双侧大脑脚梗死的临床表现、影像学特征及预后的研究

目的 分析双侧大脑脚梗死的临床表现、影像学特征及预后。 方法 回顾性分析北部战区总医院2013年7月-2016年12月收治的由DWI证实的双侧大脑脚梗死患者 的临床表现、影像学特征及预后。 结果 共纳入18例双侧大脑脚梗死患者，其中10例（55.6%）出现四肢瘫痪，11例（61.1%）出现意识 水平下降。患者病程中最重阶段NIHSS评分为12.5（4.0～20.5）分。16例（88.9%）患者病因分型为大动 脉粥样硬化型。除了双侧大脑脚外，脑桥（88.9%）、小脑（72.2%）也是常见的受累部位。16例（88.9%） 患者存在基底动脉重度狭窄或闭塞，其余2例（11.1%）患者存在椎动脉及大脑后动脉重度狭窄或闭塞。 出院3个月后对18例患者进行电话随访，其中有2例失访，13例患者预后不良（其中10例死亡）。 结论 双侧大脑脚梗死常合并脑桥和小脑梗死，主要病因为大动脉粥样硬化，主要发病机制可能 为低灌注，此类患者的预后不良。

Clinical Features,Imaging Characteristics and Prognosis in Patients with Bilateral Cerebral Peduncular Infarction

Objective To investigate the clinical manifestations, magnetic resonance imaging (MRI) features
and prognosis in patients with bilateral cerebral peduncular infarction (BCPI).
Methods The clinical data of patients with acute BCPI confirmed by DWI from July 2013 to
December 2016 were retrospectively analyzed.
Results A total of 18 BCPI patients were included, and 10 (55.6%) patients had quadriplegia, 11
(61.1%) had decreased consciousness. When the illness was most severe, the NIHSS was 12.5 (4.0-
20.5). There were 16 (88.9%) cases with large artery atherosclerosis infarction. Besides the bilateral
cerebral peduncle, the other sites involved were the pons (88.9%) and cerebellum (72.2%). 16(88.9%)
patients had basilar artery occlusion or severe stenosis, and 2 (11.1%) patients had vertebral artery
and posterior cerebral artery occlusion or severe stenosis. At 3 months follow up, 13 patients had poor
prognosis (including 10 deaths) and 2 patients were lost to follow-up.
Conclusions BCPI was often accompanied by pontine infarction and cerebellar infarction. Its main
etiology was large-artery atherosclerosis, and the mechanism was hypoperfusion. BCPI patients
usually have a poor prognosis.