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。

Analysis for Clinical Features of Cerebellar Infarction in 119 Patients

ABSTRACT Aim To investigate the etiological type of Chinese Ischemic Stroke Subclassiifcation (CISS), the lesion distribution, the concomitant lesions outside the cerebellum and the clinical manifestations in patients with acute cerebellar infarction.MethodsThe MRI images, the etiological examination ifndings and the clinical manifestations of 119 patients with acute cerebellar infarction who were admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed.ResultsAmong 119 cases of cerebellar infarction patients, 78 cases were classiifed to unilateral cerebellar infarction (UCI), 41 caseswere bilateral cerebellar infarction (BCI). The main etiological type of CISS was large artery atherosclerosis (LAA), followed by cardiogenic stroke (CS), mixing mechanism, penetrating artery disease (PAD) and other etiologies. There was no signiifcant difference in CISS between the BCI group and the UCI group. In the UCI group, posterior inferior cerebellar artery (PICA) infarction had the highest occurrence rate (36%), and there was a difference between the two groups (P<0.01). PICA+SCA infarction had the highest occurrence rate (39%) in the BCI group, but there was no signiifcant difference between the two groups; the remaining territory infarction occurrence rate in the two groups had no difference. 63 cases (52.9%) had concomitant lesions outside the cerebellum. The incidence of concomitant lesions outside the cerebellum in posterior circulation of BCI group (54%) was higher than that of the UCI group (P<0.05), while the incidence of concomitant anterior circulation lesions of the UCI group was higher than that of the BCI group (P<0.05). The main symptoms and signs included dizziness/vertigo, nystagmus, OTR, hearing impairment, cerebellar dysarthria, ataxia, and superifcial sensory disturbance, pyramidal tract sign and disturbance of consciousness. The incidence of conscious disturbance in the BCI group was higher than that in the UCI group (P<0.01), but there were no signiifcant differences of other symptoms and signs between the two groups.Conclusion
The main etiology of cerebellar infarction was large artery atherosclerosis, PICA infarction could be observed most frequently in unilateral cerebellar infarction. Bilateral cerebellar infarction was often associated with concomitant lesions outside the cerebellum in posterior circulation. Unilateral and bilateral cerebellar infarction had certain differences in cerebellar artery involvement and concomitant lesions outside the cerebellum, prompting difference of their mechanism. Bilateral cerebellar infarction tended to present more conscious disturbance and other serious CNS function defect than unilateral cerebellar infarction.