双侧对称性桥臂梗死一例并文献复习
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摘要
桥臂主要由小脑前下动脉供血,部分由小脑上动脉供血,桥臂区侧支循环丰富,孤立梗死较少见。作者回顾性分析1例影像学表现为孤立的双侧对称性桥臂梗死患者的临床资料,并结合相关文献,探讨双侧对称性桥臂梗死的临床特点及发病机制。目前双侧对称性桥臂梗死机制尚不十分明确,临床表现主要为眩晕及小脑性共济失调,可伴构音障碍、耳鸣和双耳听力障碍及周围性面瘫等。多种疾病可导致类似影像学改变,根据病史、临床特征、不同序列影像学特点,及时行头部血管成像有助于鉴别诊断。治疗上同缺血性卒中,有适应证者,血管内治疗可能使患者受益。
The middle cerebellar peduncle( MCP) is supplied mainly by the anterior inferior cerebellar artery,and partly by the superior cerebellar artery. The collateral anastomosis in the MCP area is abundant so isolated infarction of bilateral MCPs is extremely rare. A case of a patient with imaging manifestation of isolated bilateral MCPs infarction was retrospectively analyzed. Combined with the relevant literatures,the clinical characteristics and pathogenesis of bilateral MCPs infarction were discussed. At present,the pathogenesis is unclear. The main clinical manifestations are vertigo and cerebellar ataxia,accompanied by dysarthria,tinnitus,hearing loss and peripheral facial palsy. Similar imaging changes may occur in a variety of diseases. Medical history,clinical manifestations,imaging characteristics of different sequences and early cranial angiography may be helpful for differential diagnosis. The treatment is the same as ischemic stroke,and endovascular treatment may benefit the patients with indications.
The middle cerebellar peduncle( MCP) is supplied mainly by the anterior inferior cerebellar artery,and partly by the superior cerebellar artery. The collateral anastomosis in the MCP area is abundant so isolated infarction of bilateral MCPs is extremely rare. A case of a patient with imaging manifestation of isolated bilateral MCPs infarction was retrospectively analyzed. Combined with the relevant literatures,the clinical characteristics and pathogenesis of bilateral MCPs infarction were discussed. At present,the pathogenesis is unclear. The main clinical manifestations are vertigo and cerebellar ataxia,accompanied by dysarthria,tinnitus,hearing loss and peripheral facial palsy. Similar imaging changes may occur in a variety of diseases. Medical history,clinical manifestations,imaging characteristics of different sequences and early cranial angiography may be helpful for differential diagnosis. The treatment is the same as ischemic stroke,and endovascular treatment may benefit the patients with indications.
引文
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[8]张道培,禹萌,张洪涛,等.磁共振灌注成像及脑干诱发电位不同特点的桥臂梗死三例[J].中国脑血管病杂志,2016,13(9):489-492.
[9]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.
[10]Savoiardo M,Strada L,Girotti F,et al.Olivopontocerebellar atrophy:MR diagnosis and relationship to multisystem atrophy[J].Radiology,1990,174(3 Pt 1):693-696.
[11]Okamoto K,Tokiguchi S,Furusawa T,et al.MR features of diseases involving bilateral middle cerebellar peduncles[J].AJNR Am J Neuroradiol,2003,24(10):1946-1954.
[12]Dong Q,Jing G,Han J.The endovascular treatment of bilateral infarction of middle cerebellar peduncles.Etiology and endovascular treatment analysis[J].Neurosciences(Riyadh),2017,22(1):56-61.
[13]Huo X,Gao F,Sun X,et al.Endovascular Mechanical Thrombectomy with the Solitaire Device for the Treatment of Acute Basilar Artery Occlusion[J].World Neurosurg,2016,89:301-308.
[2]John S,Hegazy M,Cheng Ching E,et al.Isolated bilateral middle cerebellar peduncle infarcts[J].J Stroke Cerebrovasc Dis,2013,22(8):e645-e646.
[3]Amarenco P,Hauw JJ.Cerebellar infarction in the territory of the anterior and inferior cerebellar artery.A clinicopathological study of 20 cases[J].Brain,1990,113(Pt 1):139-155.
[4]Akiyama K,Takizawa S,Tokuoka K,et al.Bilateral middle cerebellar peduncle infarction caused by traumatic vertebral artery dissection[J].Neurology,2001,56(5):693-694.
[5]Kwon SU,Koh JY,Kim JS.Vertebrobasilar artery territory infarction as an initial manifestation of systemic lupus erythematosus[J].Clin Neurol Neurosurg,1999,101(1):62-67.
[6]Roquer J,Lorenzo JL,Pou A.The anterior inferior cerebellar artery infarcts:a clinical-magnetic resonance imaging study[J].Acta Neurol Scand,1998,97(4):225-230.
[7]沈遥遥,戴庭敏,陈蕊,等.双侧对称性小脑中脚梗死一例[J].中华神经科杂志,2015,48(8):707-708.
[8]张道培,禹萌,张洪涛,等.磁共振灌注成像及脑干诱发电位不同特点的桥臂梗死三例[J].中国脑血管病杂志,2016,13(9):489-492.
[9]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.
[10]Savoiardo M,Strada L,Girotti F,et al.Olivopontocerebellar atrophy:MR diagnosis and relationship to multisystem atrophy[J].Radiology,1990,174(3 Pt 1):693-696.
[11]Okamoto K,Tokiguchi S,Furusawa T,et al.MR features of diseases involving bilateral middle cerebellar peduncles[J].AJNR Am J Neuroradiol,2003,24(10):1946-1954.
[12]Dong Q,Jing G,Han J.The endovascular treatment of bilateral infarction of middle cerebellar peduncles.Etiology and endovascular treatment analysis[J].Neurosciences(Riyadh),2017,22(1):56-61.
[13]Huo X,Gao F,Sun X,et al.Endovascular Mechanical Thrombectomy with the Solitaire Device for the Treatment of Acute Basilar Artery Occlusion[J].World Neurosurg,2016,89:301-308.