一侧脑桥旁正中梗死临床及影像学分析

目的 探讨一侧脑桥旁正中梗死的临床及影像学特点.方法 回顾2009年7月~2011年12月在我院神经内科住院的15例脑桥旁正中梗死患者的病例资料,分析脑桥旁正中梗死患者的症状、体征、影像学表现、发病机制及预后.结果 15例患者均有一侧肢体无力,肌力从0级至轻瘫,与肢体瘫痪同侧的中枢性面瘫9例,与肢体瘫痪同侧的舌瘫7例;一侧肢体感觉障碍11例;10例起病时伴有头晕或眩晕;13例伴有构音障碍;6例有饮水呛咳;1例患者出现一侧肢体共济失调;1例患者出现复视,在体征上表现为病灶侧眼球外展障碍对侧肢体瘫痪的交叉瘫.头颅MRI示梗死灶位于一侧脑桥内侧,多为楔形,底部紧靠脑桥腹侧表面,尖部朝向脑桥被盖;病灶大部分位于基底动脉旁中央支的供血区域内,常位于脑桥中上部,很少累及第四脑室底.结论 一侧脑桥旁正中梗死位于脑桥内侧2/3区域,主要由基底动脉穿支病变引起;凡在临床诊疗中发现一侧偏瘫或偏身感觉障碍伴有头晕或眩晕、构音障碍、饮水呛咳的患者均要考虑到脑桥旁正中梗死,及时行MRI检查;一侧脑桥旁正中梗死预后较好.

The clinical and imaging analysis of unilateral paramedian pontine infarction

Objective To investigate the clinical and imaging characteristics of the unilateral paramedian pontine infarc- tion. Methods All 15 patients from July 2009 to December 2011 in our hospital were recruited in this study for retrospective re- view. The symptoms, signs, imaging findings, pathogenesis and prognosis with paramedian pontine infarction was analyzed. Re- suits Unilateral limb weakness was found in all 15 patients, muscle power from grade 0 to paresis. Central facial paralysis with ipsilateral limb paralysis was found in 9 patients, Central tongue paralysis with ipsilateral limb paralysis was found in 7 patients, hemisensory deficit was found in 11 patients, 10 cases with dizziness or vertigo, dysarthria was found in 13 patients, 6 patients had drinking cough, ipsilateral ataxia and eye movement disorder was found in 1 patient; MRI showed infarction located medial side of the pons, wedge bottom close to the ventral surface of the pons, the tip toward the pontine tagmentum; lesions mostly located next to the central branch of the basilar artery blood supply to the area, often located in central pontine very less involving fourth ventri- cle. Conclusion The lesions located inner 2/3 region of the pons, mainly caused by basilar artery arteriosclerosis and perforating artery thrombosis; In clinical practice, when patients was foud haven the sign of hemiplegia or hemidysesthesia associated with diz- ziness or vertigo, dysarthria, drinking cough, the unilateral paramedian pontine infarction must be thought; the unilateral parame- dian pontine infarction with good prognosis.