Clinical Characters Analysis In 115 Patients With Brain Stem Infarction

Objective:Retrospectively analyze the clinical information of 115 patients with brain stem infarction,compare general information,risk factors,onset symptoms,clinical manifestations,imaging features and laboratory test results between survival group and death group,and determine whether there are differences between the two groups in the above-mentioned aspects.Method:To select 115 patients with brain stem infarction in department of neurology in Shandong provincial hospital from October 2006 to December 2008.All patients were matched with clinical diagnostic criterion of cerebrovascular diseases: Sudden emergence of deficits of neurological function and lasting more than 24 hours, symptoms and physical signs can be explained by posterior circulation-vertebrobasilar arterial occlusion syndrome,and CT and MR examination confirmed as brain stem infarction.In 115 patients,there are 80 men(70.0%) and 35 women(30.0%),onset age 26～87 years old,average 59.6 years old.Patients were divided into two groups: the survival group:84 cases(73.0%),of which 58 men and 26 women;the death group:31 cases(27.0%),of which 23 men and 8 women.Statistically analyze general information,risk factors,first symptoms,clinical manifestations,imaging features and laboratory test results of the two groups.The univariate analyses were performed using SPSS for Windows version 12.0.The qualitative data is analyzed by X~2 test,and quantitative data by t test for statistical analysis.Result: 1.Hypertention,diabetes,coronary heart disease,smoking history,drinking history, history of cerebral infarction are risk factors for brain stem infarction,with respective ratio of 65.2%,22.6%,19.1%,34.8%,20.0%,21.7%,and there was no significant difference between survival group and death group.2.In this investigation,the onset symptom with the frequency of occurrence is dizziness or vertigo(48.6%),poor physical activity(14.7%),dysarthria(9.7%), disturbance of consciousness(8.7%),walking instability(4.3%),facial numbness (3.5%),headache(3.5%),drinking cough(3.5%),limb numbness(3.5%).Among them,there were 10 cases with the disturbance of consciousness as the onset symptom,of which 8 cases were in the death group,25.9%of the group,and 2 cases were in the survival group,2.4%of the group.The death group was significantly higher than the survival group,and the difference between two groups was statistically significant.3.There were only 20 patients with cross symptoms or physical signs,and the proportion was 17.4%.Clinical symptoms and physical signs of most patients are not typical,as a combination of symptoms and signs,dizziness or vertigo,nausea, vomiting,dysarthria,facial paralysis and/or tongue paralysis,hemiplegia,partial body sensory disturbance,ataxia and pathological signs.4.The average of body temperature,WBC,blood glucose levels when the survival group was admitted to hospital were 36.6℃,27×10~9/L,6.80 mmol/L,while that of the death group were 37.2℃,12.8×10~9/L,9.49 mmol/L.The above-mentioned indicators of the death group were significantly higher than that of the survival group,and the difference was statistically significant.5.Among 115 cases,78 patients were examined by CT,and 19(24%) of them were correctly detected to be brain stem infarction;92 patients were examined by MRI,and all were correctly detected.6.The location of brainstem infarction in this investigation was pons(57.4%),medulla oblongata(27.1%),midbrain(11.3%).Only 17 cases were pure brain stem infarction,and the other cases combined with infarction of other parts.7.57 patients(49.6%) had the subcortical arteriosclerotic encephalopathy(SAE),and their prognosis was worse than those without SAE.Conclusion:1.Hypertention,diabetes,coronary heart disease,smoking history,drinking history, history of cerebral infarction are all risk factors of brain stem infarction.2.Hyperthermia,high leukocyte value,hyperglycemia,disturbance of consciousness when patients were admitted to hospital indicated serious illness and poor prognosis.3.Crossover symptoms or signs of brain stem infarction are not common.4.Predilection cites of focuci for brain stem infarction are located in pons,medulla oblongata,midbrain in sequence.Pure brain stem infarction was not common,and most merge with other parts of infarction.5.MRI in the diagnosis of brain stem infarction is obviously superior to CT.6.In patients with brainstem infarction,SAE occurred in a higher incidence,and their prognosis is worse than that without SAE.