无定位体征脑干梗塞的头颅MRI及椎动脉超声分析

目的　应用头颅MRI及彩色超声多普勒观察无定位体征脑干梗塞部位、大小及双侧椎动脉形态结构和血流动力学变化。方法　对 3 0例无定位体征脑干梗塞患者行头颅MRI及双侧椎动脉超声检查 ,前者观察其梗塞部位、数量、大小 ;后者测定其双侧椎动脉收缩期峰值流速 (MAX)、舒张末期流速 (MIN)、时间平均流速 (TAMX)、管腔内径 (D) ,观察双侧椎动脉形态结构、有无斑块形成。分别与 3 0例有临床症状、体征脑干梗塞 (下称脑干梗塞 ) ,3 0例椎 基底动脉供血不足 (V BAI)及 3 0例健康者组对照比较。结果　无定位体征脑干梗塞的部位在桥脑最多 ( 2 6个 ) ,中脑次之 ( 5个 ) ,延脑最少 ( 2个 ) ,其直径一般在 1～ 8mm之间 ,数量 1～ 2个 ,双侧椎动脉D、MAX、MIN、TAMX与脑干梗塞组对比无显著差异 (P >0 .0 5 ) ,与V BAI组及健康组对比有显著差异 (P <0 .0 5 ) ,椎动脉有扭曲变形 ,并有不同程度的斑块形成。结论　桥脑是无定位体征脑干梗塞的好发部位 ,其梗塞直径一般都小于 6mm ,双侧椎动脉扭曲变形及血流速度的降低可能促进了梗塞的发生。

Skull MRI and Verteberal Ultrosonic Analysis on Brain Stem Infarction without Located Sign

Objective To observe the region and size of brain stem infarction without located sign,form and structure of bilateral vertebral arteries and dynamics change in blood flow with skull MRI and colour ultrasonic Doppler.Method Skull MRI and bilateral vertebral arteries ultrasound were undertaken in 30 patients with brain stem infarction without located sign.The former was used to observe the exact region,amount and size of infarction,the latter was used to measure systolic velocity peak(MAX),diastasis velocity(MIN),time average velocity(TAMX) and diameter(D) of bilateral vebebral arteries.The form and structure of bilateral vertebral arteries and any existent plaques were observed.The results were compared with 30 patients of brain stem infarction with clinical symptom and body sign.30 V-BAI and 30 healthy people served as the control group.Results The brain stem infarction without located sign occurred mostly in pons(n=26),secondly in midbrain(n=5),at least in medulla oblongata(n=2).The diameter was 1～8mm,the amount was 1～2.There were no statistical differences in MAX,MIN,TAMX and D compared with brain stem infarction with clinical symptom and body sign group(P>0.05).There were statistical differences compared with V-BAI group and the control group(P<0.05).Vertebral arteries distorted and different levels of plaques formed.Conclusions Pons is the common site of brain stem infarction without located sign.The diameter of infarction is usually less than 6mm.The distortion of bilateral vertebral arteries and the decrease of blood streem speed may promote the occurrence of infarction.