小脑前下动脉梗死1例报告

小脑前下动脉梗死 ,临床上罕见 ,现报告 1例如下。1　病例　男 ,6 8岁。因眩晕、口角歪斜 6小时于 1999年 11月 2 7日入院。入院前 18小时活动中出现头晕伴恶心 ,无视物旋转 ,约 2小时缓解。 6小时前晨起出现视物旋转、言语不清、口角歪斜、右面部麻木、右外耳道针刺样疼痛、耳鸣、耳聋及吞咽困难、饮水呛咳。平素体健 ,否认高血压病史。查体 :意识清楚 ,构音障碍 ,颜面无汗。双眼可见水平及旋转眼震 ,右面部针刺觉减退 ,右额纹消失 ,鼻唇沟变浅 ,右眼裂大 ,右眼闭合困难 ,示齿口角左偏 ,右耳音叉试验为骨导 >气导。软腭运动差。四肢肌力 …     

小脑前下动脉梗死的临床及影像学特点

目的探讨小脑前下动脉（AICA）梗死的临床及影像学特点。方法回顾性分析32例患者的临床资料。结果AICA梗死绝大多数以眩晕、小脑性共济失调为首发表现，第Ⅷ对颅神经受累是其特征性表现。MRI上表现为桥脑外下侧或（和）小脑中脚区域的梗死。AICA梗死预后较好，但有可能进展为基底动脉梗死。结论AICA梗死的诊断主要依靠MRI，预后较好。     

小脑前下动脉梗死的临床与磁共振成像的研究

目的 研究小脑前下动脉(AICA)梗死的临床表现及磁共振成像(MRI)特征。方法 对我院1997年1月～2001年6月4年半间通过磁共振成像(MRI)确诊的19例AICA梗死患者进行临床及MRI观察。结果AICA梗死占同期急性脑梗死的1.47％,占同期小脑梗死22.1％。危险因素与一般缺血性脑卒中午相似,即高血压、高脂血症、糖尿病是其主要的危险因素。所有患者均有眩晕及小脑性共济失调的症状体征;除一名患者外均有颅神经受累,以Ⅷ、Ⅶ、v最多见。第Ⅶ颅神经受累是AIcA梗死的一个特征性改变。AICA梗死预后较好。结论 AICA梗死并非罕见,应提高对AICA梗死临床表现及MRI特征的认识,以降低临床误诊率。     

小脑前下动脉梗死综合征16例分析

小脑前下动脉梗死(AICA)是由于小脑前下动脉血栓形成或基底动脉闭塞所致。临床表现可有：眩晕，病变同侧共济失调。耳鸣耳聋，周围性面瘫。面部痛觉减退，Horner征，向病灶侧同向凝视麻痹，对侧肢体痛温觉减退。其中第Ⅶ颅神经受累是其特征性表现。1998年～2004年2月我科共收治该病患者16例，现总结如下。     

小脑前下动脉综合征1例报告

患者,男,６９岁。因突发眩晕、视物旋转、呕吐、行走不稳和左耳聋５天于２００１年３月９日入院。既往有高血压病史５年。查体：血压２６．７／１３．３ｋＰａ,神清、语明．心肺（－）。双眼向右倒凝视,向左倒凝视时可见永平眼震,左侧Ｈｏｒｎｅｒ征,左侧面部痛觉减低,左侧周围性面瘫,左倒角膜反射消失。左耳聋。四肢肌力、肌张力、腱反射正常,锥体束征（－）。右侧颈以下肢体躯于痛觉减低。左创指鼻试验、跟膝腔试验不准。血糖：４．９２ｍｍｏｌ／Ｌ,胆固醇５．７３ｍｍｏｌ／Ｌ、甘油三脂１．８ｍｍｏｌ／Ｌ、高密度脂蛋白１．…     

双侧大脑前动脉梗死3例报告

双侧大脑前动脉同时梗死的情况很少见 ,现将我们遇到的 3例报告如下。例 1,女 ,49岁 ,工人 ,既往有高血压病史 4年 ,因晕厥伴双下肢无力入院。入院后病情逐渐加重 ,出现反应迟钝、语言少 ,但能正确回答问题 ,发热 ,体温 37℃～ 39℃之间 ,但无感染征象。以后出现嗜睡 ,言语不清 ,右侧肢体肌力差 ,上肢肌力 1级 ,下肢肌力 2级 ,右侧病理征 ( +) ,考虑为大面积脑梗死。给予尿激酶 10 0万 U静脉溶栓 ,并予甘露醇脱水治疗 ,病情继续进展 ,出现左下肢瘫 ,肌力 2～ 3级 ,并出现排尿障碍及呕吐 ,急查头颅 CT示双侧额叶脑梗死。一周后患者意识转清…     

