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表现为孤立性急性前庭综合征的脑梗死的临床分析(附15例报道)

Cerebral infarction menifested as isolated acute vestibular syndrome: a clinical analysis of 15 cases

摘要:

目的 探讨表现为孤立性急性前庭综合征(AVS)的脑梗死的临床特征、危险因素、影像学表现及预后,以提高对该病的诊治水平. 方法 回顾性收集南京同仁医院神经内科自2015年10月至2016年4月收治的15例表现为孤立性AVS的脑梗死患者的临床资料,分析其临床特征、危险因素、影像学表现及预后. 结果 (1)临床特征:患者平均年龄为(62.1±13.5)岁,中位发病时间为24 h(4~168 h);临床症状均表现为眩晕,伴有恶心(11例)、呕吐(10例)、眼震(10例)、步态不稳(14例)等.(2)危险因素:14例患者同时存在多种(≥4个)脑卒中危险因素,具体包括年龄、高血压、高血脂、糖尿病、吸烟、颈动脉狭窄、脑卒中史、脑白质变性、冠心病、房颤等.(3)影像学表现:14例患者为后循环脑梗死,梗死灶分别位于小脑半球(11例)、小脑蚓部(4例)、脑桥(3例)、小脑中脚(1例)、小脑下脚(1例)、下丘(1例),其中6例存在多个梗死灶.1例为前循环脑梗死,梗死灶位于岛叶.多数病变为较小的腔隙性梗死灶,但小脑半球下部多为较大面积梗死灶.(4)预后:经正规治疗后患者预后较好,9例症状完全缓解,6例症状好转. 结论 临床上遇到同时存在多种脑卒中危险因素且表现为孤立性AVS的患者,应考虑到脑梗死的可能,及时行相关检查早期明确诊断,尽早行正规治疗以改善患者预后.

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Objective To analyze the clinical features,risk factors,imaging features and prognoses of cerebral infarction menifested as isolated acute vestibular syndrome (AVS) to improve the diagnoses and treatments of the disease.Methods Clinical data of 15 cerebral infarction patients menifested as isolated AVS,admitted to our hospital from October 2015 to April 2016,were summarized retrospectively.The clinical features,risk factors,imaging features and prognoses of these patients were analyzed.Results (1) Clinical characteristics:the average age of cerebral infarction patients menifested as isolated AVS was 62.1 ±13.5 years old,and the median attack time was 24 (4-168) h;the main clinical manifestations were vertigo,including nausea (n=1 1),vomiting (n=10),nystagmus (n=10),and unstable gait (n=14).(2) Risk factors:14 patients had multiple risk factors of stroke (>4),and they were age,hypertension,hypedipidemia,diabetes,smoking,carotid stenosis,history of stroke,white matter degeneration,coronary heart disease,and atrial fibrillation.(3) Imaging features:14 patients were posterior circulation infarction,and the lesions were located in the cerebellar hemisphere (n=l 1),cauda cerebelli (n=4),pons (n=3),brachium pontis (n=1),brachium inferius cerebelli (n=1);inferior colliculus (n=1),and multiple lesions occurred in 6 patients;one anterior circulation infarction was located in the insula;most lesions were smaller lacunar infarcts,but the lower part of cerebellar hemisphere was mostly larger infarct.(4) Prognoses:the prognosis of patients is good after regular treatment,9 had complete symptom relief,and 6 got improvement.Conclusions When patients presented with isolated AVS and many risk factors exist in clinic,the possibility of cerebral infarction should be taken into account.Such patients should be subjected to relevant examinations in a timely manner and early diagnosis,so that they can get regular treatment as soon as possible and prognoses can be improved.

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作者: 刘岩 [1] 吕新云 [1] 陈硕 [1] 蔡兴秋 [1] 李歌 [1] 冯艳蓉 [1] 钱波 [2]
期刊: 《中华神经医学杂志》2018年17卷1期 34-38页 ISTICPKUCSCD
分类号: R743.3
栏目名称: 缺血性脑卒中
DOI: 10.3760/cma.j.issn.1671-8925.2018.01.006
发布时间: 2018-03-09
基金项目:
南京市医学科技发展项目(YKK16260)Nanjing Medical Science and Technology Development Project
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