Isolated infarcts of the pons
Isolated infarcts of the pons
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DOI：
10.1212/wnl.46.1.165
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发表时间：
1996-01-01
期刊：
影响因子：
9.9
通讯作者：
Regli, F
中科院分区：
文献类型：
--
作者：
Bassetti, C;Bogousslavsky, J;Regli, F
我们研究了36例mri证实的孤立性急性脑桥梗死患者。与固有脑桥血管的恒定区域相对应，梗死遵循可预测的分布，使我们能够描述三种主要综合征。21例患者有腹侧脑桥梗死。运动受累从轻度偏瘫（脑桥腹外侧综合征）到严重偏瘫伴双侧共济失调和构音障碍（脑桥腹内侧综合征）不等。此外，四分之三的患者有通常轻微的被盖功能障碍的临床证据。11例患者有被盖脑桥梗死，表现为被盖体征（眼球运动障碍、脑神经麻痹、感觉障碍），大多数为轻度运动缺陷（被盖脑桥综合征）。只有4个病人有交替的缺陷，这些都不符合任何所谓的经典桥脑综合征。内侧和极外侧被盖区域的梗死从未单独观察到，总是与小脑或后循环更大（和多发）的梗死有关。4例双侧腹盖脑桥梗死患者表现为急性假性球性麻痹，双侧运动障碍和被盖体征。病因检查的结果强调了基底动脉分支疾病的概念，基底动脉分支疾病是卒中最常见的推定原因（16/ 36,44 %）。基底动脉分支疾病特别与大腹侧梗死、严重的临床症状、进行性或波动性病程以及局部复发相关。推定的小动脉疾病（9/ 36,25 %）通常与小腹侧或被盖梗死和快速改善的腔隙综合征相关。大动脉狭窄（8/ 36,22%）和心脏栓塞（1/ 36,3%）比一系列后循环梗死（包括脑桥和脑桥外同时病变）更少见。三分之二的患者恢复良好，较差的结果与大面积腹侧梗死有关。
We studied 36 patients with MRI-proven isolated acute pontine infarct. Corresponding to the constant territories of intrinsic pontine vessels, infarcts followed a predictable distribution, enabling us to delineate three main syndromes. Twenty-one patients had a ventral pontine infarct. Motor involvement varied from mild hemiparesis (ventrolateral pontine syndrome) to severe hemiparesis with bilateral ataxia and dysarthria (ventromedial pontine syndrome). In addition, three-fourths of the patients had clinical evidence for usually mild tegmental dysfunction. Eleven patients had a tegmental pontine infarct, presenting tegmental signs (eye movement disorders, cranial nerve palsies, sensory disturbances), and mostly mild motor deficits (tegmental pontine syndrome). Only four patients had alternating deficits, and these never corresponded to any of the so-called classic pontine syndromes. Infarcts in the medial and the extreme lateral tegmental territory were never observed in isolation, being always associated with cerebellar or larger (and multiple) infarctions in the posterior circulation. Four patients with a bilateral ventrotegmental pontine infarct presented with acute pseudobulbar palsy, bilateral motor deficits, and tegmental signs.The results of etiologic work-up emphasize the concept of basilar artery branch disease, which was the most common presumed cause of stroke (16/36, 44%). Basilar artery branch disease was particularly associated with large ventral infarcts, severe clinical symptomatology, progressive or fluctuating course, and local recurrence. Presumed small-artery disease (9/36, 25%) was usually associated with small ventral or tegmental infarcts and rapidly improving lacunar syndromes. Large-artery stenosis (8/36, 22%) and cardioembolism (1/36, 3%) were less common than in series of posterior circulation infarcts that include simultaneous pontine and extrapontine lesions.Recovery was good in two-thirds of the patients, the worse outcome being associated with large ventral infarcts.