CAJ | 학술논문

目的：探寻双侧小脑梗死的模式和机制。方法经MRI弥散成像（ DWI）证实急性期小脑梗死的患者，根据梗死灶的分布将患者分为单侧小脑梗死组（ UCI ）和双侧小脑梗死组（ BCI ），并对两组的人口学特征、血管分布、小脑以外梗死灶以及病因进行了比较。结果因急性卒中入院的115例后循环脑梗死患者中，56例为小脑梗死或小脑合并其它部位梗死，其中单侧小脑梗死36例（64．3％），双侧小脑梗死20例（35．7％）。基线资料比较显示，脑卒中史（P＝0．002）、纤维蛋白元水平（P＝0．036）和入院时 NIHSS 评分（P＝0．001）在双侧小脑梗死组明显高于单侧小脑梗死组。按血管分布区划分，小脑后下动脉（PICA）供血区小脑梗死发生率最高，且更多发生单侧小脑梗死（ P＝0．006）；而双侧小脑梗死更常见于PICA＋小脑上动脉（SCA）供血区（P＝0．004）。双侧小脑梗死组合并小脑以外梗死灶的发生率明显高于单侧小脑梗死组（ P＝0．002），特别是合并幕下梗死灶常见（ P＝0．022）。在卒中机制上，双侧小脑梗死以大动脉粥样硬化性病变更多见（P＝0．041），责任动脉病变主要是在椎动脉V4段、V4段与BA接合处的重度狭窄或闭塞。结论双侧小脑梗死并不少见，常见于PICA＋SCA供血区；大动脉粥样硬化所致动脉源性栓塞是其卒中重要机制之一。
목적：탐심쌍측소뇌경사적모식화궤제。방법경MRI미산성상（ DWI）증실급성기소뇌경사적환자，근거경사조적분포장환자분위단측소뇌경사조（ UCI ）화쌍측소뇌경사조（ BCI ），병대량조적인구학특정、혈관분포、소뇌이외경사조이급병인진행료비교。결과인급성졸중입원적115례후순배뇌경사환자중，56례위소뇌경사혹소뇌합병기타부위경사，기중단측소뇌경사36례（64．3％），쌍측소뇌경사20례（35．7％）。기선자료비교현시，뇌졸중사（P＝0．002）、섬유단백원수평（P＝0．036）화입원시 NIHSS 평분（P＝0．001）재쌍측소뇌경사조명현고우단측소뇌경사조。안혈관분포구화분，소뇌후하동맥（PICA）공혈구소뇌경사발생솔최고，차경다발생단측소뇌경사（ P＝0．006）；이쌍측소뇌경사경상견우PICA＋소뇌상동맥（SCA）공혈구（P＝0．004）。쌍측소뇌경사조합병소뇌이외경사조적발생솔명현고우단측소뇌경사조（ P＝0．002），특별시합병막하경사조상견（ P＝0．022）。재졸중궤제상，쌍측소뇌경사이대동맥죽양경화성병변경다견（P＝0．041），책임동맥병변주요시재추동맥V4단、V4단여BA접합처적중도협착혹폐새。결론쌍측소뇌경사병불소견，상견우PICA＋SCA공혈구；대동맥죽양경화소치동맥원성전새시기졸중중요궤제지일。
Objective To evaluate the lesion patterns and stroke mechanism in patients with acute bilateral cerebellar infarcts .Methods Patients who were admitted at Xiangyang hospital over a 2-year period with acute cerebellar infarcts , proven by diffusion-weighted imaging , were studied .Cerebellar infarcts were topographically classified and divided into 2 groups:unilateral cerebellar infarct ( UCI) and bilateral cerebellar infarcts ( BCI ) .The demographics , involved territories , concomitant lesions outside the cerebellum (CLOC), and mechanisms were analyzed.Results Among 56 patients with acute cerebellar infarcts, 35.7%( n=20) were BCI.Baseline demographics were not significantly different between UCI and BCI , except for previous stroke (P=0.002), fibrinogen (P=0.036) and NIH Stroke Scale (P=0.001).Posterior inferior cerebellar artery ( PICA) infarcts were the most common in UCI ( P=0.006) , whereas PICA+superior cerebellar artery( SCA) infarcts were significantly higher in BCI ( P=0.004) .80%of patients with BCI infarcts had concomitant lesions outside the cerebellum (CLOC)(P=0.002), which were primarily restricted to the brainstem (P=0.022). Large-artery atherosclerosis was significantly higher in BCI ( P=0.041) , vertebral V 4 were the commonest artery stenosis sites followed by vertebrobasilar junction.Conclusions BCI was involved frequently in the PICA+SCA territory .Our results supports the fact that embolism resulted from large-artery atherosclerosis is the important stroke mechanism in the BCI .