Amarenco P, Hauw J J
Laboratoire de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtrière, Paris, France.
Neurology. 1990 Sep;40(9):1383-90. doi: 10.1212/wnl.40.9.1383.
We reviewed the clinical and pathologic findings in 33 patients with infarcts in the territory of the superior cerebellar artery (SCA). The clinical manifestations included the rostral basilar artery syndrome (8); coma at onset, often with tetraplegia (11); cerebellar and vestibular signs (9, with delayed coma due to cerebellar swelling in 6); and, in only 1 patient, the "classic" syndrome of the SCA. Clinical features were overshadowed by an infarct in the territory of the middle cerebral artery in 3 other patients, and the diagnosis was made only at autopsy in a fourth. Pathologically, SCA infarcts occurred in isolation in 7 patients. The most striking finding was the high frequency of associated infarcts in the territory of the rostral part of the basilar artery (73%). One-third of patients also had an infarct in the territory of the posterior inferior cerebellar artery, sometimes associated with infarction of the anterior inferior cerebellar artery. Tonsillar herniation was observed in 15 patients, 8 of whom had no infarcts in other cerebellar territories. Occlusions occurred mainly in the distal basilar artery and distal vertebral artery. The infarcts were mostly caused by cardiac and artery-to-artery emboli.
我们回顾了33例小脑上动脉（SCA）供血区梗死患者的临床和病理表现。临床表现包括延髓基底动脉综合征（8例）；起病时昏迷，常伴有四肢瘫痪（11例）；小脑和前庭体征（9例，其中6例因小脑肿胀导致延迟性昏迷）；仅1例患者出现SCA“经典”综合征。另外3例患者的临床表现被大脑中动脉供血区梗死所掩盖，第4例仅在尸检时才确诊。病理检查发现，7例患者为孤立性SCA梗死。最显著的发现是基底动脉延髓部供血区合并梗死的发生率很高（73%）。三分之一的患者在后下小脑动脉供血区也有梗死，有时合并前下小脑动脉梗死。15例患者出现小脑扁桃体疝，其中8例在其他小脑区域无梗死。闭塞主要发生在基底动脉远端和椎动脉远端。梗死大多由心源性和动脉到动脉栓塞引起。
