Bogousslavsky J, Maeder P, Regli F, Meuli R
Department of Neurology, University Hospital, Lausanne, Switzerland.
Neurology. 1994 Nov;44(11):2032-40. doi: 10.1212/wnl.44.11.2032.
We studied 22 patients with first stroke and infarct limited to the midbrain on MRI. We selected these patients (8%) from 281 with posterior circulation infarct admitted consecutively into a primary care center. All patients underwent a systematic protocol of investigations including MR imaging and angiography, and echocardiography. Most infarcts fitted well to arterial territories drawn in preestablished templates. Middle midbrain involvement was the most common, mainly in the paramedian territory supplied by the basilar artery. Infarct in the mesencephalic territory of the posterior cerebral artery was less common, while superior cerebellar artery territory infarct was extremely rare, and posterior choroidal artery territory infarct did not occur. The neurologic picture was dominated by eye-movement disorders. Patients with isolated upper or lower midbrain infarct had no localizing clinical findings, but patients with middle midbrain infarct had a localizing picture mainly with nuclear or fascicular third nerve palsies that commonly developed in isolation. Vertical gaze paresis, pure motor hemiparesis, four-limb ataxia from unilateral lesion, and hypesthetic ataxic hemiparesis also occurred. Contrary to a common view, cardioembolism was not a more common etiology than basilar artery stenosis or small-vessel disease.
我们研究了22例首次发生中风且MRI显示梗死局限于中脑的患者。我们从281例连续入住初级保健中心的后循环梗死患者中挑选出了这些患者（8%）。所有患者均接受了包括磁共振成像、血管造影和超声心动图在内的系统检查方案。大多数梗死灶与预先建立的模板中绘制的动脉区域相符。中脑中部受累最为常见，主要位于基底动脉供应的旁正中区域。大脑后动脉中脑区域的梗死较少见，而小脑上动脉区域梗死极为罕见，脉络膜后动脉区域梗死未发生。神经系统表现以眼球运动障碍为主。孤立的中脑上部或下部梗死患者没有定位性临床体征，但中脑中部梗死患者有定位表现，主要为核性或束性动眼神经麻痹，通常单独出现。垂直凝视麻痹、纯运动性偏瘫、单侧病变导致的四肢共济失调以及感觉减退性共济失调性偏瘫也会出现。与普遍观点相反，心源性栓塞并非比基底动脉狭窄或小血管病更常见的病因。
