塞的５％,而青年人大面积小脑梗塞更为少见,现将我们诊治的２例报告如下。例１,女,３０岁。于１９９１年３月２４日来诊。患者３天前生气后出现眩晕、恶心吐、走路不稳,给予对症处置,次日出现意识不清、尿便失禁而来诊,既往连续服用...     

小脑梗塞并发小脑扁桃体疝3例报告

小脑梗塞并发小脑扁桃体疝３例报告朴明液，吉万霞例１，女，５０岁。右利，有高血压及冠心病病史。在做饭时，突然头痛、头晕、频繁呕吐２天，于９５年２月１日入院。查体：ＢＰ２３／１６ｋＰａ，嗜睡，颈强３横指。四肢腥反射弱，右侧指鼻，跟膝胫试验不准。ＭＲＩ示：...     

小脑梗塞

报道了经ＣＴ或ＭＲ确诊的３５例小脑梗塞，占同期脑梗塞总数的３．３％，其中男２４例、女１１例，男女之比２．１：１，平均年龄６０．５岁。可能病因主要为高血压动脉硬化，其次为心源性因素．１例手术治疗预后良好，３４例保守治疗者死亡１１例，病死率为３２．３％，死亡病人均为合并脑干梗塞或并发梗阻性脑积水者。结合文献，对本病的临床诊断、分型，治疗及预后等方面进行了讨论。     

小脑梗塞的临床及MRI诊断分析

本文报告１２例小脑梗塞的ＭＲＩ检查，并与ＣＴ和临床检查对照。讨论了其病因、分型、ＭＲＩ平扫及Ｇｄ—ＤＴＰＡ增强所见，诊断和治疗。在小脑梗塞刀性期，Ｔ１加权像（Ｔ１Ｗ１）呈等信号或稍低信号，Ｔ２Ｗ１呈高信号。Ｇｄ—ＤＴＰＡ增强扫描及复查扫描对小脑梗塞与肿瘤的鉴别有重要意义。大面积小脑梗塞如能早期确诊仍可行保守治疗。     

小脑梗塞（附17例报告）

小脑梗塞（附１７例报告）何　我科１９９２年２月～１９９４年１月诊治经ＣＴ确诊的小脑梗塞１７例，现报告如下。１临床资料年龄４３～６１岁，平均５７岁。男１２例，女５例。病程３７ｈ～１．５年。均为急性起病。头昏或眩晕６例，向一侧跌倒３例，不能站立和步态共济...     

小脑梗塞（附14例报告）

小脑梗塞的临床诊断甚为困难,在CT及核磁共振(MRI)问世之前,绝大部分病例只能在尸检时才得以确诊。现将我院近几年经CT和核磁共振证实的14例报告如下,并对有关问题加以分析和讨论。临床资料一、一般资料男性8例,女性6例,男女之比为1.3:1;年龄<40岁和>71岁各1例。41～50岁4例,51～60岁5例,61～70岁3例,平均年龄56岁;既往有高血压动脉硬化病史5例,糖尿病1例。除1例呈亚急性起病外,其它13例均为急性起病,其中4例     

Diagnosis and initial management of cerebellar infarction

Cerebellar infarction is an important cause of stroke that often presents with common and non-specific symptoms such as dizziness, nausea and vomiting, unsteady gait, and headache. Accurate diagnosis frequently relies on careful attention to patients' coordination, gait, and eye movements--components of the neurological physical examination that are sometimes omitted or abridged if cerebellar stroke is not specifically being considered. The differential diagnosis is broad, and includes many common and benign causes. Furthermore, early-stage posterior fossa ischaemia is rarely seen with brain CT--the most commonly available initial imaging test that is used for stroke. Insufficient examination and imaging can result in misdiagnosis. However, early correct diagnosis is crucial to help prevent treatable but potentially fatal complications, such as brainstem compression and obstructive hydrocephalus. The identification and treatment of the underlying vascular lesions at an early stage can also prevent subsequent occurrences of stroke and improve patients' outcomes. Here, we review the clinical presentation of cerebellar infarction, from diagnosis and misdiagnosis to patients' monitoring, treatment, and potential complications.     

