Amarenco P, Hauw J J
Laboratoire de Neuropathologie Raymond Escourolle, Formation Associée de L'Association Claude Bernard, Hôpital de la Salpêtrière, Paris.
Neurochirurgie. 1990;36(4):234-41.
Sixteen cases of cerebellar infarction with brain stem compression and tonsillar herniation were studied post-mortem. None was operated. Cardiac embolism was the most common cause (75% of the cases). Infarction involved the superior cerebellar artery territory in 8 cases, and multiple cerebellar artery territories (including in each case the posterior inferior cerebellar artery territory) in 8 cases. It involved the cerebellum only in 10 cases. In the 6 other cases, it was associated with an infarct in the paramedian territory of the brain stem. The oedematous swelling was linked to the large size, the rostral site and the embolic causes of the infarct. Cases with massive infarction of the brain stem differed from others by severe motor weakness of the limbs in 5 cases and a deep coma in the 6th. On the contrary, only one of the 10 cases with lone cerebellar infarct had a mild hemiparesis. Thus, when a hemi- or tetraplegia occurred in the course of an oedematous cerebellar infarction, an associated massive paramedian infarction of the pons must be suspected rather than a brain stem compression. This can be taken into account when a surgical treatment is discussed.
对16例伴有脑干受压和小脑扁桃体疝的小脑梗死患者进行了尸检研究。无一例接受手术治疗。心脏栓塞是最常见的病因（占病例的75%）。8例梗死累及小脑上动脉供血区，8例累及多个小脑动脉供血区（包括每例均累及小脑后下动脉供血区）。仅10例累及小脑。其他6例与脑干旁正中区梗死相关。水肿肿胀与梗死灶的大小、头侧部位及栓塞病因有关。脑干大面积梗死的病例与其他病例不同，5例出现严重肢体运动无力，第6例出现深度昏迷。相反，10例单纯小脑梗死患者中只有1例有轻度偏瘫。因此，在水肿性小脑梗死过程中出现偏瘫或四肢瘫时，应怀疑伴有脑桥旁正中大面积梗死，而不是脑干受压。在讨论手术治疗时可考虑这一点。
