Bernasconi A, Bogousslavsky J, Bassetti C, Regli F
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Neurol Neurosurg Psychiatry. 1996 Mar;60(3):289-96. doi: 10.1136/jnnp.60.3.289.
to evaluate clinical, radiological, and prognostic features of patients with multiple acute infarcts in remote arterial territories of the posterior circulation.
Data analysis from a prospective acute stroke registry in a community based primary care centre using a standard protocol including MRI and MRA.
In three and a half years, 27 of the 236 patients (11%) with posterior circulation stroke had multiple acute infarcts in the posterior circulation as shown by gadolinium enhancement on MRI. Eighteen patients had multiple infratentorial and supratentorial infarcts including the cerebellum and posterior cerebral artery territory, with coexisting brainstem involvement in seven patients. Fourteen patients had a rostral basilar artery syndrome and cerebellar signs; four patients had a visual field defect with cerebellar signs. Causes were vertebral (six) or basilar (four) artery atheromatosis, and cardioembolism (four). Seven patients had multiple acute infarcts in the posterior circulation of the cerebellum and lower brainstem. Brainstem and cerebellar signs were found in most patients (five); aetiologies were small vessel disease (four), cardioembolism (one), and vertebral artery dissection (one). Two patients with large artery atheromatosis had multiple acute infarcts in the posterior circulation in the brainstem and posterior cerebral artery territory. One month after stroke more than 25% of the patients were dependent or had died. There was no difference in the outcome between the three groups, and recovery was linked to the size of infarcts rather than to a high number of infarcts.
multiple acute infarcts in the posterior circulation usually involve the cerebellum. Simultaneous brainstem and posterior cerebral artery territory infarcts sparing the cerebellum are uncommon. They can be suspected clinically before neuroimaging, mainly when supratentorial and infratentorial infarcts coexist. This may be important, because different patterns of infarction are associated with different causes of stroke.
评估后循环远隔动脉区域多发性急性梗死患者的临床、影像学及预后特征。
对社区基层医疗中心一项前瞻性急性卒中登记研究的数据进行分析，采用包括MRI和MRA的标准方案。
在三年半的时间里，236例后循环卒中患者中有27例（11%）在MRI上钆增强显示后循环存在多发性急性梗死。18例患者有幕下和幕上多发性梗死，包括小脑和大脑后动脉区域，7例患者同时伴有脑干受累。14例患者有延髓基底动脉综合征和小脑体征；4例患者有视野缺损和小脑体征。病因包括椎动脉（6例）或基底动脉（4例）粥样硬化以及心源性栓塞（4例）。7例患者小脑和下脑干的后循环存在多发性急性梗死。大多数患者（5例）有脑干和小脑体征；病因包括小血管病（4例）、心源性栓塞（1例）和椎动脉夹层（1例）。2例大动脉粥样硬化患者脑干和大脑后动脉区域的后循环存在多发性急性梗死。卒中后1个月，超过25%的患者出现依赖或死亡。三组患者的预后无差异，恢复情况与梗死灶大小有关，而非梗死灶数量。
后循环多发性急性梗死通常累及小脑。不累及小脑的同时发生的脑干和大脑后动脉区域梗死并不常见。在神经影像学检查之前，临床上即可怀疑此类情况，主要是在幕上和幕下梗死并存时。这可能很重要，因为不同的梗死模式与不同的卒中病因相关。
