| Purpose：Objective to detect the etiology, clinical characteristics, neuroimagingcharacteristics, differential diagnosis, therapy and prognosis by retrospectiveobservation-based study of patients diagnosed with pontine brachium infarction in ourhospital. Contribute to more extensive and profound understanding of the pontinebrachium infarction.Methods：A total of16patients who suffer from pontine brachium infarction wereenrolled in the study from December2009to January2012in the General Hospital ofShenyang Military Region Neurology department. We’ll also combine other reportedcases and try to discussion.Rusults：The group of16patients (9man,7female; average age67.56±11.47years and ranging from50to83years) were studied. There were past history ofhypertension in13patients (81%), diabetes in8cases (50%), coronary heart disease in6cases (38%), atrial fibrillation in2cases (13%), Old myocardial infarction in3cases (19%),high blood cholesterol in3cases (19%), history of cerebral infarction in6cases (38%),history of cerebral haemorrhage in2cases (13%), smoking history in8cases (50%),drinking history in4cases (25%). The group of16cases had acute onset,12cases (75%)in resting state onset, and4cases (25%) in general activities. The group of16patientswith vertigo accompanied or not accompanied by nausea, vomiting as the initialsymptom in13cases (81%); With sudden deafness accompanied or not accompanied bytinnitus as the initial symptom in5cases (31%); ataxia as the initial symptom in6cases(38%); Slurred speech as the first symptom in6cases (38%); face, with/or withoutlimb sensory disturbances as the initial symptom in3cases (19%); hydroposia bucking,with/or without dysphagia in2cases (13%); headache in1case (6.3%). The course ofthe disease, transient diplopia was in2cases (13%). The signs include-d the spontaneous level of nystagmus in7cases (44%); ipsilateral peripheral facial paralysisin7cases (44%); hearing impairment in8cases (50%); mild dysarthria in8cases (50%);ipsilateral facial hypesthesia in five5cases (31%); ataxia in13cases (81%); the same tothe gaze palsy in1case (6.3%). limb muscle strength were normal in13cases (81%);bilateral pathological signs were negative in9cases (56%). In16patients after thedisease in24hours by brain CT scan,1patients displayed bilateral pontine brachiuminfarction and bilateral cerebellum area fuzzy low density;1case displayed hypodensein the right cerebellar hemisphere; Lacunar infarction with or without periventricularwhite matter demyelination can be visibled in10cases;4cases of brain CT werenormal. Brain of MRI+DWI displayed：the new isolated unilateral pontine brachiuminfarction was6cases (38%); isolated new bilateral pontine brachium infarction was3cases (19%); pontine brachium combined brainstem or cerebellar new infarct was7cases (44%).10patients with brain MRA:8cases were vertebral-basilar arteryocclusion/stenosis;2cases of bilateral vertebral artery slender, many local of whichstenosis. The group of16patients’ laboratory examination revealed after admission：elevated blood glucose after fasting was10cases (63%); lipid abnormalities was9cases(56%); Homocysteine increased was2cases (12.5%); increased fibrinogen levels was5cases (31%); the rest of the laboratory tests were normal.10patients (63%) had ST-Tmild change of ECG; left ventricle increased in1case (6.0%); atrial fibrillation was1case (6%);4cases were normal. The chest X ray showed cardiac enlargement, aortaatherosclerosis was9cases (56%);7cases were normal. There were13patients in thegroup by transcranial Doppler ultrasound, and5cases (31%) prompted thevertebral-basilar artery blood flow abnormalities; and3cases (19%) vertebral arterystenosis or occlusion in the right side; and2cases (13%) left vertebral artery wereocclusion;1case (6%) blateral vertebral arteries stenosis;2cases were normal.15casesby carotid artery Doppler ultrasound examination,7cases (44%) prompted that thebilateral carotid arteries, vertebral artery were atherosclerosis concomited with plaqueformation in different degrees;6cases (38%) prompted one side of the vertebral arterysstenosis with blood flowslow down;1case (6%) prompted bilateral vertebral arteriesstenosis;1case (6%) was normal.8cases of hearing-impaired patients on admissionand discharge ipsilateral hearing audiometry average were:89.44dB±15.50dB;43.89dB±12.94dB. The16cases of pontine brachium infarction were according toischemic cerebrovascular disease given anti-platelet aggregation, blood circulation,brain cell activation agents and free radical scavenging agent drug treatment. Discretionary regulation of blood pressure, blood glucose, lipids, and prevention ofaspiration pneumonia, brain stomach syndrome and other complications.16patientswith average hospital stay was12.31±2.63d,2cases fully recovered and did notremain neurological symptoms and signs;10patients with symptoms improvedsignificantly, and left over the pontine brachium of the varying degrees of damagesymptoms, including3cases of deafness, with or without tinnitus,4cases of dysarthria,4cases of ataxia,3cases of peripheral facial paralysis,1case of Horner sign.3casesof exacerbations for the pontine brachium with cerebellar and/or brainstem infarction.1case died,which suffered bilateral pontine brachiums with infarction at the base ofbrain stem.Conclusions：1. The pontine brachium infarction is not uncommon, and thetypical clinical manifestations are sudden hearing loss, vertigo, cerebellar ataxia,peripheral facial paralysis, facial sensory loss and Horner syndrome. Sudden deafness,which is a unique clinical manifestations of pontine brachium infarction.2. Pontinebrachium infarction is common in patients who are old age, with hypertension,diabetes, cerebral infarction and other risk factors, which mainly caused by thrombosisbecause of arterial atherosclerosis, and cardiac embolism is rare in pontine brachiuminfarction.3. Neuroimaging of pontine brachium infarction can be expressed as anisolated unilateral pontine brachium infarction, isolated bilateral pontine brachiuminfarction, unilateral pontine brachium with other posterior circulation infarction, andbilateral pontine brachium with other posterior circulation infarction.4. Prognosis ofisolated unilateral and bilateral pontine brachium infarction is relatively good, which ofpontine brachium with other posterior circulation infarction is relatively poor. Prognosisof the later have even increased the risk of life-threatening. |
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