司艳红　丁长青　王圣乾　赵辉　丁爱兰

[摘要] 目的 分析小脑梗死临床及影像学表现特征。方法 回顾性分析该院2015年1月—2016年12月临床确诊的32例小脑梗死病例的临床及影像学资料。所有患者均行多排螺旋CT及1.5T MRI检查，MRI包括常规T1WI、T2WI、FLAIR及DWI序列，22例有MRA资料，13例有CTA资料。结果 临床表现主要为眩晕及小脑共济失调等。梗死病灶位于左侧8例，右侧12例，单纯小脑蚓部2例，两侧小脑10例。病程中呈出血性脑梗死1例，伴脑干梗死9例，枕叶梗死7例。首次CT阴性23例，MRIT2WI、FLAIR尤其是DWI序列显示病灶最佳。结论 小脑梗死多以眩晕及小脑共济失调为表现但并不特异，MRI可清晰显示小脑梗死，为诊断小脑梗死最佳的影像学成像选择。

[关键词] 小脑；梗死；眩晕；磁共振成像；诊断

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）01（c）-0175-05

[Abstract] Objective This paper tries to analyze the clinical and imaging features of cerebellar infarction. Methods From January 2015 to December 2016 in this hospital， 32 patients with cerebellar infarction confirmed clinically were enrolled， the clinical and images data were analyzed retrospectively. All patients underwent multi-slice spiral CT and 1.5T MRI examinations， MRI included routine T1WI， T2WI， FLAIR and DWI sequences. 22 cases had MRA data， and 13 cases had CTA data. Results The main clinical manifestations were vertigo and cerebellar ataxia. The lesions located in the left side in 8 cases， located in the right side in 12 cases， merely cerebellar vermis involved in 2 cases， bilateral cerebellar hemisphere involved in 10 cases. There was one case of hemorrhagic cerebral infarction in the course of disease， 9 cases were accompanied by brain stem infarction， 7 cases were accompanied with occipital infarction. The first CT was negative in 23 cases. MRIT2WI and FLAIR， especially DWI sequence， showed the lesion best. Conclusion Cerebellar infarction is mostly with vertigo and cerebellar ataxia and which is very heterogeneous. MRI can clearly show cerebellar infarction， so it is the best imaging modality of choice for diagnosing cerebellar infarction.

[Key words] Cerebellum； Infarction； Vertigo； Magnetic resonance imaging； Diagnosis

小腦供血动脉之间有广泛的吻合支，发生于小脑的梗死较为少见，其占脑梗死的的3%以下。临床表现并无特异性，多以头晕、头痛、恶心、呕吐、步态失稳等症状就诊。小脑大面积急性梗死可致脑积水及脑干后下部受压，可致死亡。单凭临床易于漏误诊[1]。近年的研究表明，大多数小脑梗死最初多没有被注意到，很多时候需为CT或MRI诊断。MRI无后颅窝伪影，其液体衰减反转恢复（FLAIR）尤其是扩散加权成像（DWI）可早期诊断小脑梗死，为进一步的优化临床干预治疗提供有力证据支持[2]。现回顾性分析该院2015年1月—2016年12月临床确诊的32例小脑梗死病例的临床及影像学资料，旨在探讨脑梗死临床及影像学表现特征，提高认识。报道如下。……