小脑前下动脉梗死的临床特征及病因探讨(附22例报告)

目的 分析小脑前下动脉(AICA)梗死的临床表现及MR改变，并探讨AICA梗死形成的原因。方法 对22例AICA梗死患者的临床表现、MRI及MRA进行分析。结果 AICA梗死的主要累及小脑中脚和(或)脑桥外下方，其症状体征以眩晕及共济失调为主，可合并多组颅神经受累，以Ⅷ对颅神经受累最具特征性。MRA上单纯AICA梗死单侧者，基底动脉(BA)显示良好，双侧AICA梗死及合并其它小脑梗死者BA未显影或显示狭窄。结论 AICA梗死的诊断主要依靠MRI，MRA对判定病因及预后有重要意义。     

小脑各动脉梗死的临床及影像学研究

目的 研究小脑各动脉梗死的临床表现及MRI、MRA(DSA)特征。方法 对我院2001年6月1日～2003年5月31日2年间经MRI确诊的45例小脑梗死患进行临床及MRI观察。结果 小脑梗死占同期急性脑梗死的7．1％。主要危险因素为高血压、糖尿病、高脂血症、冠心病。88．9％首发头晕，11．1％首发意识障碍，82．2％急性起病，17．8％进展性起病，进展病程5～14天。可伴有颅神经受累等脑干损害。大部分小脑梗死患预后尚好。结论 应提高对小脑梗死临床表现及小脑各动脉灌注区MRI特征的认识，起源动脉(如椎动脉或基底动脉)粥样斑块延伸，或分支区域低灌注可能是引起后循环多条动脉灌流区梗死的主要原因。     

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。     

急性双侧小脑梗死

目的 探讨急性小脑梗死的临床和影像学表现特点和相互关系,病因和发生机制以及预后.方法 选择我科住院的15例双侧小脑多发性梗死患者,对其血管危险因素、临床表现、MRI病变形态、分布和临床的关系,可能的病因性发病机制以及预后进行分析.结果 本组双侧小脑梗死占全部小脑梗死患者的23.8%.急性双侧小脑梗死以双侧PICA供血区的多发性梗死最多见(66.7%).主要临床表现为头晕/眩晕(93.3%)、恶心、呕吐(93.3%)、共济失调(60%)和构音障碍(58.7%).双侧小脑梗死多表现为大病变侧的单侧体征如共济失调.除上述小脑症状外,双侧PICA供血区梗死,特别是内侧支分布区受累(6例)时,突出的临床表现为眩晕,其中4例表现为孤立性假性眩晕;AICA梗死患者的特征表现为双侧耳聋;而SCA供血区梗死的临床表现特点是构音障碍、单侧共济失调,偶可出现大病变对侧的耳聋.Rankin评分均在3分或3分以下,死亡1例.结论 急性小脑多发性梗死主要发生于双侧PICA供血区,主要临床症状和体征为头晕/眩晕、恶心呕吐、共济失调等体征多数限局于单侧肢体,出现于小脑梗死较大的一侧.病因多数为心源性栓塞或主动脉粥样硬化性栓塞所致.预后较好.     

双侧小脑中脚梗死10例临床特点和病因学初步研究

目的探索双侧小脑中脚梗死的临床和影像学特征、病因和潜在机制, 以提高临床认识。方法回顾性连续性收集首都医科大学附属北京天坛医院2020年1月1日至2022年4月30日诊断为急性双侧小脑中脚梗死患者的临床资料, 记录其入院时社会人口学数据、脑卒中危险因素、临床症状和体征以及入院时美国国立卫生研究院卒中量表(NIHSS)评分。根据头颅磁共振弥散成像评估其脑梗死的部位和特点, 头颅磁共振血管造影或计算机断层血管造影成像评估其椎-基底动脉颅外段和颅内段血管情况。采用中国缺血性卒中病因分型评估脑梗死病因学分型和发病机制。结果本研究共纳入10例双侧小脑中脚急性梗死患者, 其中男性8例, 女性2例, 发病年龄51.0～86.0(64.8±11.4)岁, 入院时NIHSS评分为2.0～12.0(4.9±2.9)分。所有患者均有脑卒中危险因素, 最常见的是高血压(10例)和脂蛋白代谢异常(8例)。最常见的临床表现为眩晕(10例), 其次是共济失调(9例)和构音障碍(8例)。10例中4例为孤立性双侧小脑中脚梗死, 6例合并其他椎-基底动脉供血脑区梗死, 其中4例为合并小脑半球梗死, 与临床症状相一致。所有...     

