Clinical Analysis In 64 Cases With Brainstem Infarction

Objective:Retrospectively analyze the clinical information of 64 Patients with brainstem infarction,comparing general information,risk factors,clinical manifestations,imaging features and prognosis between progression group and non progression group,clarify the clinical characteristics of the two groups.Method:Relevant clinical data of 64cases with brainstem infarction were collected in the department of neurology,China-Japan union hospital of Jilin University from 2009 march to 2010 november. In 64 cases , there are 45male cases(69.2%),and 19 female cases(30.8%). All Patients were matched with the revised Diagnostic criteria of 4th National Conference on Cerebrovascular Disease announced by Chinese Medical Association in 1995. All patients were identified by CT or MRI,as having fresh brainstem infarction. Patients with brainstem infarction were divided into two groups according to the decrease of NHISS:the progression group(n=23,35.9%) and non progression group (n=41,64.1%).Statistically analyze general information,risk factors,first symptoms,clical manifestations and imaging features of the two groups. Using SPSS 17.O statistical software,the qualitative data of the two groups was analyzed by X2 test.Result:1.Risk factors in a deseending order for brainstem infarction were hypertention,smoking,hyperlipidemia,coronary heart disease,diabetes,history of previous stroke and drinking,with respective ratio of62.5%,40.6%,32.8%,21.8%,20.3%,20.3% and 15.6%.Patients in the progression group were tended to suffer more hypertention and diabetes than the non progression group and there was significant difference between the two groups.2.In this investigation , the onset symptom with the frequency of occurrence are dizziness or vertigo(40.6%) , hemiplegia (32.8%) ,dysarthria(25.0%),quadriplegia(9.4%),disturbance of consciousness(9.4%),diplopia(7.8%),dysphagia(6.3%) and walking instability(4.7%).There were no statistically difference between two groups among all these onset symptoms.3.The clinical manifestations of all brainstem infarction in a descending order of frequency were as follows: dizziness or vertigo(67.2%) ,dysarthria(51.6%),hemiplegia (42.2%),facial paralysis and glossoplegia (35.9%),partial body sensory dysfunction(26.6%), bulbar paralysis(26.6%),diplopia(20.3%),nystagmus(20.3%),quadriplegia(14.1%),disturbance of consciousness(14.1%), dysphagia(6.3%) and ataxia(12.5%).?.Among them,patients in progression group with hemiplegia,quadriplegia,disturbance of consciousness and ataxia were significantly more than patients in non progression group.4. There were only 17 patients with typical clinical manifestation of brainstem infarcion,and the proportion is26.6%,including 1 locked-in syndrome,1 wallenberg syndrome,1 top of basilar syndrome and 1 Raymond-Cestan syndrome.5.Hyperthermia in the first 24 hours from the onset of brainstem stroke,in the progression group,there were 12 cases(52.2%).Of 12 cases,6 cases were between 37.4～38℃,while 6 cases over 38℃and 6cases with infection.In the non progression group,4(9.8%)cases occur fever,3cases with temperature 37.4～38℃,1case with temperature over 38℃and 2 cases with infection. There were significant defference between the two groups in temperature between 37.4～38℃,over 38℃and combined with infection.5.Among the 64 cases,60 patients went through brain MRI 6 hours after the onset and the positive dectection rate of brainstem lesion was100%. At the same time,28 patient underwent head CT examination 24hours after onset,and the positive rate of CT scan for brainstem infarction in our investigation was 42.9%.6.The location of brainstem infarction in this investigation was pons(59.4%),medulla oblongata(21.9%),midbrain(12.5%),pons and medulla oblongata together(4.7%),three parts of brainstem together(1.6%),brainstem infarction combined with cerebellar(7.8%),brainstem infarction combined with thalamus(4.7%)and brainstem infarction combined with anterior circulation area(48.4%).Conclusion:1.Among hypertention,diabetes,coronary heart disease,smoking,drinking,history of previous stroke ,hypertension and diabetes are the main risk factors of progression of brainstem infarction.2.Brainstem infarcion tend to progress in patients with the clinical manifestation with hemiplegia,quadriplegia,disturbance of consciousness and ataxia.3.The fever within 24 hours of brainstem stroke onset was predictive factors of deterioration.Moreover,the higher the temperature was,the more frequent the deterioration would be.4.MRI in the diagnosis of brainstem infarction is obviously superior to CT.