Kim J S, Lee J H, Im J H, Lee M C
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Stroke. 1995 Jun;26(6):950-5. doi: 10.1161/01.str.26.6.950.
Although there have been sporadic reports of lacunar syndromes due to pontine base infarction, studies of clinical-radiological correlation in sufficient numbers of patients have not yet been reported.
We studied the clinical features of 37 patients with acute infarcts that mainly involved the base of the pons and correlated the clinical syndromes with the radiological findings.
The clinical presentations included pure motor hemiparesis (PMH) in 17, sensorimotor stroke in 3, ataxic hemiparesis (AH) in 4, and dysarthria-clumsy hand (DA-CH) syndrome in 6 patients. Variants of AH included 1 patient with dysarthria-hemiataxia and 2 with quadrataxic hemiparesis, and in 4 patients dysarthria-facial paresis syndrome was considered a variant of DA-CH syndrome. Hypertension was the single most common and important risk factor, and the pathogenetic mechanisms of ischemia were likely to be small arterial (lacunar) occlusion or basilar atheromatous branch occlusion in most of the patients. Our clinical-radiological correlation study suggested that large lesions involving the paramedian caudal or middle pons correlate with severe hemiparesis (PMH), whereas lesions of similar size located in the paramedian rostral pons tended to produce DA-CH syndrome. Lesions producing AH were located variously but tended to spare the pyramidal tracts. The prognosis of these patients is fair or good, although residual hemiparesis remained in patients with initially severe hemiparesis.
Our data suggest that the various lacunar syndromes that follow pontine base infarcts reflect the balance of the involvement of the corticospinal, corticopontocerebellar, and corticobulbar tracts. Analysis of radiological findings aids in determining the clinical-anatomic correlation in patients with pontine base infarction.
尽管已有关于脑桥基底部梗死所致腔隙综合征的零星报道，但尚未有足够数量患者的临床与影像学相关性研究报告。
我们研究了37例主要累及脑桥基底部的急性梗死患者的临床特征，并将临床综合征与影像学表现进行关联分析。
临床表现包括17例纯运动性偏瘫（PMH）、3例感觉运动性卒中、4例共济失调性偏瘫（AH）以及6例构音障碍-手笨拙（DA-CH）综合征。AH的变异型包括1例构音障碍-偏身共济失调患者和2例四共济失调性偏瘫患者，4例构音障碍-面肌无力综合征被认为是DA-CH综合征的变异型。高血压是最常见且最重要的单一危险因素，大多数患者的缺血发病机制可能是小动脉（腔隙性）闭塞或基底动脉粥样硬化分支闭塞。我们的临床与影像学相关性研究表明，累及脑桥尾侧或中部旁正中区域的大病灶与严重偏瘫（PMH）相关，而位于脑桥嘴侧旁正中区域的类似大小病灶倾向于导致DA-CH综合征。导致AH的病灶位置各异，但往往不累及锥体束。这些患者的预后尚可或良好，尽管最初有严重偏瘫的患者仍遗留偏瘫后遗症。
我们的数据表明，脑桥基底部梗死后的各种腔隙综合征反映了皮质脊髓束、皮质脑桥小脑束和皮质延髓束受累的平衡情况。影像学表现分析有助于确定脑桥基底部梗死患者的临床-解剖学相关性。
