Zhongguo cuzhong zazhi (Nov 2022)
急性单发小脑小梗死的临床特征 Clinical Features of Acute Single Small Cerebellar Infarction
Abstract
目的 探讨急性小脑小梗死的临床影像特征及可能的发病机制。 方法 回顾性连续纳入2016年1月-2019年12月在首都医科大学附属朝阳医院神经内科住院的急性小脑梗死患者。根据梗死灶大小分为小脑小梗死（梗死灶直径＜2 cm）和小脑大梗死（梗死灶直径≥2 cm）组。比较2组的人口学信息、血管危险因素、卒中病因分型[中国缺血性脑卒中亚型（China ischemic stroke subclassification，CISS）]、入院时血压、实验室检查指标、临床症状和体征等方面的差异，以及2组受累血管分布、血管狭窄部位、脑白质病变等影像学特征。 结果 共入组121例小脑梗死患者，其中小脑小梗死组43例，小脑大梗死组78例。2组既往病史差异无统计学意义。与小脑大梗死组相比，小脑小梗死组中男性（51.2% vs. 82.1%，P＜0.001）、吸烟（51.2% vs. 70.5%，P=0.034）的比例较低，入院时收缩压（146.2±18.2 mmHg vs. 154.6±19.8 mmHg，P=0.022）和入院次日空腹血糖（6.08±1.98 mmol/L vs. 8.12±3.46 mmol/L，P＜0.001）水平较低，临床症状中眩晕（32.6% vs. 64.1%，P＜0.001）和头痛（9.3% vs. 28.2%，P=0.015）的发生率较低。2组的CISS分型分布差异有统计学意义（P＜0.001），虽然2组中均以大动脉粥样硬化型最多见，但小脑大梗死组中大动脉粥样硬化型的比例明显更高（89.7% vs. 48.8%）,小脑小梗死组中不明原因型更多（32.6% vs. 5.1%）。2组受累血管分布差异有统计学意义（P＜0.001），2组均以小脑后下动脉受累最多见，但小脑小梗死组中小脑前下动脉（20.9%）和小脑上动脉（25.6%）受累的比例高于大梗死组（小脑前下动脉0，小脑上动脉1.3%），小脑大梗死组中多血管分布更多见（47.4%）。2组后循环血管狭窄部位和脑白质高信号差异无统计学意义。 结论 急性小脑小梗死和小脑大梗死患者中与血管危险因素有关的既往病史情况无显著差异，后循环系统血管狭窄部位相似，提示两者可能存在相同的发病机制。小梗死患者中眩晕和头痛症状较大梗死患者的发生率低。 Abstract: Objective To investigate the clinical and imaging features and possible pathogenesis of acute small cerebellar infarction. Methods The inpatients with acute cerebellar infarction in Department of Neurology of Beijing Chaoyang Hospital, Capital Medical University from January 2016 to December 2019 were enrolled in this retrospective study. According to the infarction size, the patients were divided into small cerebellar infarct (infarction diameter <2 cm) and large cerebellar infarct (infarction diameter ≥2 cm) groups. The demographics, vascular risk factors, classification of etiology (China ischemic stroke subclassification, CISS), blood pressure at admission, laboratory tests, clinical symptoms and signs, involved vascular territories, vascular stenosis location and white matter lesions between two groups were compared. Results A total of 121 patients were included, with 43 cases in small cerebellar infarct group and 78 in large cerebellar infarct group. There was no statistical difference in medical history between the two groups. Compared with large cerebellar infarct group, small cerebellar infarct group had lower percentage of males (51.2% vs. 82.1%, P<0.001), smoking (51.2% vs. 70.5%, P=0.034), lower level of systolic blood pressure (146.2±18.2 mmHg vs.154.6±19.8 mmHg, P=0.022) and fasting blood glucose at admission (6.08±1.98 mmol/L vs.8.12±3.46 mmol/L, P<0.001), and lower incidence of vertigo (32.6% vs. 64.1%, P<0.001) and headache (9.3% vs. 28.2%, P=0.015). There was statistical difference in the distribution of CISS type between the two groups (P<0.001). Although the large artery atherosclerosis was the most common type in both groups, the proportion of large artery atherosclerosis was higher in large cerebellar infarct group (89.7% vs. 48.8%), and the proportion of undetermined etiology was higher in small cerebellar infarct group (32.6% vs. 5.1%). There was statistical difference in involved vascular distribution between the two groups, and posterior inferior cerebellar artery (PICA) was the most commonly involved in both groups. The percentage of involved anterior inferior cerebellar artery (AICA) (20.9% vs. 0) and superior cerebellar artery (SCA) (25.6% vs. 1.3%) were higher in small cerebellar infarct group than that in large cerebellar infarct group, and the multiple vessels involvement was more common in large cerebellar infarct group (47.4%). There was no statistical difference in the degree of posterior circulation vascular stenosis between the two groups. Conclusions There was no significant difference in medical history related to vascular risk factors between the patients with small or large cerebellar infarct, and the degree of posterior circulation vascular stenosis was similar, suggesting that the two types of cerebellar infarct may have similar pathogenesis. The incidence of vertigo and headache was lower in patients with small cerebellar infarct, compared to patients with large cerebellar infarct.
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