小脑分水岭梗死患者临床及影像学特点分析

目的分析小脑分水岭梗死患者的临床特点及影像学特征。方法收集房山区第一医院神经内科2011-09-2014-12住院的小脑梗死患者147例,均行头颅MRI、椎动脉彩超、经颅多普勒(TCD)、颅内动脉核磁血管造影(MRA)检查,必要时进行计算机断层摄影血管造影(CTA)和/或数字减影血管造影(DSA)检查。根据小脑梗死部位将患者分为小脑区域性梗死组和小脑分水岭梗死组,比较两组患者的危险因素、临床及影像学特点。结果 (1)小脑区域性脑梗死109例,小脑分水岭梗死38例(25.9%),两组在年龄、性别构成以及合并高血压、糖尿病、高脂血症、吸烟及心房纤颤比例比较无统计学差异。(2)与区域性脑梗死比较,小脑分水岭脑梗死组失水状态、晕厥等前驱症状发生率较高(21.1%比9.2%,P=0.026),后循环多发病灶发生率较低(21.1%比38.5%,P=0.002),NHISS评分低(2.7±1.9比6.1±2.5,P=0.000)。(3)两组小脑梗死患者发生后循环大血管病变比例无统计学差异(52.6%比36.7%,P=0.085);分析非心源性脑梗死病例发现,分水岭梗死存在大动脉狭窄几率高于区域性脑梗死(47.4%比30.2%,P=0.002)。结论小脑分水岭梗死与区域性脑梗死相比危险因素相同,病因略有不同。分水岭梗死患者临床症状轻,但前驱症状发生率高。     

68例急性小脑梗死患者的颅脑磁共振特点与病因及预后的关系

目的 探讨急性小脑梗死患者颅脑磁共振特点与病因及预后的关系。方法 收集临床及影像学检查确诊的68例急性小脑梗死患者,总结其颅脑磁共振特点,分析不同供血动脉受累的相关病因及预后。结果 PICA组比例最高为44.1%,SCA组占16.2%,AICA组占10.3%,多动脉受累组占11.8%,同时伴幕上受累组占17.6%。大动脉粥样硬化是PICA梗死的主要原因(P<0.05),心源性栓塞是伴幕上受累的小脑梗死的主要原因(P<0.05),其余动脉供血区梗死未见明显相关病因(P>0.05)。出院时及3个月后随访时mRS≥3或死亡患者例数多动脉受累组明显多于单动脉受累组,且差异明显(P<0.05)。结论 TOAST分型中的大动脉粥样硬化型和心源性栓塞与受累动脉供血区有一定关系,多动脉受累比单动脉受累预后差。     

小脑梗死52例临床分析

目的深入探讨小脑梗死的病因、临床表现、影像学改变、诊断及治疗。方法对1997年4月～2002年11月我院收治的52例小脑梗死患者的临床资料进行回顾性分析。结果该病51～60岁为高发年龄段，病因及危险因素主要为高血压病及心脏病。最主要的临床表现为眩晕、小脑性共济失调。此外．头痛重要又易被忽视．占本组患者的32．7％。头部CT48h内阳性率30．8％。头部MRI确诊率100％。46例经内科保守治疗．6例行外科于术治疗．总治愈率48．1％．死亡率5．8％．脑疝为主要死因。结论中老年人持续出现眩晕、共济失调要注意小脑梗死的可能．头部MRI确诊小脑梗死优于头部CT．一般采用内科保守治疗．病情严重者应外科手术，防治脑疝。     

