Clinical And Iconographic Analyses Of Brainstem Stroke In 111 Cases

Backgrounds and Objectives:The clinical manifestations of brainstem apoplexy are complex and diverse, most of which are untypical and have significant individual differences. Missed diagnosis and misdiagnosis could happen easily without iconography evidences. Through analyzing the clinical characteristic and iconography of brainstem apoplexy and exploring their relationship, This study is aimed to enhance the knowledge of this disease.Methods:The clinical characteristic and iconography in 111 patients of brainstem apoplexy were analyzed retrospectively, including 77 male cases (63.96%)and 40 female cases (36.04%).86 cases were brainstem infarction(77.48%),22 cases were brainstem hemorrhage(19.82%)and 3 cases were mixed stroke(2.70%). Each ischemic diagnosis has been proved by cranial MRI and each hemorrhagic diagnosis has been confirmed by cranial CT. The imaging document was analyzed in all cases. For imaging research ,the brainstem was divided into three sections—midbrain, pons and medulla oblongata. Every section was further divided into different levels according to the anatomical structure. And every level was divided in details into 5 locations on axial plane: ventral lateral, ventral medial, dorsal lateral, dorsal medial and centre. The location, the shape, the distribution, the number of lesions and the hemorrhagic amount were recorded in each case. The clinical symptoms and signs of each case were summarized and concluded. The relationship between stroke location and the impairment of neurological function, and brainstem syndrome as well, was analyzed in details. Through all above, the clinical manifestations and iconographic characteristic were explored.Results:①The primary clinical manifestations of patients were complex and diverse, which included such most common signs as limb paralysis in 67 (60.36%)cases, central facial palsy in 51(45.95%),sensory disturbance in 45 (40.54%),lallation in 38(34.23%), central tongue palsy in 27(24.32%), dizziness in 21(18.92%).②Hypertension and atherosclerosis were the major factors causing brainstem stroke.③Of 111 brainstem stroke ,92 stroke were in single-section, which included 4 cases occurring in midbrain(4.35%) , 74 cases occurring in pons(80.43%) and 14 cases occurring in medulla(15.2%). From the view of stroke type, ischemia was major. The majority of brainstem haemorrhage occurred in pons.④Lesion in hypothalamus level was the most common in Midbrain stroke, majority of which occurred in ventral lateral position, seldom in dorsal. Lesion in Middle level was the most common in pontine stroke, majority of which occurred in ventral position, especially ventral lateral, secondly in centre, less in dorsal. Lesions in middle and upside level were the most common in medulla stroke, majority of which occurred in dorsal lateral position, secondly in ventral, seldom in centre.⑤The cases of Classical brainstem stroke clinical syndrome were uncommon in clinical practice. There were 81 cases of Non-crossing paralysis in our samples, whose most common manifestations were central facial and (or) tongue palsy, combined with limb paralysis and (or not) paresthesia. Such cases could easily be misdiagnosed as the supratentorial lesion without localization by imaging evidences.Conclusions:①The most common clinical manifestations of brainstem stroke were limb paralysis, central facial palsy, sensory disturbance, lallation and central facial palsy.②From the view of lesion location, the most common was the stroke in pons, secondly in medulla, least in midbrain. From the view of stroke type, ischemia was the majority.③Lesion in hypothalamus level was the most common in midbrain stroke, which mainly occurred in ventral lateral position. Lesion in middle level was the most common in pontine stroke, which mainly occurred in ventral lateral position. Lesion in middle and upside level were the most common in medulla stroke, which mainly occurred in dorsal lateral position.④Clinical manifestations of most brainstem stroke are atypical. The cases of Classical brainstem stroke clinical syndrome were uncommon in clinical practice.⑤Characteristic brainstem syndromes are few.Examinations of cranial imaging (CT, MRI) are of great importance to the diagnosis of brainstem stroke.