Stroke Unit, U.O. Neurologia Vascolare, Spedali Civili di Brescia, P.le Spedali Civili, 1, Brescia, Italy,
Neurol Sci. 2014 Feb;35(2):259-63. doi: 10.1007/s10072-013-1502-x. Epub 2013 Jul 13.
Isolated midbrain infarction is rare and little is known about etiology and patient's long-term follow up. We aimed to describe the clinical features, the causative diseases and the outcome of patients with isolated midbrain infarction who were admitted to our center, focusing on vascular abnormalities of posterior circulation. All patients with first acute ischemic stroke limited to the midbrain were included and their demographic features, neurological symptoms, neuroimaging data, and cardiovascular risk factors were recorded. Functional outcome, using modified Rankin scale, was assessed at discharge and at the 3 month follow up evaluation. We found nine patients with acute isolated midbrain infarction, representing 0.61 % of all ischemic stroke admitted to our center. The most common cause of stroke was small-vessel disease (88.8 %). At stroke onset, none of the patients had consciousness disturbances, and four patients (44.4 %) had gait impairment, five patients (55.5 %) presented with diplopia due to involvement of the third nerve or fascicular type of third-nerve palsy, seven patients (77.7 %) had vascular anomalies of vertebrobasilar circulation: the most frequent was vertebral artery hypoplasia [four patients (44.4 %)]. At follow up evaluation, seven patients (77.7 %) had a good functional outcome and no patients experienced recurrence of cerebrovascular events. As isolated midbrain infarction is uncommon, specific ocular motor signs, mainly third-nerve palsy, may help to identify and localize the mesencephalic infarct. Abnormalities in vertebrobasilar circulation, such as hypoplastic basilar or vertebral artery, are frequently associated with isolated midbrain ischemia. The hypoplastic vertebrobasilar system may predispose to posterior ischemic stroke.
孤立性中脑梗死很少见，其病因和患者的长期预后知之甚少。我们旨在描述入组我院的孤立性中脑梗死患者的临床特征、病因疾病和结局，重点关注后循环的血管异常。所有首次局限于中脑的急性缺血性卒中患者均被纳入研究，记录其人口统计学特征、神经症状、神经影像学数据和心血管危险因素。使用改良 Rankin 量表评估出院时和 3 个月随访时的功能结局。我们共发现 9 例急性孤立性中脑梗死患者，占我院收治的所有缺血性卒中患者的 0.61%。最常见的卒中病因是小血管疾病（88.8%）。发病时，无 1 例患者有意识障碍，4 例（44.4%）有步态障碍，5 例（55.5%）因第三神经受累或第三神经麻痹束状型出现复视，7 例（77.7%）存在椎基底动脉血管异常：最常见的是椎动脉发育不良[4 例（44.4%）]。随访评估时，7 例（77.7%）患者的功能结局良好，无患者发生脑血管事件再发。由于孤立性中脑梗死并不常见，特定的眼球运动体征，主要是第三神经麻痹，可能有助于识别和定位中脑梗死。基底动脉或椎动脉发育不良等椎基底动脉异常常与孤立性中脑缺血相关。发育不良的椎基底动脉系统可能易导致后循环缺血性卒中。
