Anatomical Study On The Location Diagnosis Of Isolated Vertigo Cerebellar Infarction And Brainstem Infarction

Dizziness and vertigo are the most common symptoms in the medical field.Vertigo refers to the illusion of movement such as a sense of rotation or swing when there is no movement.The definition of isolated vertigo refers to pure paroxysmal or persistent vertigo and does not involve other nervous systems.At present,it is relatively difficult to diagnose whether vertigo is a central source or peripheral vertigo.In particular,the early diagnosis of isolated vertigo-type cerebellar and brainstem infarction caused by cerebellar and brainstem stroke lesions is more difficult and the treatment is ineffective.Objective:This study intends to use cross-sectional cadaveric specimens,MRI images of healthy volunteers and clinical history and imaging examination,assessment and other related data analysis with isolated vertigo,cerebellar brainstem infarction patients.The purpose of this study was to explore how to quickly locate and identify isolated vertigo cerebellum and brain stem infarction through medical history,physical examination,and related imaging examinations to avoid irreversible harm to patients.Methods:The selection of 5 adult cadaveric heads(male 3,female 2),to obtain MRI brain images,according to isometric method respectively made of thick 5mm layer transected specimens.Selected 5 cases of healthy volunteers were obtained transverse,sagittal and coronal MRI images,MRA.From January 2016 to October 2017,674 patients with isolated vertigo who were admitted to the Department of Neurology of Dong'e County People's Hospital were collected.Complete diffusion-weighted magnetic resonance imaging(DWI)was performed and 50 patients were diagnosed with isolated vertigo.Patients with cerebellum-and brain stem infarctiorn were given hospitalization and data collection and retrospective analysis.Results:At the level of the caudal end of the pons and the rostral head,the cerebellar deltoid inner facial nerve and the vestibular cochlear nerve move to the anterolateral side.The vestibular nerve passes through the inner ear,the inner ear canal to the vestibular and semicircular canals.The anterolateral aspect of the medulla oblongata is cerebellar pompom.The fourth ventricle is located on the dorsal side of the pons and the cerebellum,with a nodule immediately behind the fourth ventricle.The posterior lateral part of the nodule and the posterior inferior part of the cerebellum are the cerebellar tonsils.The bottom of the fourth ventricle is the diamond nest.From the medial to the lateral,the medial longitudinal bundles,the hypoglossal nerve anterior nucleus,the vestibular medial nucleus,the vestibular descending branch,the vestibular inferior nucleus,and the cerebellar inferiors are successively seen.By the level of the lower medulla and cerebellar tonsils,the bulge on the ventral side of the medulla oblongata and the bulges on both sides of the midline is pyramidal,and the dorsum of the pyramidal dorsolateral oval is olive,and its deeper surface is the lower olive nucleus.The posterolateral side of the pyramid is the left and right vertebral arteries respectively.The bilateral vertebral artery ascends to synthesize the basilar artery at the pontine bulbal sulcus.The posterolateral prominent part of the medulla oblongata is bilateral cerebellar tonsils,and the cerebellar tonsils are adjacent to both sides of the medulla and occipital foramen.50 cases diagnosed with isolated vertigo cerebellar infarction and brain stem infarction:There were 30 patients with 2 or more risk factors,accounting for 60%(18 cases of two risk factors,8 cases of 3 risk factors,4 cases of 4 risk factors).Coronary heart disease(including atrial fibrillation)in 6 cases,accounting for 12%;history of stroke in 10 cases,accounting for 20%.The infarct sites were cerebellum,medulla oblongata,pons and midbrain,among which 38 cases were common in the cerebellum(17 cases in the posterior cerebellum,17 cases of cerebellar tonsils,2 cases of the nodule,I case of inferior cerebellar peduncle,and 1 case of cerebellar inferior)accounted for 76%.The other 12 cases(2 cases of the medial vestibular nucleus,2 cases of nucleus prepositus hypoglossi,7 cases of the pons,and 1 case of midbrain)accounted for 24%.According to the anatomical structure,50 patients were divided into six different acute vestibular syndromes.They were limited to the unilateral vestibular nucleus,unilateral nucleus prepositus hypoglossi,unilateral cerebellar flocculus,unilateral cerebellar tonsils,cerebellum nodules and unilateral inferior cerebellar peduncle.The lesion involved the left side of the posterior circulation in 26 cases,accounting for 52%;the lesion involved the right side of the posterior circulation in 18 cases,accounting for 36%.The infarcted area was most commonly seen in the PICA blood supply area,of which 41 were PICA blood supply areas,accounting for 82%.Among the 50 patients,there were 21 patients with dominant vertebral artery arteries,accounting for 42%(12 cases of unilateral vertebral arteries were slender,6 cases of unilateral vertebral artery occlusion,and 3 cases of vertebral artery stenosis).According to the TOAST classification,perforator artery in 39 cases,accounting for 78%.After 3 months of follow-up,mRS score,0 points in 44 cases,accounting for 88%.Conclusion:1.The level of the end of the pons or the head of the medulla is a typical level for the identification of flocculus,nodules,and cerebellar tonsils.The bottom of the fourth ventricle in this layer is a marker structure that identifies the nucleus prepositus hypoglossi,the medial vestibular nucleus,and the inferior cerebellar peduncle.The correct identification of these anatomical positions contributes to the diagnosis of the isolated central vestibular syndrome.2.Patients with isolated vertigo and more than two stroke-related risk factorsand/or vertebral artery dominance(developmental stenosis or occlusion of the contralateral vertebral artery)should be highly alert to the occurrence of isolated vertigo cerebellar infarction and brainstem infarction,and the physician should improve the corresponding MRI.3.Even if patients exhibit peripheral vestibular lesions and negative MRI features,they should carefully look for central signs of patients with isolated vertigo.Imaging of DWI in MRI is helpful in locating diagnosis.4.For patients with isolated vertigo cerebellar infarction and brain stem infarction,the vascular screening should be actively improved.It is necessary to screen for patients with large vascular lesions in the intracranial and extracranial,early intervention therapy or second-grade stroke prevention.5.In patients with isolated vertigo cerebellar infarction and brainstem infarction,the perforating artery type was much considered in the etiological classification of those patients.After active treatment with antiplatelet and statins,most of the prognosis was better.