桥臂梗死的颅神经损伤特征及近期预后分析
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摘要
(1)目的探讨桥臂梗死的颅神经损伤特征及近期预后的特点。(2)方法回顾性分析2014年1月～2018年5月于华北理工大学附属医院住院的桥臂梗死患者,收集并记录颅神经损伤情况、美国国立卫生研究院脑卒中量表(NIHSS)评分、修正的Ranking量表(mRS)评分等基线资料。分析比较单侧和双侧桥臂梗死患者入院和发病7天时颅神经损伤特征及近期预后。(3)结果共纳入53例桥臂梗死患者,其中单侧梗死32例,双侧梗死21例;颅神经受累特征:Ⅶ47例(88.68%),Ⅷ38例(71.70%),Ⅴ35例(66.04%),Ⅵ25例(41.17%),以Ⅶ损伤最多;双侧桥臂梗死患者中有1例死亡。单侧和双侧桥臂梗死治疗7天时NIHSS评分秩和检验结果为Z=-2.632,P <0.01;Z=-2.077,P <0.05;单双侧桥臂梗死治疗7天时mRS评分秩和检验结果为Z=-4.747,P <0.01;Z=-2.451,P <0.05。单侧组与双侧组患者治疗7天时NIHSS评分差的非参数检验结果为Z=-2.202,P <0.05;治疗7天时mRS评分差的非参数检验结果为Z=-2.025,P <0.05,提示单侧桥臂梗死预后较好。(4)结论桥臂梗死主要损伤第Ⅴ、Ⅵ、Ⅶ、Ⅷ对颅神经,第Ⅶ对颅神经受累最多见。单侧及双侧桥臂梗死组治疗7天时预后均较好;单侧桥臂梗死预后较双侧好。
Objective To explore the characteristics of cranial nerve injury and recent prognosis of pontine brachium infarction.Methods Retrospective analysis of bridge arm infarction patients hospitalized at the North China University of Science and Technology Affiliated Hospital from January 2014 to May 2018,collected and recorded cranial nerve damage,National Institute of Health stroke scales(NIHSS)score,Mified Rankin Scale(mRS)score and other baseline data.The characteristics and recent prognosis of cranial nerve injury in patients with unilateral and bilateral bridge arm infarction were analyzed.Results A total of 53 patients with infarction were included,including 32 with unilateral infarction and 21 with bilateral infarction.The characteristics of cranial nerve involvement were VII47(88.68%),VIII 38(71.70%),and V 35(66.04%).VI 25(41.17%),with the most damage to VII,one of the patients with bilateral brachial infarction died.The NIHSS score rank test results of unilateral and bilateral brachial infarction were Z=-2.632,P <0.01,Z=-2.077,P <0.05.mRS score rank sum test at 7days of single and bilateral brachial infarction.The result was Z=-4.747,P <0.01,Z=-2.451,P <0.05.The non-parametric test results of NIHSS scores at 7days of treatment in unilateral and bilateral groups were Z=-2.202,P <0.05.The nonparametric test results of poor mRS scores at 7days of treatment were Z=-2.025,P <0.05.It suggested that the prognosis of unilateral bridge arm infarction was better.Conclusion The infarction of the pontine brachium mainly damages the cranial nerves of V,VI,VII and VIII,and the most common cranial nerve involvement of the VII.The prognosis of the unilateral and bilateral brachial infarction group is better at 7days of treatment,the prognosis of unilateral brachial infarction is better than that of both sides.
