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目的探讨脑干腹侧部中线旁对称性脑梗死综合征的临床特点。方法对11例脑干腹侧部中线旁对称性脑梗死患者的临床资料及影像学检查进行回顾性分析。比较7例孤立性脑干病灶与4例合并后循环其他部位病灶患者,6例老年与5例中青年患者的临床资料。结果患者均为急性起病,以不同程度的意识障碍、眼球运动障碍及四肢瘫痪为主要特点;病灶累及延髓1例,延髓脑桥交界区1例,单纯累及脑桥3例,同时累及中脑和脑桥4例,单纯累及中脑2例;3例死亡,3例持续性意识障碍,5例好转。孤立性脑干病灶与后循环多发病灶患者高脂血症、吸烟史和出院改良的Rankin量表≥4分比较,差异有统计学意义(P<0.05,P<0.01);老年患者意识障碍、合并肺感染、死亡或未愈比例较中青年患者高(P<0.05,P<0.01)。结论脑干腹侧部中线旁对称性脑梗死是椎基底动脉梗死的一种特殊类型,常见病因为椎基底动脉穿支闭塞,临床症状复杂多样,老年患者预后更差。
Objective To investigate the clinical features of symptomatic cerebral infarction in the ventral midline of the brain stem. Methods The clinical data and imaging findings of 11 patients with symptomatic cerebral infarction in the ventral midline of the trunk were retrospectively analyzed. The clinical data of 7 cases of solitary brainstem lesions and 4 cases of other parts of the combined cycle after the disease, 6 cases of elderly and 5 cases of middle-aged and young patients were compared. Results All patients were acute onset, with varying degrees of disturbance of consciousness, eye movement disorders and quadriplegia as the main features. The lesions involved the medulla oblongata in 1 case, medullary pontine junction in 1 case, simple involvement of the pons in 3 cases, involving the midbrain and pons 4 cases, simple middle cerebral 2 cases; 3 died, 3 cases of persistent disturbance of consciousness, 5 cases improved. There were significant differences in hyperlipidemia, smoking history and improved Rankin Scale ≥4 in patients with solitary brain stem lesions and multiple episodes of posterior circulation, the difference was statistically significant (P <0.05, P <0.01) The proportion of patients with pulmonary infection, death or unhealed was higher than that of middle-aged and young patients (P <0.05, P <0.01). Conclusion Sympathetic cerebral infarction in the ventral midline of the trunk stem is a special type of vertebrobasilar artery infarction. The common cause is occlusion of the vertebrobasilar artery. The clinical symptoms are complex and diverse, and the prognosis of elderly patients is worse.