Hokkoku Keiichi, Sonoo Masahiro, Murashima Hideharu, Iwanami Tomoko, Nishiyama Kyouhei, Kawamura Yasuomi, Arai Yuko, Tsukamoto Hiroshi, Hatanaka Yuki, Shimizu Teruo
Department of Neurology, Teikyo University School of Medicine.
Rinsho Shinkeigaku. 2011 Apr;51(4):248-54. doi: 10.5692/clinicalneurol.51.248.
We report 13 patients presenting with predominantly sensory strokes due to brainstem infarction, without any other brainstem symptoms such as hemiparesis, dysarthria or vertigo. All of them had lacunar infarctions localized at the medial lemniscus and/or spinothalamic tract, at the pontine (12 patients) or midbrain (1 patient) tegmentum. The presenting symptom was dysesthesia with a variety of distributions for all cases, and a thalamic-pain-like unpleasant dysesthesia persisted in 4 patients. The lesion on brain MRI was usually very small, and was sometimes overlooked by radiological evaluation, which led to a long delay in the correct diagnosis of a stroke in two cases. Median nerve somatosensory evoked potentials showed a depressed N20 amplitude or a loss of the P15 potential unilaterally with preserved P13/14 potential in 7 out of 10 cases examined, and was useful in localizing the lesion intracranially. During the 4-year study period, 10 patients with brainstem infarctions were admitted to our department as acute sensory stroke cases (2.1% of all acute strokes), whereas 11 patients with thalamic infarctions (2.3%) were admitted due to similar symptoms. Cases with brainstem infarctions had sensory symptoms localized below the neck more frequently (5/10) than cases with thalamic infarctions (1/11), thus would be more likely to be confused with cervical or peripheral nerve disorders. The relative frequency of brainstem infarction as compared to thalamic infarction was higher than that in previous reports, implying that some cases with brainstem infarction might have been overlooked due to difficulty in obtaining the correct diagnosis. One should always keep this syndrome in mind when assessing patients with acute-onset sensory symptoms.
我们报告了13例因脑干梗死导致以感觉性卒中为主的患者，无任何其他脑干症状，如偏瘫、构音障碍或眩晕。所有患者均有腔隙性梗死，位于内侧丘系和/或脊髓丘脑束，在脑桥（12例患者）或中脑（1例患者）被盖部。所有病例的首发症状均为感觉异常，分布多样，4例患者持续存在丘脑痛样不愉快的感觉异常。脑部MRI上的病变通常非常小，有时会被影像学评估忽略，导致2例患者的卒中正确诊断延迟很长时间。在10例接受检查的病例中，正中神经体感诱发电位显示7例单侧N20波幅降低或P15电位消失，而P13/14电位保留，这有助于颅内病变的定位。在4年的研究期间，10例脑干梗死患者以急性感觉性卒中病例收入我科（占所有急性卒中的2.1%），而11例丘脑梗死患者（2.3%）因类似症状入院。脑干梗死病例的感觉症状位于颈部以下的频率（5/10）高于丘脑梗死病例（1/11），因此更有可能与颈部或周围神经疾病混淆。与丘脑梗死相比，脑干梗死的相对发生率高于以往报道，这意味着一些脑干梗死病例可能因难以获得正确诊断而被忽视。在评估急性起病的感觉症状患者时，应始终牢记这一综合征。
