CEREBELLAR INFARCTION - CLINICAL AND ANATOMIC OBSERVATIONS IN 66 CASES
CEREBELLAR INFARCTION - CLINICAL AND ANATOMIC OBSERVATIONS IN 66 CASES
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DOI：
10.1161/01.str.24.1.76
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发表时间：
1993-01-01
期刊：
影响因子：
8.3
通讯作者：
WELCH, KMA
中科院分区：
文献类型：
--
作者：
KASE, CS;NORRVING, B;WELCH, KMA
背景和目的：小脑梗死的临床特征因血管受累而异。我们研究了小脑后下动脉或小脑上级动脉的领土梗死的患者，以比较他们的临床表现，过程和预后。方法：我们回顾性分析了66例小脑梗死患者的临床特点，实验室数据和影像学研究连续收集在五个机构。所有的小脑梗塞都记录在计算机断层扫描或磁共振成像。结果：两个不同的配置文件出现，这取决于涉及的血管领域。在36例小脑后下动脉梗死患者中，眩晕、头痛和步态不平衡三联征在卒中发作时占主导地位。计算机断层扫描显示11例（30%）有严重的小脑占位效应，7例伴有脑积水。在这7名患者（19%）中，梗死后肿胀导致脑干压迫，导致4人死亡。在30例上级小脑动脉梗死患者中，步态障碍在发病时占主导地位，眩晕和头痛明显较少见。临床过程通常是良性的。计算机断层扫描显示只有2例（7%）出现明显的小脑占位效应、脑积水和脑干压迫。推测脑栓塞是上级小脑动脉分布梗死患者的主要卒中机制，而在小脑后下动脉分布梗死患者中，卒中机制在心源性栓塞和后循环动脉疾病之间平分。小脑后下动脉和上级小脑上动脉分布的小脑梗死在临床表现上有明显差异，过程和预后。这些差异应有助于选择适当的监测和治疗策略。
Background and Purpose: Cerebellar infarction displays different clinical features, depending on the vascular territory involved. We studied patients with infarcts in the territories of the posterior inferior cerebellar artery or the superior cerebellar artery to compare their clinical presentation, course, and prognosis.Methods: We retrospectively analyzed the clinical features, laboratory data, and imaging studies of 66 patients with cerebellar infarction collected consecutively at five institutions. All the cerebellar infarcts were documented on computed tomographic scan or magnetic resonance imaging.Results: Two distinct profiles emerged, depending on the vascular territory involved. In 36 patients with posterior inferior cerebellar artery territory infarcts, a triad of vertigo, headache, and gait imbalance predominated at stroke onset. Computed tomography showed severe cerebellar mass effect in 11 cases (30%), with associated hydrocephalus in seven. In these seven patients (19%), postinfarct swelling led to brain stem compression that resulted in four deaths. In 30 patients with superior cerebellar artery infarcts, gait disturbance predominated at onset; vertigo and headache were significantly less common. The clinical course was usually benign. Computed tomography showed marked cerebellar mass effect, hydrocephalus, and brain stem compression in only two instances (7%). Presumed cerebral embolism was the predominant stroke mechanism in patients with superior cerebellar artery distribution infarcts, whereas in those with posterior inferior cerebellar artery distribution infarcts, the stroke mechanism was equally divided between cardiogenic embolism and posterior circulation arterial disease.Conclusions: Cerebellar infarcts in the posterior inferior cerebellar artery and superior cerebellar artery distribution have distinct differences in clinical presentation, course, and prognosis. These differences should help in the selection of appropriate monitoring and treatment strategies.