摘要
目的了解以眼肌麻痹为主要表现的脑干梗死惠者临床和影像学表现、病因以及疾病进展相关危险因素。方法收集脑干梗死住院患者的临床资料,分析眼肌麻痹的类型、伴随神经系统症状和体征、责任血管和病灶、病因、病情进展的相关因素。结果 32例眼肌麻痹患者分为:核下性(2例)、核性(21例)、核间性(4例)和混合性眼肌麻痹(5例)。伴随症状以眩晕最常见。有9例为多发病灶。磁共振血管成像(magnetic resonance angiography,MRA)显示与梗死灶相关的血管狭窄或闭塞有11例,其中后循环8例,前循环3例。病情进展者与不进展者相比,Essen卒中风险评分量表(Essen Stroke Risk Score,ESRS)评分高、磁共振成像(magneticresonance imaging,MRI)显示病灶更多发、更多伴随其他的神经系统定位体征(P<0.05或<0.01)。结论脑干梗死引起的眼肌麻痹可有各种表现,以核性动眼神经麻痹最常见。ESRS评分高、MRI病灶多发、伴随神经系统阳性体征多者要警惕病情进展。
Objective To describe the clinical features, magnetic resonance imaging（MRl） findings, pathogenesis and risk factors of stroke progression of brainstem infarction dominantly manifested as ophthalmoplegia. Methods Thirty-two patients presenting with ophthalmoplegia with or without minimal accompanied neurological sings were studied. To analysis the types of ophthamopoegia, accompanied neurological symptoms, responsible blood vessel and focus, pathogenesis and risks of stroke progression. Results In 32 cases included, four types of ophthalmolegia were classified：sub-nuclear（2 cases）, nuclear（21 cases）, inte-rnuclear（4 cases） and mixed ophthalmoplegia（5 cases）. Vertigo was the most common accompanied symptom. Nine patients had multiple lesions. Vascular occlusion or stenoses were found in 11 patients：8 at the posterior cerebral circulation, 3 at the anterior cerebral circulation. Vascular risk factors were more common in progressive stroke group than non-progressive groups. Multiple infarction lesion and accompanied neurological signs were statistically correlated with stroke progression. Conclusion Clinical features of ophthalmoplegia caused by brainstem infarction varies, in which nuclear oculomotor nerve ophthalmoplegia was the most common type. The responsible artery included both large and small blood cerebral vessels, patients with Essen Stroke Risk Score （ESRS）〉3 score, multiple infarction lesions and accompanied positive neurological signs showed higher possibilities of progression, suggesting a more aggressive prevention.
出处
《中国卒中杂志》
2011年第7期514-518,共5页
Chinese Journal of Stroke
基金
北京市卫生系统高层次人才培养项目(2009-02-009)
关键词
脑干梗死
眼肌麻痹
症状和体征
Brain stem infarctions
Ophthalmoplegia
Signs and symptons
