Clinical spectrum of pontine infarction -: Clinical-MRI correlations
Clinical spectrum of pontine infarction -: Clinical-MRI correlations
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DOI：
10.1007/s00415-002-0879-x
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发表时间：
2002-12-01
影响因子：
6
通讯作者：
Evyapan, D
中科院分区：
文献类型：
--
作者：
Kumral, E;Bay端lkem, G;Evyapan, D
我们收集了超过6年的150例急性孤立性脑桥梗死患者的临床和影像学表现。所有患者住院期间均行CT、MRI及磁共振血管造影（MRA）检查。在对脑桥病变边界的临床放射学分析中，有五种主要的临床模式依赖于脑桥固有动脉的恒定区域：(1)脑桥前内侧综合征（58%）表现为运动障碍，构音障碍，共济失调，三分之一的患者有轻微的被盖体征；(2)半数患者的脑桥前外侧综合征（17%）伴有运动和感觉缺陷，与前内侧梗死综合征相比，与被盖体征（56%）相关的频率更高；(3)被盖脑桥综合征（10%）表现为轻度运动缺陷，并伴有感觉综合征、眼动障碍和前庭系统症状，包括眩晕、头晕和共济失调；(4)双侧脑桥综合征（11%）表现为短暂性意识丧失、四肢瘫痪和急性假性球麻痹；(5)单侧多发脑桥梗死（4%）很少观察到，并且总是与严重的感觉运动缺陷和被盖征相关。在我们的系列中，没有梗死发生在极端背侧和外侧被盖的脑桥区域，这主要与小脑梗死有关。卒中的主要病因为基底动脉分支病变（BABD） 59例（39%），其次为小动脉病变（SAD） 31例（21%），椎基底动脉大动脉病变27例（18%），心脏栓塞12例（8%），未发现卒中病因的16例（11%）。我们的研究结果表明，有可能确定桥脑梗死的临床亚组，其中BABD和SAD是卒中的最常见原因。急性发作后，除双侧脑桥病变外，预后一般都很好。
We sought clinical and radiological findings of 150 consecutive patients with acute isolated pontine infarct who were admitted to our Stroke Unit over 6 years. In all patients CT, MRI and magnetic resonance angiography (MRA) were performed during the hospitalization. On clinico-radiological analysis regarding the pontine lesion boundaries there were five main clinical patterns that depended on the constant territories of intrinsic pontine arteries: (1) anteromedial pontine syndrome (58 %) presented with motor deficit with dysarthria, ataxia, and mild tegmental signs in one third of patients; (2) anterolateral pontine syndrome (17 %) developed with motor and sensory deficits in half of the patients, and were associated with tegmental signs (56 %) more frequently than the anteromedial infarct syndrome; (3) tegmental pontine syndrome (10 %) presented with mild motor deficits and associated with sensory syndromes, eye movement disorders and vestibular system symptoms including vertigo, dizziness and ataxia; (4) bilateral pontine syndrome (11 %) consisted with transient consciousness loss, tetraparesis and acute pseudobulbar palsy; (5) unilateral multiple pontine infarcts (4 %) were rarely observed, and were always associated with severe sensory-motor deficits and tegmental signs. In our series, there was no infarct in the extreme dorsal and lateral tegmental pontine territories which have been mostly associated with cerebellar infarctions. The main etiology of stroke was basilar artery branch disease (BABD) in 59 patients (39 %), followed by small-artery disease (SAD) in 31 (21 %), large-artery disease of vertebrobasilar arteries in 27 patients (18 %), cardioembolism in 12 (8 %) and in 16 patients (11 %) no cause of stroke was found. Our findings suggest that it is possible to identify clinical subgroups of pontine infarction, in which BABD and SAD were the most common causes of stroke. After an acute onset, outcome is in general excellent except in those with bilateral pontine lesions.