小脑梗死45例临床分析.docVIP

小脑梗死45例临床分析 　　作者：李砺 作者单位：大连机车医院，辽宁 大连 116021; 　　【摘要】 目的：探讨小脑梗死的病因、临床表现、影像学改变、诊断及治疗。方法：对我科1999年5月至2007年1月收治的45例患者的临床资料进行回顾性分析。结果：病因及危险因素为高血压、心脏病、高脂血症及糖尿病。最主要临床表现为眩晕及小脑性共济失调。头部CT 48 h内阳性率为35.6%,头部MRI阳性率为100%。内科保守治疗的治愈率为40.0%,病死率为11.1%,脑疝为主要死因。结论：患者持续出现眩晕、共济失调要注意小脑梗死的可能,头部MRI确诊小脑梗死优于头部CT, 一般采用内科保守治疗,注意防治脑疝。 　　【关键词】 小脑梗死 临床分析 脑疝 　　Clinical Analysis of 45 Patients with Cerebellar Infarction 　　LI Li，DONG Linlin 　　1.Dalian Jiche Hospital,Dalian,Liaoning 116021,China; 　　2.The Affiliated Zhongshan Hospital of Dalian University,Dalian,Liaoning 116001,China 　　Abstract：Objective To investigate the etiology,clinical manifestations,the changes of CT/MRI,diagnosis and treatment of cerebellar infarction.Methods The data of 45 patients with cerebellar infarction admitted in our department during 1999～2007 were retrospectively analyzed. Results The main etiology and typical clinical manifestation were vertigo and cerebellar ataxia.The positive rate of CIs CT examination was 35.6%.Its positive rate of MRI was 100%.The cure rate was 40.0% and death rate was 11.1% in the patients who received conservative treatment. The cerebral hernia was the main death reason.Conclusion If the patients occur vertigo and ataxia continuously cerebellar infarction should be paid attention to.MRI is superior to CT in the diagnosis of cerebellar infarction. Generally,the patients were treated by medical method.It should be paid attention to the prevention and treatment of cerebral hernia. 　　Key words：Cerebellar infarction;Clinical analysis;Cerebral hernia 　　小脑位于后颅窝这一较特殊的部位,且供应小脑的3对动脉:小脑上动脉(superior cerebellar arteries, SCA)、小脑前下动脉(anterior inferiorcerebellar arteries,AICA)、小脑后下动脉(posteriorinferior cerebellar arteries,PICA)从椎动脉或基底动脉发出后亦同时供血于脑干,故临床表现复杂多样,给诊断和治疗造成了一定的困难。PICA区的梗死在小脑梗死中最多见,主要由于其行程长,侧支吻合少,故当缺血发生时易形成梗死[1]。为了探讨小脑梗死的病因、临床表现、影像学改变、治疗及预后,我们对1999年5月至2007年1月在我院住院的45例小脑梗死患者的临床资料进行了回顾性分析。 　　1 资料与方法 　　1.1 一般资料 　　45例小脑梗死患者中,男34例,女11例;年龄50岁～76岁,平均年龄65.4岁。既往患