小脑前下动脉综合征一例

正1病例资料患者,男性,62岁。主因"反复头晕21天"于2015年9月6日入院。患者21 d前无明显诱因出现眩晕、复视,伴呕吐,为胃内容物,10 min后出现左耳明显听力下降,耳鸣,至外院住院治疗,诊断为"突发性耳聋",给予甲强龙冲击、高压氧治疗及对症治疗后症状改善,但仍有眩晕、复视、耳鸣、听力下降等症状,转到我院进一步诊治。既往史:高血压病1 0年,最高血压     

急性孤立性双侧小脑中脚梗死1例报告并文献复习

<正>小脑中脚(MCP)由对侧脑桥核发出的白质纤维组成,是皮质小脑通路的一部分。MCP由多条血管供血,该区域梗死并不常见,而孤立性双侧MCP梗死则更为罕见。本文报道1例孤立性双侧小脑中脚梗死病例的诊治经过,结合文献资料简要探讨孤立性双侧小脑中脚梗死的病因、发病机制、诊断及治疗。1病例资料患者,男性,54岁,因"头晕5 d,走路不稳11 h"于2019-03-21入院。患者入院前5 d无明显诱因出现头晕,天旋地转感,于平卧后可缓解,但仍有头昏沉感,坐位及站立时加重。伴恶心,呕吐胃内容物数次,无头痛、耳鸣、听力下降、视物双影。入院前11 h患者出现站立及行走不稳。急诊行头部核     

小脑前下动脉瘤五例报告

目的探讨小脑前下动脉（AICA）动脉瘤的临床特征、治疗方式的选择及操作技巧。方法回顾性分析5例AICA动脉瘤的临床资料。结果AICA远端囊性动脉瘤3例，其中2例位于内听道口，1例化于小脑绒球腹侧、面听神经背侧，并伴有同侧小脑半球小型隐匿性血管畸形，术中借助神经内镜发现动脉瘤，3例均行手术夹闭，并于术后住院期间行脑血管造影复查，夹闭满意；AICA近端囊性动脉瘤2例，均采用血管内介入治疗。患者预后优4例，良1例。结论AICA远端动脉瘤宜首选手术夹闭，术是辅助神经内镜有助于提高显微手术效果；AICA近端动脉瘤宜首选血管内介入治疗。     

Anterior and posterior inferior cerebellar artery infarction with sudden deafness and vertigo

We report a patient with anterior and posterior inferior cerebellar artery infarction, which manifested as profound deafness, transient vertigo, and minimal cerebellar signs. We suspect that ischaemia of the left internal auditory artery, which originates from the anterior inferior cerebellar artery, caused the deafness and transient vertigo. A small lesion in the middle cerebellar peduncle in the anterior inferior cerebellar artery territory and no lesion in the dentate nucleus in the posterior inferior cerebellar artery territory are thought to explain the minimal cerebellar signs despite the relatively large size of the infarction. Thus a relatively large infarction of the vertebral-basilar territory can manifest as sudden deafness with vertigo. Neuroimaging, including magnetic resonance imaging, is strongly recommended for patients with sudden deafness and vertigo to exclude infarction of the vertebral-basilar artery territory.     

Ocular torsion associated with infarction in the territory of the anterior inferior cerebellar artery: frequency, pattern, and a major determinant

BACKGROUND: Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) can cause the vestibular dysfunction in the roll plane of the vestibuloocular reflex with abnormal ocular torsion (OT). There has been no systemic study that carefully investigates the nature of OT that occurs with AICA infarction. OBJECTIVES: To investigate the frequency, the characteristic patterns of OT associated with AICA territory infarction, and the crucial site for determining the direction of OT in AICA territory infarction. METHODS: We studied 12 consecutive cases of infarction in the territory of the AICA diagnosed by brain MRI. Fundus photography, prism cover test, and subjective visual vertical tilting test were performed to evaluate the function of the otolith system. Pure tone audiogram was also performed to evaluate the function of the auditory system. RESULTS: Nine (75%) of 12 patients exhibited pathological ocular torsion (OT). Two types of pathological OT were found: ipsiversive OT accompanying skew deviation (n=6), and contraversive OT only (n=3). Six patients with ipsiversive OT with skew deviation showed an audiovestibular loss with canal paresis and hearing loss ipsilaterally whereas three patients with contraversive OT without skew deviation had a normal audiovestibular response. In all cases with pathological OT, the direction of the subjective visual vertical tilt corresponded to the direction of the OT. CONCLUSIONS: Our findings emphasize that the peripheral vestibular structure with inner ear probably plays a crucial role in determining the direction of OT associated with AICA territory infarction.     

