椎动脉与基底动脉粥样硬化所致双侧脑干梗死形态及分布的对比研究

目的探讨椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死患者梗死灶的形态以及分们的特点。方法回顾性分析25例椎动脉或基底动脉粥样硬化所致双侧脑干梗死患者的影像学资料，根据血管病变部位分为椎动脉病变组（17例）和基底动脉病变组（8例），比较两组患者的梗死灶的形态以及分布情况。结果①17例椎动脉病变患者均存在双侧椎动脉闭塞或严重狭窄（狭窄率为70％～99％），其中8例为双侧椎动脉闭塞，9例为一侧椎动脉闭塞合并对侧椎动脉重度狭窄，病变部位多位于颅内；基底动脉病变组8例患者中，基底动脉闭塞3例，狭窄5例，其中3例为重度狭窄，2例狭窄率为50％～69％。②椎动脉病变组和基底动脉病变组双侧脑干多发性小梗死灶（〈1cm）分别为15例（15／17）和3例（3／8），P〈0．05；单个大梗死灶（≥1cm）累及双侧脑十分别为3例（3／17）和6例（6／8），P〈0．05；合并小脑梗死分别为13例（13／17）和2例（2／8），P〈0．05。，结论椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死梗死灶的形态以及分布有所不同，前者双侧脑干多发小梗死灶较多见，后者累及双侧脑干的大梗死灶多见。

Comparison of the morphology and distribution of bilateral brain stem infarction caused by vertebral-basilar atheroselerosis

Objective To investigate the morphology and distribution characteristics of bilateral brain stem infarction caused by vertehral or basilar atheroselerosis. Methods The neuroradiological data of 25 patients with bilateral brain stem infarction caused by vertebral or basilar atheroselerosis were analyzed retrospectively. The patients were divided into either a vertebral artery lesion group（ n = 17） and a basilar artery lesion group （ n = 8 ） according to the location of vascular lesions. The morphology and distribution of the infarctions in the two groups were compared. Results ① The patients in the vertebral artery group had bilateral vertebral artery occlusion or severe stenosis （ stenotic rate 70% - 99% ） , 8 of them bad bilateral vertebral artery occlusion, and 9 patients had unilateral vertebral artery occlusion and severe stenosis of contralateral vertebral artery, most of the lesions were located in intracranial segment of vertebral arteries, the 8 patients in the basilar artery lesion group, 3 had basilar artery occlusion and 5 had basilar artery stenosis, 3 of them had severe stenosis. ② Multiple bilateral small infarcts in brain stem （ 〈 1 cm） occured in the vertebral artery lesion and basilar artery lesion groups were 15 （15/17） and 3 （3/8） patients respectively （P 〈 0.05） ; single large infarction （ ≥ 1 cm） involved bilateral brain stem were 3 （ 3/ 17 ） and 6 （ 6/8 ） patients respectively （ P 〈 0.05 ） ; and the combined cerebellar infarctions were 13 （ 13/ 17） and 2 （2/8） patients respectively （ P 〈 0.05 ） in the 2 groups. Conclusion The morphology and distribution of bilateral brain stem infarction caused by vertebral and basilar atheroselerosis are different. The former usually cause muhiple small infarcts in the bilateral brain stem, and the latter usually cause large infarcts in the bilateral brain stem.