急性小脑、小脑脚梗死的临床特点与MRI分型

目的 探讨急性小脑、小脑脚梗死的MRI分型与临床表现之间的关系。方法 对45例小脑、小脑脚梗死患者的临床及MRI资料进行分析,并对MRI表现按动脉支配区进行分型。结果 小脑下后动脉（PICA）区梗死23例,小脑下前动脉（AICA）区梗死13例,小脑上动脉（SCA）区硬死9例;小脑脚型16例,小脑脚小脑型17例,小脑型12例;各类型的临床表现均有其特点。结论 MRI分型可提高对本病的诊断水平。     

Multiple large and small cerebellar infarcts

To assess the clinical, topographical, and aetiological features of multiple cerebellar infarcts,18 patients (16.5% of patients with cerebellar infarction) were collected from a prospective acute stroke registry, using a standard investigation protocol including MRI and magnetic resonance angiography. Infarcts in the posterior inferior cerebellar artery (PICA)+superior cerebellar artery (SCA) territory were most common (9/18; 50%), followed by PICA+anterior inferior cerebellar artery (AICA)+SCA territory infarcts (6/18; 33%). One patient had bilateral AICA infarcts. No infarct involved the PICA+AICA combined territory. Other infarcts in the posterior circulation were present in half of the patients and the clinical presentation largely depended on them. Large artery disease was the main aetiology. Our findings emphasised the common occurrence of very small multiple cerebellar infarcts (<2 cm diameter).These very small multiple cerebellar infarcts may occur with (13 patients/18; 72%) or without (3/18; 22%) territorial cerebellar infarcts. Unlike previous series, they could not all be considered junctional infarcts (between two main cerebellar artery territories: 51/91), but also small territorial infarcts (40/91). It is suggested that these very small territorial infarcts may be endzone infarcts, due to the involvement of small distal arterial branches. It is possible that some very small territorial infarcts may be due to a microembolic process, but this hypothesis needs pathological confirmation.     

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.     

The anterior inferior cerebellar artery infarcts: a clinical-magnetic resonance imaging study

Acute infarcts of the anterior inferior cerebellar artery (AICA) are unusual. We report 15 cases of AICA infarcts and their correlation with the topography of the lesion by brain MRI. During 2 years we prospectively identified 7 cases of AICA infarcts among 770 acute strokes (0.9% of the acute strokes seen in our department). We studied these cases and also another 8 that we found retrospectively. Most patients (8/15) had a unilateral affeétation of both middle cerebellar peduncle (MCP) and inferior lateral pontine area (ILP), in these cases the main symptoms were vertigo, ataxia, peripheral facial palsy and hypoacusia. Two other patients had isolated MCP infarcts and were characterized by peripheral vertigo and ataxia, without hypoacusia or facial palsy. Another 2 patients had isolated ILP territory infarct characterized by vertigo, left peripheral facial palsy without hypoacusia and mild or no ataxia. One patient had a Gasperini syndrome. Finally 3 patients had bilateral AICA infarcts due to basilar thrombosis. The etiology was atherosclerosis in 9 patients, lacunar due to hypertension in 1, cardiac embolism in 1, migraine in 1 and unknown in 3. Among the 15 patients only 2 died, both with AICA plus infarcts. In the remaining patients a follow-up during a mean of 31 months (3 months to 12 years) showed no recurrences.     

The clinical and topographic spectrum of cerebellar infarcts: A clinical—magnetic resonance imaging correlation study

