Tettenborn B, Caplan L R, Sloan M A, Estol C J, Pessin M S, DeWitt L D, Haley C, Price T R
Stroke Service, New England Medical Center, Boston, MA 02111.
Neurology. 1993 Mar;43(3 Pt 1):471-7. doi: 10.1212/wnl.43.3_part_1.471.
To study the clinical features and causes of postoperative brainstem and cerebellar infarcts.
Two groups were studied. The 10 group 1 patients had cardiac (eight) or aortic (two) surgery. The 12 group 2 patients had noncardiac-nonvascular surgery, including orthopedic (five), gynecologic (four), and general (three). Patients were studied by stroke services at university hospitals in Boston (13), Charlottesville (three), Baltimore (three), and Mainz (three) during 2 consecutive years.
Onset of strokes was immediately postoperative (six), during the first 48 postoperative hours (nine), and delayed 3 days or more (seven). Clinical syndromes were altered level of consciousness or cognition (15), vestibulocerebellar (four), and hemiparesis with focal brainstem signs (three). Infarction involved the brainstem (13), cerebellum (13), and posterior cerebral artery hemispheric territory (10). Causes: In group 1, five infarcts were due to cardiogenic embolism and three to embolism from the aorta. One patient had a postoperative pontine lacunar infarct and one developed an infarct in the territory of a known stenotic basilar artery. In group 2, one patient had vertebral artery injury from instrumentation, one had medical complications with severe hemorrhage and hypotension, and 10 most likely had position-related vertebral artery thromboses.
Patients with postoperative brainstem and cerebellar infarcts present with altered consciousness or vestibulocerebellar syndromes. The major cause of brain infarcts after cardiac surgery is embolism from the heart and aorta. The causes of infarction after general surgery are less clear, but neck positioning during or after surgery may play an important role by promoting thrombi in compressed arteries that later embolize intracranially when neck motion becomes free.
研究术后脑干和小脑梗死的临床特征及病因。
研究分为两组。第1组10例患者接受了心脏（8例）或主动脉（2例）手术。第2组12例患者接受了非心脏非血管手术，包括骨科手术（5例）、妇科手术（4例）和普通外科手术（3例）。连续两年间，波士顿（13例）、夏洛茨维尔（3例）、巴尔的摩（3例）和美因茨（3例）的大学医院的卒中服务团队对这些患者进行了研究。
卒中发作时间为术后即刻（6例）、术后48小时内（9例）以及延迟3天或更久（7例）。临床综合征包括意识或认知水平改变（15例）、前庭小脑综合征（4例）以及伴有局灶性脑干体征的偏瘫（3例）。梗死累及脑干（13例）、小脑（13例）以及大脑后动脉半球区域（10例）。病因：在第1组中，5例梗死是由于心源性栓塞，3例是由于主动脉栓塞。1例患者术后发生脑桥腔隙性梗死，1例在已知狭窄的基底动脉区域发生梗死。在第2组中，1例患者因手术器械导致椎动脉损伤，1例因内科并发症出现严重出血和低血压，10例很可能是与体位相关的椎动脉血栓形成。
术后脑干和小脑梗死患者表现为意识改变或前庭小脑综合征。心脏手术后脑梗死的主要原因是心脏和主动脉的栓塞。普通外科手术后梗死的原因尚不清楚，但手术期间或术后颈部的位置可能通过促使受压动脉形成血栓起重要作用，当颈部活动恢复正常时，这些血栓随后会栓塞至颅内。
