本文選題：Percheron動脈 + 腦梗死��； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：Percheron動脈綜合征（Percheron artery syndrome）的發(fā)病機制為起源于一側(cè)大腦后動脈P1段的單支共干丘腦穿通動脈——Percheron動脈（AOP）閉塞，影像學(xué)表現(xiàn)為中線旁雙側(cè)丘腦區(qū)伴或不伴中腦梗死。該病在臨床上極為少見，本研究旨在提高臨床醫(yī)生對Percheron動脈綜合征的認識和診斷水平，從而采取及時、合理的治療，改善患者預(yù)后。 方法：回顧分析并隨訪重慶醫(yī)科大學(xué)附屬第一、第二醫(yī)院2012年01月至2013年12月入院的9例Percheron動脈綜合征患者的一般資料、臨床表現(xiàn)、影像學(xué)資料、治療及預(yù)后等情況，復(fù)習(xí)文獻并總結(jié)Percheron動脈綜合征的臨床特點。 結(jié)果：9例Percheron動脈綜合征患者中，男性5例，女性4例。年齡44～83歲，平均年齡67歲。1例系慢性乙型病毒型肝炎肝硬化失代償期、脾大脾功能亢進，行脾臟切除術(shù)后1天發(fā)病。6例有高血壓病史，2例有糖尿病史，其中1例有反復(fù)后循環(huán)TIA病史，2例既往有腦梗死病史。風(fēng)濕性心臟病心房纖顫病史者1例。吸煙者5例。該病典型臨床表現(xiàn)為“三聯(lián)征”：意識障礙、記憶力缺損、垂直注視麻痹。本組9例患者均為急性起病，突發(fā)意識障礙，其中眼球下視麻痹者3例，眼瞼下垂者1例，伴肢體無力者6例，1例出現(xiàn)幻覺、持續(xù)性全身燒灼樣疼痛、抑郁表現(xiàn)。9例患者病歷資料中，有4例記錄存在記憶力障礙，2例記憶力正常。9例均在起病后行頭部CT檢查，其中4例頭部CT顯示：雙側(cè)丘腦低密度影。9例均在發(fā)病后3天內(nèi)行腦MRI檢查，均顯示雙側(cè)丘腦梗死灶，其中有2例可見中腦“V字征”。有4例患者于發(fā)病后行腦MRA或頭頸部CTA檢查，，但均未發(fā)現(xiàn)AOP存在。本組9例病人均按缺血性卒中治療，出院時，有6例病情好轉(zhuǎn)，平均隨訪1.15年，僅1例完全恢復(fù)，余隨訪病例均遺留有不同程度眼球垂直運動障礙、肢體無力或認知功能障礙。 結(jié)論：Percheron動脈綜合征主要表現(xiàn)為急性起病，有不同程度意識障礙、垂直注視麻痹、記憶缺損等，腦CT/MRI檢查提示中線旁雙側(cè)丘腦伴或不伴中腦梗塞。腦MRI出現(xiàn)“中腦V字征”對Percheron動脈綜合征有重要提示意義。本病主要按缺血性腦血管病治療，預(yù)后較差。
[Abstract]:Objective the pathogenesis of Percheron artery syndrome is the occlusion of single common thalamic perforating artery (PAP) originated from P1 segment of the posterior cerebral artery. The imaging findings are bilateral thalamic area with or without mesencephalic infarction. The purpose of this study is to improve the understanding and diagnosis of Percheron's arterial syndrome, so as to take timely and reasonable treatment to improve the prognosis of the patients. Methods: the general data, clinical manifestation, imaging data, treatment and prognosis of 9 patients with Percheron artery syndrome were retrospectively analyzed and followed up in the first and second affiliated Hospital of Chongqing Medical University from January 2012 to December 2013. To review the literature and summarize the clinical features of Percheron artery syndrome. Results among 9 patients with Percheron's arterial syndrome, 5 were male and 4 were female. The mean age was 67. 1 years old. The patients had decompensated stage of cirrhosis of chronic hepatitis B, hypersplenism. 6 cases had hypertension history 1 day after splenectomy, 2 cases had diabetes history. One patient had a history of recurrent posterior circulation TIA and 2 had a history of cerebral infarction. One case had a history of atrial fibrillation in rheumatic heart disease. There were 5 smokers. The typical clinical manifestations of the disease are triple sign: consciousness disorder, memory impairment, vertical fixation paralysis. All the 9 patients had acute onset and sudden disturbance of consciousness, including 3 cases of hypoophthalmic paralysis, 1 case of blepharoptosis, 6 cases of limb weakness, 1 case of hallucination, and 1 case of persistent systemic burning pain. Of the 9 cases with depression, 4 cases had memory disorder, 2 cases had normal memory, and 9 cases had head CT examination after the onset of the disease. Among them, 4 cases showed head CT: bilateral hypodense thalamus were examined with MRI within 3 days after onset, and bilateral thalamic infarction was revealed in all cases. "V sign" of midbrain was found in 2 cases. Brain MRA or head and neck CTA were performed in 4 patients, but no AOP was found. All the 9 patients were treated with ischemic stroke. At discharge, 6 cases were improved, with an average follow-up of 1. 15 years, only 1 case recovered completely. The remaining cases were left with different degrees of ocular vertical movement disorder, limb weakness or cognitive dysfunction. Conclusion the main symptoms of the disease are acute onset, different degree of consciousness disorder, vertical fixation paralysis, memory deficit and so on. CT/MRI examination indicates bilateral thalamus with or without midline infarction. The appearance of midbrain V sign in MRI has important implications for Percheron artery syndrome. This disease is mainly treated by ischemic cerebrovascular disease, the prognosis is poor.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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1 付潔;Percheron動脈綜合征9例臨床分析[D];重慶醫(yī)科大學(xué);2014年

本文編號：1974253