We studied 34 consecutive patients with non–mass-producing cerebellar infarcts using a standard protocol of investigations including magnetic resonance imaging (MRI). We analyzed the topography of infarcts to determine the involved arterial territories and we correlated the findings with neurological dysfunction and potential causes of stroke. Sixteen patients had an infarct in the territory of the posterior inferior cerebellar artery (PICA); 2, in the territory of the anterior inferior cerebellar artery (AICA); 13, in the territory of the superior cerebellar artery (SCA); and 8 had junctional infarcts between the territories of the medial and lateral branches of the PICA or PICA/SCA territories. PICA or medial PICA territory infarcts were manifested by acute vertigo and truncal ataxia, while the patients with lateral PICA territory infarcts presented with unsteadiness, limb ataxia and dysmetria without dysarthria. Patients with infarcts in the AICA territory were characterized by limb and trunk ataxia associated with signs of lateropontine involvement. Patients with SCA territory infarcts presented with dysarthria, unsteadiness and/or vertigo, limb ataxia, and dysmetria. Cardiac embolism was the main cause of large infarcts in the territories of the PICA (8/16) or SCA (4/7). Multiple small infarcts were associated with vertebrobasilar atherosclerosis (8/12). These clinical–MRI correlations allow better definition of the topographic and etiological spectrum of cerebellar infarction, which was previously based on pathological studies in subjects with severe infarction.     

Vertigo and the anterior inferior cerebellar artery syndrome.

We present two patients with clinical features of infarction in the distribution of the anterior inferior cerebellar artery (AICA) who had vertigo as an isolated symptom for several months prior to infarction. Both had risk factors for cerebrovascular disease and other episodes of transient neurologic symptoms not associated with vertigo. At the time of infarction they developed vertigo, unilateral hearing loss, tinnitus, facial numbness, and hemiataxia. MRI identified hyperintense lesions in the lateral pons and middle cerebellar peduncle on T2-weighted images. Audiometry and electronystagmography documented absent auditory and vestibular function on the affected side. Since the blood supply to the inner ear and the vestibulocochlear nerve arises from AICA, a combination of peripheral and central symptoms and signs is characteristic of the AICA infarction syndrome. The vertigo that preceded infarction may have resulted from transient ischemia to the inner ear or the vestibular nerve.     

Cluster analysis and patterns of findings on cranial magnetic resonance imaging of the elderly: the Cardiovascular Health Study

OBJECTIVE: To characterize patterns of findings on cranial magnetic resonance imaging (MRI) of the elderly using a statistical technique called cluster analysis. SUBJECTS AND METHODS: The Cardiovascular Health Study is a population-based, longitudinal study of 5888 people 65 years and older. Of these, 3230 underwent cranial MRI scans, which were coded for presence of infarcts and grades for white matter, ventricles, and sulci. Cluster analysis separated participants into 5 clusters based solely on patterns of MRI findings. Participants comprising each cluster were contrasted with respect to cardiovascular risk factors and clinical manifestations. RESULTS: One cluster was low on all the MRI findings (normal) and another was high on all of them (complex infarcts). Another cluster had evidence for infarcts alone (simple infarcts), whereas the last 2 clusters lacked infarcts, one having enlarged ventricles and sulci (atrophy) and the other having prominent white matter changes and enlarged ventricles (leukoaraiosis). Factors that distinguished these clusters in a discriminant analysis were age, sex, several measures of hypertension, internal carotid artery wall thickness, smoking, and prevalent claudication before the MRI. The atrophy group had the highest percentage of men and the normal group had the lowest. Cognitive and motor performance also differed across clusters, with the atrophy cluster performing better than may have been expected. CONCLUSIONS: These MRI patterns identified participants with different vascular disease risk factors and clinical manifestations. Results of these exploratory analyses warrant consideration in other populations of elderly people. Such patterns may provide clues about the pathophysiology of structural brain changes in the elderly.     

无共济失调小脑梗死12例临床分析

目的:探讨无共济失调小脑梗死的临床特点、梗死区域及早期诊断对疾病预后的意义。方法:回顾性分析12例以眩晕为主要症状但无共济失调表现的小脑梗死的临床资料。结果:患者年龄58～78岁,CT检查未发现梗死灶,MRI阳性率为100%。脑梗死主要危险因素为高血压、糖尿病、高脂血症和心房颤动。11例患者小脑梗死的病灶主要位于单侧小脑半球后下部,属于小脑后下动脉(PICA)供血区域;1例小脑梗死的病灶位于小脑蚓部后部及其附近的两侧小脑半球,属于小脑后下动脉中间支(mPICA)供血区域。结论:无共济失调小脑梗死常见于PICA供血区。对于中老年眩晕患者,无论有无共济失调表现,都应完善MRI检查明确有无小脑梗死。     