Bilateral simultaneous cerebellar infarction in the medial branches of the posterior inferior cerebellar artery territories

We present an unusual case of simultaneous bilateral cerebellar infarction in the territory of the medial and intermediate branches of the posterior inferior cerebellar arteries (mPICA). The patient, a 57-yr old woman, had no risk factors for cerebrovascular disease but a long-standing hypertension. Pathogenetic hypotheses of this unusual ischemic site of lesion may be referred to: A) two PICAs arising from an occluded basilar artery; B) both medial branches arising from the same PICA on one side; C) a haemodynamic mechanism with hypoperfusion in the most peripheral branches of the arteries; D) a double, simultaneous embolic stroke in mPICAs territory. Based on clinical course, supraortic duplex-scan, echocardiography, MRI, angioMRI and CT scans, and digital subtraction angiography, none of these hypotheses could be clearly associated with the pathogenesis of the lesion. Nevertheless, we propose that an anomalous common mPICA for both cerebellar territories should represent the necessary condition for the ischemic insult and, simultaneously, other factors should intervene as possible determining events.

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Sommario Descriviamo il caso di un infarto bilaterale nel territorio delle branche mediali della arteria cerebellare postero inferiore (mPICA). La paziente, una donna di 57 anni, non aveva fattori di rischio per cerebropatia vascolare, eccettuata una lunga storia di ipertensione arteriosa. Sono state formulate diverse ipotesi patogenetiche in grado di giustificare questo inusuale sito di lesione: A) due PICA che originino da una arteria basilare occlusa; B) entrambe le branche mediali che originino dalla stessa PICA in un lato; C) una genesi emodinamica con una ipoperfusione nelle branche più periferiche delle arterie; D) un doppio simultaneo stroke embolico nel territorio delle mPICA. Sulla base del decorso clinico e degli esami strumentali (Ecodoppler dei vv. epiaortici, ecocardiogramma, RM, angioRM, TC ed angiografia digitale intrarteriosa) nessuna di queste ipotesi può essere singolarmente considerata come responsabile della lesione. Proponiamo, quindi, che una anastomosi tra le PICA debba rappresentare la necessaria predisponente condizione sulla quale siano poi intervenuti ulteriori fattori determinanti l'evento ischemico acuto.

     

小脑后下动脉解剖变异致双侧小脑梗死2例报道并文献复习

目的 探讨小脑后下动脉(posterior inferior cerebellar artery, PICA)解剖变异致双侧小脑梗死的临床特征及发病机制。方法 对2例经颅脑MRI确诊的双侧小脑梗死患者采用CT血管造影(CTA)、磁共振血管成像(MRA)或数字减影血管造影(DSA)显示其头颈部血管,从而了解后循环血管的形态特征并复习相关文献。结果 病例1经DSA证实左侧椎动脉较细,远端管腔闭塞,通过右椎动脉代偿供血原左侧PICA供血区但欠充分,双侧PICA共同起源于右侧椎动脉。病例2经CTA证实右侧椎动脉较左侧明显细且远端显示欠清,MRA示双侧PICA共同起源于左侧椎动脉。结论 2例双侧小脑梗死患者均存在一侧椎动脉优势供血,且双侧PICA共同起源于该侧椎动脉。在该解剖变异基础上一侧椎动脉发生病变时可出现双侧小脑梗死。因此,在临床中出现双侧小脑梗死时临床医师不能忽略这一解剖变异基础。     

Lesion patterns and etiology of ischemia in the anterior inferior cerebellar artery territory involvement: a clinical – diffusion weighted – MRI study

The topography and mechanism of stroke in the anterior inferior cerebellar artery (AICA) territory are delineated before, but the detailed clinical spectrum of lesions involving AICA territory was not studied by diffusion weighted imaging (DWI). We reviewed 1350 patients with posterior circulation ischemic stroke in our registry. We included patients if the diagnosis of AICA territory involvement was confirmed, and DWI, and magnetic resonance angiography were obtained in the 3 days of symptoms onset. The potential feeding arteries of the AICA territory were evaluated on magnetic resonance imaging (MRI) using a three-dimensional rotating cineoangiographic method. There were 23 consecutive patients with lesion involving AICA territory, six with isolated lesion in the AICA territory, six with posterior inferior cerebellar artery, 11 with multiple posterior circulation infarcts (MPCIs). The clinical feature of isolated AICA infarct was vertigo, tinnitus, dysmetria, ataxia, facial weakness, facial sensory deficits, lateral gaze palsy, and sensory-motor deficits in patients with pontine involvement. Patients with largest lesion extending to the anterior and inferolateral cerebellum showed mixed symptomatology of the lateral medullary (Wallenberg's syndrome) and AICA territory involvement. Patients with MPCIs presented various clinical pictures with consciousness disturbances and diverse clinical signs because of involvement of different anatomical structures. Large-artery atherosclerotic disease in the vertebrobasilar system was the main cause of stroke in 12 (52%) patients, cardioembolism (CE) in one (4%), and coexisting large-artery disease and a source of CE in four (17%). The main cause of stroke was atheromatous vertebrobasilar artery disease either in the distal vertebral or proximal basilar artery. The outcome was usually good except those with multiple lesions. The new MRI techniques and clinical correlations allow better definition of the diverse topographical and etiological spectrum of AICA territory involvement and associated infarcts which was previously based on pathological and conventional MRI studies.