小脳梗塞の臨床的検討(神経内科学教室岩田誠教授退任記念特別号)

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Background and Purposed: Vertigo and headache are common symptoms at the onset of cerebellar infarction, although many patients have few neurological deficits, and are misdiagnosed. In this study, we investigated the clinical characteristics in admitted patients with acute cerebellar infarction. Methods: Data from 33 consecutively admitted patients with acute cerebellar infarction were analysed. We investigated the relationships between vascular lesions and clinical findings. Results: Eighty-eight percent of the patients had posterior inferior cerebellar artery (PICA) territory lesions. Headache was significantly more frequent (60%) in patients with PICA territory infarction than in those with superior cerebellar artery (SCA, 20%) or anterior inferior cerebellar artery (AICA, 24%, p = 0.044). Dysarthria was significantly less frequent (36%) in patients with PICA territory infarction than in those with SCA (57%) or AICA (60%, p = 0.017). Eight out of 10 patients with bilateral cerebellar infarction were categorized into a cardiogenic embolism. A total of 58% were misdiagnosed on admission. All five patients with arterial dissection were not diagnosed. Only one patient misdiagnosed was evaluated by a neurologist. Forty-eight percent of patients had good clinical outcomes. Conclusions: Headache was frequent and dysarthria was infrequent in patients with PICA territory infarction. Bilateral lesions were frequent in patients with SCA and AICA territory infarctions. Almost all bilateral cerebellar infarctions were cardiogenic embolism. Many patients with acute cerebellar infarction were misdiagnosed at first evaluation. Cerebellar infarction are likely to be misdiagnosed. In particular, arterial dissection are easily misdiagnosed, and delaying in consulting a neurologist was a major factor in the delay of diagnosis.
2008-02-25

小脳梗塞の臨床的検討(神経内科学教室岩田誠教授退任記念特別号)

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