后组颅神经及相关结构MRI研究

目的 通过正常人体后组颅伸经及相关结构的研究，为颅底病变的诊断和治疗提供可靠的影像解剖学依据。方法 健康志愿者120例行后组颅神经及周围结构MRI检查并进行相关影像学测量。结果 后组颅神经均不同程度存在血管压迫现象（右侧：16％、左侧：10％）；双侧舌咽-迷走-副神经复合体之间的距离男性大于女性（P=0.013＜0．05），并与个体的发育有关系；舌咽-迷走-副神经复合体与脑干正中矢状化之间的夹角与年龄关系非常密切，性别间无显著性差异。结论采 用MRI扫描序列获得的正常人体后组颅神经及相关参考值为临床提供了重要的断面影像学依据。     

Atherothrombotic cerebellar infarction: vascular lesion-MRI correlation of 31 cases.

BACKGROUND AND PURPOSE: Correlation of MRI findings with atherosclerotic vascular lesions has rarely been attempted in patients with cerebellar infarction. The aim of this study was to correlate the MRI lesions with the vascular lesions seen on conventional cerebral angiography in cerebellar infarction. METHODS: The subjects included 31 patients with cerebellar infarcts who underwent both MRI and conventional cerebral angiography. We analyzed the risk factors, clinical findings, imaging study, and angiography results. We attempted to correlate MRI lesions with the vascular lesions shown in the angiograms. RESULTS: The vascular lesions seen on angiograms were subdivided into 3 groups: large-artery disease (n=22), in situ branch artery disease (n=6), and no angiographic disease with hypertension (n=3). The proximal segment (V1) lesions of vertebral artery were the most common angiographic features in patients with large-artery disease in which stroke most commonly involved the posterior inferior cerebellar artery (PICA) cerebellum. The V1 lesions with coexistent occlusive lesions of the intracranial vertebral and basilar arteries were correlated with cerebellar infarcts, which had no predilection for certain cerebellar territory. The intracranial occlusive disease without V1 lesion was usually correlated with small cerebellar lesions in PICA and superior cerebellar artery (SCA) cerebellum. The subclavian artery or brachiocephalic trunk lesion was associated with small cerebellar infarcts. The in situ branch artery disease was correlated with the PICA cerebellum lesions, which were territorial or nonterritorial infarct. No angiographic disease with hypertension was associated with small-sized cerebellar infarcts within the SCA, anterior inferior cerebellar artery, or SCA cerebellum. CONCLUSIONS: Our study indicates that the topographic heterogeneity of cerebellar infarcts are correlated with diverse angiographic findings. The result that large-artery disease, in which nonterritorial infarcts are more common than territorial infarcts, is more prevalent than in situ branch artery disease or small-artery disease, suggest that even a small cerebellar infarct can be a clue to the presence of large-artery disease.     

The impact of magnetic resonance imaging on the management of acute ischemic stroke.

Despite rapid advances in imaging technology, the etiology of stroke remains unestablished in 40% of patients. MRI improves localization in acute stroke. However, it is not known whether "accurate localization" results in better management. We reviewed the hospital records of all patients admitted with a diagnosis of acute ischemic stroke and who had had cranial CTs and MRI within 10 days of admission. Between January 1987 and June 1990, 116 patients (69 men, 47 women; mean age, 66 years) were identified. Compared with CT localization, infarcts were better localized in nine of 39 patients with cerebral cortical lesions, in 20 of 22 patients with brainstem and cerebellar lesions, and in three of three patients with isolated cerebellar lesions. In 22 patients (18.9%), MRI showed multiple infarcts in two or more vascular territories, suggesting embolic disease and leading to anticoagulation. MRI also showed arterial occlusions in 11 patients (9.5%). Based on the information obtained with MRI, the clinical diagnosis was changed in 19 patients (16.3%), resulting in changes in the management of most of those patients. Thus, we confirm earlier reports that MRI improves localization after acute cerebral infarction and show that such information alters patient management.