Analysis Of Clinical Characteristics Of 85 Patients With Bilateral Brainstem Infarction

Objective:The clinical data of patients with bilateral brainstem infarction were analyzed,by summarizing their clinical characteristics to analyze whether the risk factors and the clinical symptoms and signs have a differential influence on the infarct location,and explore the correlation between clinical manifestations,related risk factors and the degree of neurological function deficit.Methods:Collect and analyze the relevant clinical data including the manifestations,symptoms and signs,gender,age,history of stroke,hypertension,diabetes,smoking and drinking,blood glucose,blood lipid,blood homocysteine,BMI and others of the hospitalized patients with acute bilateral brainstem infarction in the Department of Neurology of the Second Hospital of Jilin University.The degree of neurological deficit was scored by the National Institutes of Health Stroke Scale(NIHSS)and the e-NIHSS(an Expanded National Institutes of Health Stroke Scale,e-NIHSS),the new infarction sites are conformed with Diffusion Weighted Imaging and Apparent Diffusion Coefficient.By summarizing the clinical characteristics and analyzing the influence of risk factors on infarction sites,there is no significant clinical correlation between infarction location and corresponding symptoms.In the measurement data,the normal distribution was expressed by mean ± standard deviation(±S);T test / one-way analysis of variance was used for comparison between groups;the non-normal distribution was expressed by M(P25,P75),and the Mann-Whitney U /Kruskal-Wallis test was used for the comparison between groups.Results:(1)A total of 85 patients with acute bilateral brainstem infarction were surveyed with an average age of(62.21±9.671)years,including56 cases from males(65.9%)and 29 cases from females(34.1%);62cases(72.9%)were hypertension,46 cases(54.1%)were diabetes,30cases(35.3%)were cardiovascular disease,33 cases(38.8%)were cerebrovascular disease,40 cases(47.1%)were smoking,27 cases(31.8%)were drinking,63 cases(74.1%)were hyper-lipidemia,26 cases(30.6%)were hyper-homo cysteinemia,62 cases(72.0%)were overweight BMI.The predominant sites of bilateral brainstem infarction were 45 cases of pons(52.9%),27 cases of mixed site(31.8%),8 cases of medulla oblongata(9.4%),and 5 cases of midbrain(5.9%).(2)The clinical manifestations of and signs of bilateral brainstem infarction in a descending order of frequency were as follows: paralysis,dysarthria,positive pathological signs,dizziness,facial paralysis,ataxia,restricted eye movement,nausea and vomiting,nystagmus,paresthesia,choke when drinking,diplopia or blurred vision,disturbance of consciousness,swallowing difficulty and headache.(3)There is no statistic difference meaning among gender,age,hypertension,diabetes,cardiovascular disease,cerebrovascular disease,smoking,drinking,hyperlipidemia,high homocysteine and BMI in different cerebral infarction sites(P>0.05);and there are no significant statistical discrepancies in the degree of neurological deficit of patients with bilateral brainstem infarction(P>0.05).(4)Different clinical symptoms and signs have statistical significance among various infarction site groups(P< 0.05).When double vision or blurred vision and dysarthria occur in bilateral midbrain regions,cerebral infarction have more possibilities to happen;the incidences of dysarthria,limb inactivity,facial paralysis and ataxia in groups with moderate and severe symptoms are significantly higher than those in groups with mild symptoms,and the divergence have statistical significance(P< 0.05);the incidences of diplopia or blurred vision,nausea and vomiting,dizziness and nystagmus in groups with moderate and severe symptoms are significantly lower than that in the groups with mild symptoms,and the difference is also statistically significant(P<0.05).(5)The degree of neurological deficit is statistically significant among different infarct sites(P<0.05).The incidences of moderate and severe neurological deficits in the pons,medulla oblongata,and mixed sites are higher than that in the midbrain.(6)NIHSS and e-NIHSS were used to evaluate the degree of neurological impairment in patients with bilateral brainstem infarction.The variation rate of the score in the medulla oblongata was higher than that of pons,midbrain and mixed sites,and the difference is not statistically significant(P> 0.05).Conclusion:(1)There is no significant difference in the risk factors of patients with bilateral brainstem infarction between different infarction sites,but the infarction sites are correlated with the degree of neurological deficits and clinical symptoms and signs.(2)The patients with bilateral brainstem infarction,the moderate to severe neurological deficits are more likely to have dysarthria,limb movement,facial paralysis and ataxia;the mild group are more likely to have nausea and vomiting,dizziness and nystagmus.(3)e-NIHSS score is more comprehensive than NIHSS score in assessing patients with bilateral brainstem infarction and is more suitable for patients with medulla oblongata infarction.