关键词: 卒中; 小脑梗死; 病因; 梗死体积; 病因分型; 危险因素

Abstract: Objective  To investigate the clinical and imaging features and possible pathogenesis of acute small cerebellar infarction.
Methods  The inpatients with acute cerebellar infarction in Department of Neurology of Beijing Chaoyang Hospital, Capital Medical University from January 2016 to December 2019 were enrolled in this retrospective study. According to the infarction size, the patients were divided into small cerebellar infarct (infarction diameter <2 cm) and large cerebellar infarct (infarction diameter ≥2 cm) groups. The demographics, vascular risk factors, classification of etiology (China ischemic stroke subclassification, CISS), blood pressure at admission, laboratory tests, clinical symptoms and signs, involved vascular territories, vascular stenosis location and white matter lesions between two groups were compared.
Results  A total of 121 patients were included, with 43 cases in small cerebellar infarct group and 78 in large cerebellar infarct group. There was no statistical difference in medical history between the two groups. Compared with large cerebellar infarct group, small cerebellar infarct group had lower percentage of males (51.2% vs. 82.1%, P<0.001), smoking (51.2% vs. 70.5%, P=0.034), lower level of systolic blood pressure (146.2±18.2 mmHg vs.154.6±19.8 mmHg, P=0.022) and fasting blood glucose at admission (6.08±1.98 mmol/L vs.8.12±3.46 mmol/L, P<0.001), and lower incidence of vertigo (32.6% vs. 64.1%, P<0.001) and headache (9.3% vs. 28.2%, P=0.015). There was statistical difference in the distribution of CISS type between the two groups (P<0.001). Although the large artery atherosclerosis was the most common type in both groups, the proportion of large artery atherosclerosis was higher in large cerebellar infarct group (89.7% vs. 48.8%), and the proportion of undetermined etiology was higher in small cerebellar infarct group (32.6% vs. 5.1%). There was statistical difference in involved vascular distribution between the two groups, and posterior inferior cerebellar artery (PICA) was the most commonly involved in both groups. The percentage of involved anterior inferior cerebellar artery (AICA) (20.9% vs. 0) and superior cerebellar artery (SCA) (25.6% vs. 1.3%) were higher in small cerebellar infarct group than that in large cerebellar infarct group, and the multiple vessels involvement was more common in large cerebellar infarct group (47.4%). There was no statistical difference in the degree of posterior circulation vascular stenosis between the two groups.
Conclusions  There was no significant difference in medical history related to vascular risk factors between the patients with small or large cerebellar infarct, and the degree of posterior circulation vascular stenosis was similar, suggesting that the two types of cerebellar infarct may have similar pathogenesis. The incidence of vertigo and headache was lower in patients with small cerebellar infarct, compared to patients with large cerebellar infarct.

Key words: Stroke; Cerebellar infarction; Etiology; Infarct volume; Classification of etiology; Risk factor