Cioffi F A, Bernini F P, Punzo A, D'Avanzo R
Acta Neurochir (Wien). 1985;74(3-4):105-12. doi: 10.1007/BF01418797.
After reviewing the literature, a personal series of 10 adult patients with cerebellar infarction diagnosed by CT scan is described. The clinical picture in young adult men is characterized by rapid onset of headache, vomiting, vertigo, ataxia and blurred vision. After this sudden onset the patients may present a stable course or a rapid or delayed onset of brain stem compression, revealed by impairment of consciousness. CT scan is the diagnostic method of choice. The correlation between angiographic and CT localization of the infarction is not good. For therapy the following policy is suggested: in alert and clinically stable patients: medical treatment (mannitol, glycerol, dexamethason), ICP and serial CT monitoring; in alert patients with hydrocephalus or mass effect: medical treatment and monitoring as mentioned before; ventricular drainage if ICP surpasses 350 mm H2O; in patients with impaired consciousness and hydrocephalus or mass effect: immediate ventricular drainage. If it is not followed by prompt improvement of the level of consciousness, an emergency suboccipital craniectomy with removal of the infarcted tissue should be done.
在查阅文献之后，本文描述了经CT扫描确诊的10例成人小脑梗死患者的个人病例系列。年轻成年男性的临床表现特点为头痛、呕吐、眩晕、共济失调和视力模糊起病迅速。在这种突然起病之后，患者可能呈现病情稳定的过程，也可能出现脑干受压的快速或延迟发作，表现为意识障碍。CT扫描是首选的诊断方法。梗死的血管造影定位与CT定位之间的相关性不佳。对于治疗，建议采取以下策略：对于意识清醒且临床稳定的患者：采取药物治疗（甘露醇、甘油、地塞米松），进行颅内压（ICP）监测及系列CT监测；对于有意识清醒但伴有脑积水或占位效应的患者：采取上述药物治疗及监测；如果颅内压超过350mmH₂O，则进行脑室引流；对于意识障碍且伴有脑积水或占位效应的患者：立即进行脑室引流。如果意识水平没有迅速改善，则应紧急行枕下颅骨切除术并清除梗死组织。
