十例Percheron动脉梗死患者的临床特征分析

目的分析10例Percheron动脉梗死患者的临床特征,以期提高临床对该病的认识。方法选取2015年9月—2018年10月六安市人民医院收治的Percheron动脉梗死患者10例,回顾性分析其首发症状、临床表现、危险因素、发病机制、影像学特征、治疗策略、预后及后遗症等。结果(1)首发症状及临床表现:4例以意识障碍为首发症状,其中1例伴有应激性溃疡及反复呕吐,1例发病前出现黑蒙,1例伴有头晕、复视;6例表现为肢体偏瘫,2例表现为反应下降,2例表现为人事不知,1例表现为眼睑下垂。(2)危险因素及发病机制:7例合并高血压,4例合并2型糖尿病,3例合并血脂异常,4例吸烟;5例为小动脉闭塞性病变,2例为大动脉粥样硬化性病变,1例为心源性栓塞(心房颤动),2例发病机制不明。(3)影像学特征:10例患者颅脑CT检查均未见丘脑病变,行颅脑磁共振成像(MRI)检查发现双侧丘脑旁正中区域呈对称或不对称蝶形长T1、长T2信号,弥散加权成像(DWI)示双侧丘脑旁正中区域、中脑高信号,1例见中脑“V”字征。(4)治疗策略、预后及后遗症:10例患者均给予神经内科专科治疗,其中1例采用阿替普酶(rt-PA)静脉溶栓治疗后意识障碍很快缓解;随访3个月,4例患者预后良好,6例患者预后不良,其中3例放弃治疗而死亡;5例患者遗留肢体偏瘫,2例患者遗留眼球运动障碍。结论Percheron动脉梗死“三联症”为意识障碍、记忆障碍、双侧垂直注视性麻痹,但临床表现为典型“三联症”的Percheron动脉梗死患者可能很少;Percheron动脉梗死的发病机制尚存在争议,而不同丘脑核受累在Percheron动脉梗死患者中的阶段性作用尚不完全清楚;Percheron动脉梗死患者病情进展较快,预后多不良,静脉溶栓及动脉介入治疗可能有利于改善Percheron动脉梗死患者预后。

Clinical Features of Ten Patients with Percheron Artery Infarction

Objective To analyze the clinical features of ten patients with Percheron artery infarction,in order to improve the clinical understanding.Methods A total of ten patients with Percheron artery infarction were selected in the People's Hospital of Liuan from September 2015 to October 2018,their initial symptoms,clinical manifestations,risk factors,pathogenesis,imaging characteristics,therapeutic strategies,prognosis and sequelae were retrospectively analyzed.Results(1)Initial symptoms and clinical manifestations:4 cases occurred disturbance of consciousness as initial symptoms,thereinto into 1 case accompanied with stress ulcer and repeated vomiting,1 case occurred amaurosis before attack,1 case accompanied with dizziness and diplopia;6 cases performed as limb hemiplegia,2 cases performed as reaction decline,2 cases performed as personal ignorance,1 case performed as blepharoptosis.(2)Risk factors and pathogenesis:7 cases merged with hypertension,4 cases merged with type 2 diabetes mellitus,3 cases merged with dyslipidemia,4 cases with smoking;5 cases were occluded lesions of arterioles,2 cases were atherosclerotic lesions of great arteries,1 case was cardiogenic embolism(atrial fibrillation),2 cases'pathogenesis were not clear.(3)Imaging characteristics:cerebral CT scanning results of the ten patients did not show thalamic lesions,but cerebral MRI examination results showed bilateral symmetrical or asymmetrical butterfly pattern of long T1 and long T2 signal beside thalamus and in the middle of thalamus,DWI results showed increased signal intensity beside thalamus and in the middle of thalamus(bilateral),and in midbrain,thereitno 1 case occurred"V"-shape sign in midbrain.(4)Therapeutic strategies,prognosis and sequelae:all of the ten patients received specific neurologic treatment,thereinto 1 case'disturbance of consciousness relived quickly after intravenous thrombolysis of rt-PA;4 cases'prognosis were good but the other 6 cases'prognosis were poor during the 3-month follow-up,thereinto 3 cases abandoned treatment and died;5 cases left limb hemiplegia,2 cases left disorder of ocular movement.Conclusion Trilogy of Percheron artery infarction includes disturbance of consciousness,memory disorder and bilateral vertical fixation paralysis,but there may be few typical patients performed as trilogy of Percheron artery infarction on clinic;it is controversial about the pathogenesis of Percheron artery infarction so far,moreover the staged impact of different thalamic nucleus involvement is not yet clear;progress of state of Percheron artery infarction is relatively fast,and most of patients'prognosis are poor,however intravenous thrombolysis and arterial intervention are possibly helpful to improve the prognosis.