| Objective:Retrospectively analyze the clinical information of 100 patients with brainstem infarction, comparing general information, risk factors, clinical manifestations, imaging features and prognosis between typical group and atypical group, clarify the characteristics of atypical cases of brainstem infarction and provide assistance for the clinical diagnosis and treatment.Method:Relevant clinical data of 100 cases with brain stem infarction were collected in the Department of Neurology, First Hospital of Jilin University from January to December in 2008. All patients were matched with the revised diagnostic criteria of 4th National Conference on Cerebrovascular Disease, announced by Chinese Medical Association in 1995. Symptoms and physical signs could be interpreted by vertebrobasilar arterial occlusion syndrome, all patients were identified by CT or MRI, as having fresh brainstem infarction. In 100 cases, there are 68 male cases (68.0%), and 32 female cases (32.0%). Patients with brainstem infarction were divided into two groups:the atypical group of 75 cases (75%), including 49 males and 26 females and the typical group of 25 cases (25%), including 19 males and 6 females. General information, risk factors, clinical manifestations, imaging features and prognosis of the two groups were statistically analyzed. Using SPSS 17.0 statistical software, the qualitative data of the two groups was analyzed by X2 test, quantitative data was analyzed by t test for statistical analysis.Result:1. Risk factors in a descending order for brainstem infarction were hypertention, diabetes, history of previous stroke, hyperlipidemia and heart disease, with respective ratio of 80%,57%,28%,25%,24%. Patients in the atypical group were tended to suffer more diabetes than the ones in the typical group and there was significant difference between the two groups.2. The clinical manifestations of typical brainstem infarction group in a descending order of frequency were as follows:dizziness (68%), paralysis (64%), dysphagia (52%), dysarthria (44%), loss of consciousness (36%), nystagmus (28%), while the specific brainstem syndromes count for 20%, cross-symptoms or signs count for 16%3. The clinical manifestations of atypical brainstem infarction group in a descending order of frequency were as follows:paralysis(46.7%), dizziness or vertigo (37.3%), dysarthria (36%), ipsilateral central facial paralysis and glossoplegia (6.7%) and so on. Among the 75 atypical brainstem infarction cases, 51 cases (51%) with clinical manifestations of hemiplegia, ipsilateral central facial paralysis and glossoplegia and partial body sensory dysfunction, and they were mistakenly diagnosed as supratentorial cerebral infarction at first. Also, there were 11 cases (11%) with the clinical features of dizziness or vertigo, nausea and vomiting, without positive neurological signs, thus they were diagnosed as the suspicion of posterior circulation ischemia.4. Among the 100 cases,93 patients went through brain MRI with the detection of brainstem infarction in all 93 cases, therefore the positive dectection rate of brainstem lesion was 100% by MRI. At the same time,30 patients underwent head CT examination, only 17 cases were detected with brainstem infarction while all of them were confirmed by MRI as having brainstem lesions. Thus the positive rate of CT scan for brainstem infarction in our investigation was 56.7%.5. According to the model of posterior circulation distribution published by Caplan, among the 100 cases,there were 7 cases in the proximal group,57 cases in the middle group,16 cases in the distal group, and 20 cases in the mixed group (including 5 cases in the proximal middle group,10 cases in the middle distal group,3 cases in the proximal middle and distal group). Brainstem infarction lesions were most frequently found in pons, then in midbrain and medulla oblongata. Brainstem infarction lesions in the atypical group were often combined with supratentorial lesions, and the combination rate was higher than that of the typical group.6. When patients were discharged after treatment, they were evaluated according to the adjusted Rankin's scale. The poor prognosis counts for 20% of all cases including 8cases of death (8%) and 12 cases of severe disability (12%).While the good prognosis counts for 80% of total cases, including 67 cases with mild disabilities (67%) and 13 cases non-disabled (13%).Conclusion:1. Diabetes were the major risk factors for brain stem infarction in atypical group.2. Atypical brainstem infarction generally originated under three circumstances:â‘ . Brain infarction mimicing cerebral hemisphere ischemic stroke, which can be attribute to the relatively higher location of the lesions, or the brain stem lesion as lacunar infarction, or posterior circulation steal syndrome.â‘¡. Posterior circulation ischemia with clinical symptoms while the neurological physical examination was negative.â‘¢. Asymptomatic brainstem infarction.3. Brainstem infarction lesions most frequently appear in the pons, followed by midbrain, and then medulla oblongata. Brain stem infarction lesions in the atypical group are often combined with supratentorial lesions which is higher than the typical group.4. Head MRI is important for diagnosing atypical brainstem infarction. MRI examination in the early stage of the disease can improve the diagnosis.5. Most patients of atypical brainstem infarction group have good prognosis which counts for 85.3% versus a poor one with 14.7%.
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