Percheron动脉综合征9例临床分析

发布时间：2018-06-03 21:36

本文选题：Percheron动脉 + 脑梗死　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：Percheron动脉综合征（Percheron artery syndrome）的发病机制为起源于一侧大脑后动脉P1段的单支共干丘脑穿通动脉——Percheron动脉（AOP）闭塞，影像学表现为中线旁双侧丘脑区伴或不伴中脑梗死。该病在临床上极为少见，本研究旨在提高临床医生对Percheron动脉综合征的认识和诊断水平，从而采取及时、合理的治疗，改善患者预后。方法：回顾分析并随访重庆医科大学附属第一、第二医院2012年01月至2013年12月入院的9例Percheron动脉综合征患者的一般资料、临床表现、影像学资料、治疗及预后等情况，复习文献并总结Percheron动脉综合征的临床特点。结果：9例Percheron动脉综合征患者中，男性5例，女性4例。年龄44～83岁，平均年龄67岁。1例系慢性乙型病毒型肝炎肝硬化失代偿期、脾大脾功能亢进，行脾脏切除术后1天发病。6例有高血压病史，2例有糖尿病史，其中1例有反复后循环TIA病史，2例既往有脑梗死病史。风湿性心脏病心房纤颤病史者1例。吸烟者5例。该病典型临床表现为“三联征”：意识障碍、记忆力缺损、垂直注视麻痹。本组9例患者均为急性起病，突发意识障碍，其中眼球下视麻痹者3例，眼睑下垂者1例，伴肢体无力者6例，1例出现幻觉、持续性全身烧灼样疼痛、抑郁表现。9例患者病历资料中，有4例记录存在记忆力障碍，2例记忆力正常。9例均在起病后行头部CT检查，其中4例头部CT显示：双侧丘脑低密度影。9例均在发病后3天内行脑MRI检查，均显示双侧丘脑梗死灶，其中有2例可见中脑“V字征”。有4例患者于发病后行脑MRA或头颈部CTA检查，，但均未发现AOP存在。本组9例病人均按缺血性卒中治疗，出院时，有6例病情好转，平均随访1.15年，仅1例完全恢复，余随访病例均遗留有不同程度眼球垂直运动障碍、肢体无力或认知功能障碍。结论：Percheron动脉综合征主要表现为急性起病，有不同程度意识障碍、垂直注视麻痹、记忆缺损等，脑CT/MRI检查提示中线旁双侧丘脑伴或不伴中脑梗塞。脑MRI出现“中脑V字征”对Percheron动脉综合征有重要提示意义。本病主要按缺血性脑血管病治疗，预后较差。
[Abstract]:Objective the pathogenesis of Percheron artery syndrome is the occlusion of single common thalamic perforating artery (PAP) originated from P1 segment of the posterior cerebral artery. The imaging findings are bilateral thalamic area with or without mesencephalic infarction. The purpose of this study is to improve the understanding and diagnosis of Percheron's arterial syndrome, so as to take timely and reasonable treatment to improve the prognosis of the patients. Methods: the general data, clinical manifestation, imaging data, treatment and prognosis of 9 patients with Percheron artery syndrome were retrospectively analyzed and followed up in the first and second affiliated Hospital of Chongqing Medical University from January 2012 to December 2013. To review the literature and summarize the clinical features of Percheron artery syndrome. Results among 9 patients with Percheron's arterial syndrome, 5 were male and 4 were female. The mean age was 67. 1 years old. The patients had decompensated stage of cirrhosis of chronic hepatitis B, hypersplenism. 6 cases had hypertension history 1 day after splenectomy, 2 cases had diabetes history. One patient had a history of recurrent posterior circulation TIA and 2 had a history of cerebral infarction. One case had a history of atrial fibrillation in rheumatic heart disease. There were 5 smokers. The typical clinical manifestations of the disease are triple sign: consciousness disorder, memory impairment, vertical fixation paralysis. All the 9 patients had acute onset and sudden disturbance of consciousness, including 3 cases of hypoophthalmic paralysis, 1 case of blepharoptosis, 6 cases of limb weakness, 1 case of hallucination, and 1 case of persistent systemic burning pain. Of the 9 cases with depression, 4 cases had memory disorder, 2 cases had normal memory, and 9 cases had head CT examination after the onset of the disease. Among them, 4 cases showed head CT: bilateral hypodense thalamus were examined with MRI within 3 days after onset, and bilateral thalamic infarction was revealed in all cases. "V sign" of midbrain was found in 2 cases. Brain MRA or head and neck CTA were performed in 4 patients, but no AOP was found. All the 9 patients were treated with ischemic stroke. At discharge, 6 cases were improved, with an average follow-up of 1. 15 years, only 1 case recovered completely. The remaining cases were left with different degrees of ocular vertical movement disorder, limb weakness or cognitive dysfunction. Conclusion the main symptoms of the disease are acute onset, different degree of consciousness disorder, vertical fixation paralysis, memory deficit and so on. CT/MRI examination indicates bilateral thalamus with or without midline infarction. The appearance of midbrain V sign in MRI has important implications for Percheron artery syndrome. This disease is mainly treated by ischemic cerebrovascular disease, the prognosis is poor.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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