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目的探讨以眩晕为主要表现的小脑梗死的临床特点、误诊原因及早期诊断对疾病预后的意义。方法回顾性分析10例以眩晕为主要症状但无共济失调表现的小脑梗死的临床资料。结果患者年龄40～70岁,CT检查未发现梗死灶,MRI阳性率为100%。脑梗死主要危险因素为高血压、糖尿病、高脂血症。入院诊断为椎基底动脉供血不足。8例患者小脑梗死的病灶主要位于单侧小脑半球后下部,属于小脑后下动脉(PICA)供血区域;2例小脑梗死的病灶位于小脑蚓部后部及其附近的两侧小脑半球,属于小脑后下动脉中间支(mPICA)供血区域。结论无共济失调小脑梗死常见于PICA供血区。对于有脑梗死危险因素的眩晕患者,如果症状频繁发作或持续时间长,即使无共济失调表现,也应完善MRI检查明确有无小脑梗死。
Objective To investigate the clinical features of cerebellar infarction with dizziness as the main manifestation, the causes of misdiagnosis and the significance of early diagnosis on the prognosis of the disease. Methods The clinical data of 10 patients with cerebellar infarction with vertigo as the main symptom but without ataxia were retrospectively analyzed. Results The patients were 40-70 years old. No infarction was detected by CT. The positive rate of MRI was 100%. The main risk factors for cerebral infarction are hypertension, diabetes and hyperlipidemia. Admitted to the diagnosis of vertebrobasilar insufficiency. 8 patients with cerebellar infarction mainly located in the lower part of the unilateral posterior cerebellar hemisphere, belonging to the feeding area of the posterior inferior cerebellar artery (PICA); 2 cases of cerebellar infarction lesions in the cerebellar vermis behind and in the vicinity of the bilateral cerebellar hemispheres, belonging to the cerebellum Posterior inferior arteries (mPICA) blood supply area. Conclusion Ataxia-free cerebellar infarction is common in PICA blood supply area. For patients with vertigo who have risk factors for cerebral infarction, if the symptoms frequently occur or persist for long periods of time, there should be a complete examination of the MRI to determine whether there is a cerebellar infarction, even if there is no evidence of ataxia.