小脑后下动脉动脉瘤的诊断和治疗

目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。     

小脑半球髓母细胞瘤的诊断和治疗

目的：探讨小脑半球髓母细胞瘤的临床特点。方法：收集经手术证实的小脑半球髓母细胞瘤16例,对其临床资料进行回顾性分析。其中男10例,女6例,平均年龄20.3岁,常见症状和体征为高颅压征和共济失调,术前有脑积水者6例,占37.5%,16例患者均行开颅肿瘤切除术。结果：本组患者13例获随访,术后平均生存时间为74.9个月,术后5年生存率为65.2%。结论：小脑半球髓母细胞瘤与中线区髓母细胞瘤的发病年龄、临床症状及预后均有所不同,临床上较易误诊,小脑半球髓母细胞瘤发病年龄较大,转移较少,预后较好。     

儿童小脑毛细胞型星形细胞瘤的诊治(附15例报告)

目的总结儿童小脑毛细胞型星形细胞瘤的临床资料，探讨其诊治特点。方法分析儿童小脑毛细胞型星形细胞瘤15例的影像学、病理学特点及术中所见和预后情况。结果肿瘤全切除13例，次全切或大部切除2例。术后发热2例，均于术后3d内消失；头痛2例，随病情好转而逐渐消失。余病例未出现新的症状和体征。术后随访未见到复发。结论儿童小脑毛细胞型星形细胞瘤有其独特的临床特点，在条件允许的情况下应尽可能切除肿瘤。     

肿瘤样脑梗塞的诊治

目的探讨肿瘤样脑梗塞的诊断及鉴别诊断。方法回顾性分析6例术前诊断为脑肿瘤，术后经病理证实为脑梗塞病例的临床表现及影像学特点、诊治经过及病程转归。结果6例均经手术治疗，术后病理证实为脑梗塞。术前诊断：4例为胶质瘤，1例为转移瘤，1例为胆脂瘤。5例治愈，1例轻残。结论正确的鉴别有助于脑梗塞患者的明确诊断而免于不必要的手术，对于占位效应明显或合并出血、感染的病人应手术治疗。动态观察可避免误诊。     

Late hemorrhagic transformation of cerebellar infarction under anticoagulant treatment

Anticoagulant treatment after cerebral infarcts is still debated due to the imperfectly evaluated risk of hemorrhagic transformation. In the case reported here the hemorrhage developed during anticoagulant treatment instituted 18 days after the onset of the infarct. The role of previously administered aspirin is discussed.     

Clinical outcome following surgical treatment for bilateral cerebellar infarction

Tsitsopoulos PP, Tobieson L, Enblad P, Marklund N. Clinical outcome following surgical treatment for bilateral cerebellar infarction.
Acta Neurol Scand: 2011: 123: 345–351.
© 2010 John Wiley & Sons A/S. Objectives – To analyze the initial clinical and radiological findings, the surgical treatment, and the clinical outcome following surgical decompression in patients with space‐occupying bilateral cerebellar infarction. Materials and Methods – Ten patients with expansive bilateral cerebellar infarction and decreased level of consciousness were operated with suboccipital craniectomy, removal of the infarcted tissue, and placement of external ventricular drainage. Long‐term outcome was assessed using the modified Rankin scale (mRS). Results – Mean Glasgow coma scale (GCS) score before surgery was 8.9 ± 3.3 and improved to 12.6 ± 3.6 at discharge. At the long‐term follow‐up (median 57.6 months), six patients had a favorable outcome (mRS 1.3 ± 0.8). Four patients, all with an associated brain stem infarct, had a poor outcome. Conclusions – In the absence of brain stem infarcts, surgical treatment resulted in a favorable clinical outcome and should be considered a treatment option for patients with expansive bilateral cerebellar infarction.