Clinical Features And Prognosis Of Pontine Arm Infarction

Objectives 1 To investigate the magnetic resonance imaging,clinical manifestations and cranial nerve injury characteristics of pontine arm infarction.2 To explore the prognostic characteristics of unilateral and bilateral brachial infarction with NIHSS score and mRS score as the final observation indexes at admission and 7 days after admission.Methods A retrospective analysis was made on the patients with pontine-arm infarction diagnosed by craniocerebral magnetic resonance imaging in the second and fourth wards of Neurology Department of the Affiliated Hospital of North China University of Technology from January 2014 to May 2018.The subjects were selected strictly according to the inclusion and exclusion criteria.The craniocerebral magnetic resonance imaging and vascular injury characteristics of the subjects were collected and recorded.The clinical manifestations and cranial nerves were recorded.Damage characteristics were analyzed.The signal status of lesions in the pontobrachial region,distribution characteristics of responsible vessels,clinical manifestations,and characteristics of cranial nerve involvement were analyzed.Baseline data such as National Institutes of Health Stroke Scale(NIHSS)score and Modified Ranking Scale(mRS)score were collected and recorded.At the same time,NHISS score and mRS score at admission and on the 7th day were used as prognostic indicators to explore the characteristics of short-term prognosis.Results 1 Fifty-three patients with pontine infarction were included according to the standard.The signal of pontine infarction on MRI was low on T1 WI,high on T2 WI,slightly high on FLAIR,and high on DWI in 53 cases.Among them,44 cases(83.02%)had unilateral infarction,9 cases(16.98%)had bilateral infarction,22 cases(41.51%)had demyelinating lesions outside the bridge arm and 10 cases(18.87%)had cerebellar infarction.According to the results of MRA,41 cases(77.36%)of pontine brachial infarction involved basilar artery,40 cases(75.47%)of vertebral artery,35 cases(66.04%)of anterior inferior cerebellar artery and 25 cases(47.17%)of internal carotid artery.There was a significant difference between the different involved vessels in brachial infarction(P< 0.05).It can be concluded that there are differences among different types of vessels in brachial infarction stenosis/occlusion.In this study,40 cases(75.5%)of the first symptoms of bridge arm infarction were vertigo,of which 7 cases were isolated vertigo,29 cases were rotational vertigo,thirty-four cases(64.2%)of ataxia and 31 cases(58.5%)of facial hypoesthesia were followed,2 cases were sudden deafness,11 cases(20.8%)were tinnitus and hearing loss,5 cases were accompanied by vertigo and ataxia.Peripheral facial paralysis and tinnitus.The injured cranial nerves in 53 patients mainly included V,VI,VII and VII.The most injured cases were 47,accounting for 88.68%.Only 2 cases(3.77%)of bilateral pontine brachial infarction were found to have simultaneous cranial nerve injuries.The results showed that the recovery of cranial nerves in unilateral pontine infarction patients was faster than that in bilateral pontine infarction patients.There were 2 cases of bilateral pontine-arm infarction involving cranial nerve IX and VII.The recovery rate of cranial nerve was 0 after admission,as shown in Figure 4.2 The risk factors of unilateral and bilateral bridge arm infarction were compared.The results showed that the risk factors of unilateral and bilateral bridge arm infarction were hyperlipidemia,NIHSS < 5 at admission,mRS < 3 at admission,and hypoperfusion with statistical significance(P< 0.05).Compared with the NIHSS score at admission and at 7 days,the NIHSS score at 7 dayswas significantly lower than that at admission(P< 0.05).Compared with the mRS score at admission and at 7 days,the NIHSS score at 7 days was significantly lower than that at admission(P< 0.05).The mRS score at 7 days was lower than that at admission.On the7 th day,the NIHSS score of unilateral and bilateral bridge arm infarction was compared.The results showed that the NIHSS score of unilateral and bilateral bridge arm infarction was different on the 7th day(P< 0.05).The NIHSS score of unilateral and bilateral bridge arm infarction was lower than that of bilateral bridge arm infarction.On the 7th day,the mRS score of unilateral and bilateral bridge arm infarction was different on the 7th day(P< 0.05)The mRS score of unilateral brachial infarction was lower than that of bilateral brachial infarction.Conclusions 1 One-sided lesions were common in patients with pontine arm infarction,and the main responsible vessel was the vertebrobasilar artery system.The main lesions of the basilar artery accounted for 77.36%,and 47.17% had anterior circulation lesions.Clinical manifestations: Vertigo was the most common first symptom,but only isolated vertigo,followed by ataxia and facial sensory disorders.Cranial nerve involvement was common.The top four wereⅦ(88.68%),Ⅷ(71.70%),V(66.04%)and VI(41.17%).2In terms of prognosis,most of the patients had good prognosis at 7 days of admission.The prognosis of unilateral pontobrachial infarction is better than that of bilateral pontobrachial infarction.Figure 4;Table 7;Reference 60.