摘要
目的研究急性双侧桥臂梗死患者的临床表现、影像学、发病机制及预后相关影响因素。方法连续收集2016年10月至2021年10月于天津市环湖医院住院治疗的急性双侧桥臂梗死患者,收集患者的人口学信息、临床症状及体征、影像学及预后等资料。用二元Logistic回归分析年龄、性别、卒中危险因素、梗死部位、血管情况、入院时美国国立卫生研究院卒中量表(NIHSS)评分及卒中进展情况与双侧桥臂梗死患者90 d预后的相关性。结果共纳入112例急性双侧桥臂梗死患者。最常见的临床特点为共济失调(84.8%,95/112)和眩晕(75.0%,84/112);23例(20.5%,23/112)患者首发症状为耳鸣/听力下降,其中4例为突发性耳聋。伴脑桥梗死90例(80.4%),伴中脑梗死22例(19.6%),伴延髓梗死21例(18.8%),伴小脑梗死86例(76.8%),孤立性双侧桥臂梗死仅有8例(7.1%,8/112)。在进行血管影像学检查的患者中,89.0%(89/100)存在椎基底动脉系统中重度狭窄/闭塞,65.0%(65/100)的患者双侧椎动脉和(或)基底动脉中重度狭窄/闭塞。发病机制以大动脉粥样硬化型为主(79.5%,89/112)。进展性卒中(OR=7.765,95%CI 2.760~21.841,P<0.001)及入院时NIHSS评分较高(OR=1.196,95%CI 1.085~1.318,P<0.001)是双侧桥臂梗死患者预后不良的独立危险因素。结论急性双侧桥臂梗死患者首发症状多为眩晕,急性前庭及听力障碍是桥臂梗死的特征性表现。孤立性双侧桥臂梗死临床少见,影像学检查显示多数合并后循环其他部位梗死,脑桥及小脑是最易累及的部位。发病机制以大动脉粥样硬化型为主。进展性卒中及入院时NIHSS评分较高是患者预后不良的独立危险因素。
Objective To investigate the clinical manifestation,imaging,pathogenesis and prognostic factors associated with acute bilateral brachium pontis infarction.Methods Patients with acute bilateral brachium pontis infarction who were admitted to the Tianjin Huanhu Hospital from October 2016 to October 2021 were collected for retrospective analysis.The demographic information,clinical symptoms and signs,imaging and prognosis of the patients were collected.Binary Logistic regression was used to analyze the correlation between age,gender,stroke risk factors,infarct site,vascular condition,National Institutes of Health Stroke Scale(NIHSS)score on admission,stroke progression,and 90-day prognosis of patients with acute bilateral brachium pontis infarction.Results A total of 112 patients with acute bilateral brachium pontis infarction were included.The most common clinical features were ataxia(84.8%,95/112),and vertigo(75.0%,84/112);the first symptom was tinnitus/hearing loss in 23 patients(20.5%,23/112),of whom 4 patients had sudden deafness.Among the 112 patients,isolated bilateral brachium pontis infarcts were found only in 8 cases(7.1%),whereas pontine infarcts in 90 cases(80.4%),midbrain infarcts in 22 cases(19.6%),medullary infarcts in 21 cases(18.8%),and cerebellar infarcts in 86 cases(76.8%).Of the patients who underwent vascular imaging,moderate-to-severe stenosis/occlusion of the vertebrobasilar artery system was present in 89.0%(89/100),and moderate-to-severe stenosis/occlusion of the vertebral arteries and/or basilar arteries was present bilaterally in 65.0%(65/100)of the patients.Pathogenesis was predominantly the large atherosclerotic type(79.5%,89/112).Progressive stroke(OR=7.765,95%CI 2.760-21.841,P<0.001)and higher NIHSS score on admission(OR=1.196,95%CI 1.085-1.318,P<0.001)were independent risk factors for poor prognosis in patients with bilateral brachium pontis infarction.Conclusions The first symptom in patients with acute bilateral brachium pontis infarction is dizziness,and acute vestibular and hearin
作者
袁子云
刘然
相蕾
岳伟
Yuan Ziyun;Liu Ran;Xiang Lei;Yue Wei(Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China;Clinical College of Neurology,Neurosurgery,and Neurorehabilitation,Tianjin Medical University,Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2024年第8期859-866,共8页
Chinese Journal of Neurology
基金
天津市卫生健康科技项目(TJWJ2021QN061,ZC20134)。
关键词
脑梗死
桥臂
磁共振成像
预后
Brain infarction
Brachium pontis
Magnetic resonance imaging
Prognosis