Objective To explore the characteristics of cranial nerve injury and recent prognosis of pontine brachium infarction.Methods Retrospective analysis of bridge arm infarction patients hospitalized at the North China University of Science and Technology Affiliated Hospital from January 2014 to May 2018,collected and recorded cranial nerve damage,National Institute of Health stroke scales(NIHSS)score,Mified Rankin Scale(mRS)score and other baseline data.The characteristics and recent prognosis of cranial nerve injury in patients with unilateral and bilateral bridge arm infarction were analyzed.Results A total of 53 patients with infarction were included,including 32 with unilateral infarction and 21 with bilateral infarction.The characteristics of cranial nerve involvement were VII47(88.68%),VIII 38(71.70%),and V 35(66.04%).VI 25(41.17%),with the most damage to VII,one of the patients with bilateral brachial infarction died.The NIHSS score rank test results of unilateral and bilateral brachial infarction were Z=-2.632,P <0.01,Z=-2.077,P <0.05.mRS score rank sum test at 7days of single and bilateral brachial infarction.The result was Z=-4.747,P <0.01,Z=-2.451,P <0.05.The non-parametric test results of NIHSS scores at 7days of treatment in unilateral and bilateral groups were Z=-2.202,P <0.05.The nonparametric test results of poor mRS scores at 7days of treatment were Z=-2.025,P <0.05.It suggested that the prognosis of unilateral bridge arm infarction was better.Conclusion The infarction of the pontine brachium mainly damages the cranial nerves of V,VI,VII and VIII,and the most common cranial nerve involvement of the VII.The prognosis of the unilateral and bilateral brachial infarction group is better at 7days of treatment,the prognosis of unilateral brachial infarction is better than that of both sides.
引文
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[11]Gokcal E,Niftaliyev E,Baran G,et al.Progressive deficit in isolated pontine infarction:The association with etiological subtype,lesion topography and outcome[J].Acta Neurolologica Belgica,2017,117(3):649-654
[12]Preziosa P,Rocca MA,Mesaros S,et al.Relationship between damage to the cerebellar peduncles and clinical disability in multiple sclerosis[J].Radiology,2014,271(3):822-830
[13]Murakami M,Kawarabuki K,Inoue Y,et al.Ruptured pseudoaneurysm after gamma knife surgery for vestibular schwannoma[J].Neurologia Medico Chirurgica(Tokyo),2016,56(1):38-42
[2]Picelli A,Zuccher P,Tomelleri G,et al.Prognostic importance of lesion location on functional outcome in patients with cerebellar ischemic stroke:aprospective pilot study[J].Cerebellum,2017,16(1):257-261
[3]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257
[4]项正兵,吴晓牧.桥臂梗死18例临床及影像特征分析[J].中国医药导报,2015,12(20):41-43
[5]李慎军,郭洪伟,王树才,等.共存病与急性脑梗死长期预后的关系[J].中华神经科杂志,2014,47(8):558-561
[6]何凡,吕彦,曲方,等.孤立的双侧脑桥臂梗死神经血管影像分析及文献复习[J].解放军医药杂志,2016,28(3):47-49
[7]Gokcal E,Niftaliyev E,Baran G,et al.Progressive deficit in isolated pontine infarction:the association with etiological subtype,lesion topography and outcome[J].Acta Neurolologica Belgica,2017,117(3):649-654
[8]Baran G,Gultekin TO,Baran O,et al.Association between etiology and lesion site in ischemic brainstem infarcts:A retrospective observational study[J].Neuropsychiatric Dis ease Treatment,2018,14:757-766
[9]Zhang Zhiyong,Liu Zhiqiang,Qin Yu,et al.Clinical and radiological features of wallerian degeneration in the middle cerebellum after pons invasion[J].Chinese Journal of Medicine,2018,131(6):665-671
[10]李雪丽,徐丽君.以孤立性眩晕为首发症状的双侧对称性桥臂梗死1例[J].山东大学学报(医学版),2016,54(12):90-92
[11]Gokcal E,Niftaliyev E,Baran G,et al.Progressive deficit in isolated pontine infarction:The association with etiological subtype,lesion topography and outcome[J].Acta Neurolologica Belgica,2017,117(3):649-654
[12]Preziosa P,Rocca MA,Mesaros S,et al.Relationship between damage to the cerebellar peduncles and clinical disability in multiple sclerosis[J].Radiology,2014,271(3):822-830
[13]Murakami M,Kawarabuki K,Inoue Y,et al.Ruptured pseudoaneurysm after gamma knife surgery for vestibular schwannoma[J].Neurologia Medico Chirurgica(Tokyo),2016,56(1):38-42