中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2013年
3期
172-175
,共4页
陈珂楠%郭舜源%陈桂花%耿昱
陳珂楠%郭舜源%陳桂花%耿昱
진가남%곽순원%진계화%경욱
脑梗死%脑桥%运动障碍%椎底动脉供血不足%磁共振成像
腦梗死%腦橋%運動障礙%椎底動脈供血不足%磁共振成像
뇌경사%뇌교%운동장애%추저동맥공혈불족%자공진성상
Brain infarction%Pons%Movement disorders%Vertebrobasilar insufficiency%Magnetic resonance imaging
目的 对比分析急性期进展性和无进展性孤立单侧脑桥梗死患者的病因、影像学和临床表现,并探讨累及脑桥表面的梗死与进展性运动障碍的关系.方法 回顾性分析经磁共振成像证实的新发孤立单侧脑桥梗死患者58例,其中31例入院1周内完成头、颈部CT血管造影成像.根据卒中发生后5d内动态的美国国立卫生研究院卒中评分(NIHSS)情况,58例患者分为两组.组1:有进展性运动障碍(23例)；组2:无进展性运动障碍(35例).比较两组的危险因素、神经功能缺损程度、临床表现、梗死灶分布以及大小和形态、基底动脉病变情况.结果 组1和组2主要病因均为基底动脉分支病变.组1[21/23(91.3％)]中病灶累及脑桥腹侧表面的比例高于组2[20/35(57.1％),x2 =7.817,P=0.005].组1患者平均入院时NIHSS评分(6.7±2.9)高于组2(4.5±2.4,t=3.121,P =0.003).组1患者卒中发生1个月时的平均改良Rankin量表(mRS)评分[(2.2±1.1)分]高于组2[(1.5±0.8)分,t =2.909,P=0.004].经Logistic回归分析发现,累及脑桥表面的梗死与进展性运动障碍的发生呈正相关(OR=9.670,95％ CI1.171 ～79.856,P=0.035).结论 进展性孤立单侧脑桥梗死的病因主要为基底动脉分支病,其初始症状较无进展的孤立单侧脑桥梗死重,前者短期残障程度也较高,累及脑桥表面的梗死可作为进展性卒中的预测指标.
目的 對比分析急性期進展性和無進展性孤立單側腦橋梗死患者的病因、影像學和臨床錶現,併探討纍及腦橋錶麵的梗死與進展性運動障礙的關繫.方法 迴顧性分析經磁共振成像證實的新髮孤立單側腦橋梗死患者58例,其中31例入院1週內完成頭、頸部CT血管造影成像.根據卒中髮生後5d內動態的美國國立衛生研究院卒中評分(NIHSS)情況,58例患者分為兩組.組1:有進展性運動障礙(23例)；組2:無進展性運動障礙(35例).比較兩組的危險因素、神經功能缺損程度、臨床錶現、梗死竈分佈以及大小和形態、基底動脈病變情況.結果 組1和組2主要病因均為基底動脈分支病變.組1[21/23(91.3％)]中病竈纍及腦橋腹側錶麵的比例高于組2[20/35(57.1％),x2 =7.817,P=0.005].組1患者平均入院時NIHSS評分(6.7±2.9)高于組2(4.5±2.4,t=3.121,P =0.003).組1患者卒中髮生1箇月時的平均改良Rankin量錶(mRS)評分[(2.2±1.1)分]高于組2[(1.5±0.8)分,t =2.909,P=0.004].經Logistic迴歸分析髮現,纍及腦橋錶麵的梗死與進展性運動障礙的髮生呈正相關(OR=9.670,95％ CI1.171 ～79.856,P=0.035).結論 進展性孤立單側腦橋梗死的病因主要為基底動脈分支病,其初始癥狀較無進展的孤立單側腦橋梗死重,前者短期殘障程度也較高,纍及腦橋錶麵的梗死可作為進展性卒中的預測指標.
목적 대비분석급성기진전성화무진전성고립단측뇌교경사환자적병인、영상학화림상표현,병탐토루급뇌교표면적경사여진전성운동장애적관계.방법 회고성분석경자공진성상증실적신발고립단측뇌교경사환자58례,기중31례입원1주내완성두、경부CT혈관조영성상.근거졸중발생후5d내동태적미국국립위생연구원졸중평분(NIHSS)정황,58례환자분위량조.조1:유진전성운동장애(23례)；조2:무진전성운동장애(35례).비교량조적위험인소、신경공능결손정도、림상표현、경사조분포이급대소화형태、기저동맥병변정황.결과 조1화조2주요병인균위기저동맥분지병변.조1[21/23(91.3％)]중병조루급뇌교복측표면적비례고우조2[20/35(57.1％),x2 =7.817,P=0.005].조1환자평균입원시NIHSS평분(6.7±2.9)고우조2(4.5±2.4,t=3.121,P =0.003).조1환자졸중발생1개월시적평균개량Rankin량표(mRS)평분[(2.2±1.1)분]고우조2[(1.5±0.8)분,t =2.909,P=0.004].경Logistic회귀분석발현,루급뇌교표면적경사여진전성운동장애적발생정정상관(OR=9.670,95％ CI1.171 ～79.856,P=0.035).결론 진전성고립단측뇌교경사적병인주요위기저동맥분지병,기초시증상교무진전적고립단측뇌교경사중,전자단기잔장정도야교고,루급뇌교표면적경사가작위진전성졸중적예측지표.
Objective To analyze the causes,neuroimaging and clinical manifestations of isolated unilateral pontine infarction and to discuss its relationship to progressive motor deficit(PMD).Methods All 58 patients with isolated acute unilateral pontine infarction confirmed by magnetic resonance imaging (MRI) were recruited in this study for retrospective review.Thirty-one patients of them had brain and neck multi-slice spiral CT angiography(CTA) within 1 week after admission.PMD severity was accessed using the dynamic National Institutes of Health Stroke Scale (NIHSS) within 5 days after onset.All 58 patients were divided into two groups:patients with PMD (23 cases) in group 1 and patients without PMD (35 cases) in group 2.Two groups were compared for the risk factors,initial NIHSS scores,modified Rankin Scale (mRS) scores at 1 month after onset,clinical manifestations,infarction distribution,size and morphology of infarctions and basilar artery lesions.Results The major cause was pathologic changes in basilar artery branch in both groups(6/12 in group 1 and 10/19 in group 2).The proportion of patients with infarction extending to the pontine surface in group 1 was higher than that in group 2 (21/23,91.3％ vs 20/35,57.1％,x2 =7.817,P =0.005).Initial NIHSS score in group 1 was higher than that in group 2(6.7 ±2.9 vs 4.5 ± 2.4,t =3.121,P =0.003).mRS score at 1 month after onset in group 1 was higher than that in group 2(2.2 ± 1.1 vs 1.5 ± 0.8,t =2.909,P =0.004).The Logistic regression analysis showed that isolated unilateral pontine infarction extending to the pontine surface was positively related to PMD (odds ratio 9.670,95％ confidence interval 1.171-79.856,P =0.035).Conclusions Progressive isolated unilateral pontine infarction is mostly caused by pathologic changes in basilar artery branch.Patients with PMD have a more severe initial clinical manifest and they have a worse short-term prognosis than patients without PMD.Isolated unilateral pontine infarction extending to the pontine surface may be a risk predictor in stroke evolution.
