Araştırma Makalesi
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İzole Pons İnfarktlarının Topografik Lokalizasyonu

Yıl 2022, Cilt: 17 Sayı: 1, 152 - 155, 21.03.2022
https://doi.org/10.17517/ksutfd.779050

Öz

Giriş:
İzole pontin enfarktüsü (IPI), diğer beyin bölgelerinin tutulmadığı yaygın bir inme lokalizasyonudur.
Metod:
1 Ağustos 2019- 1 Mart 2020 tarihleri arasında XXXX hastanesi nöroloji kliniğinde hospitalize edilen hastalar retrospektif olarak incelendi. Kumral ve ark’nın belirlediği şekilde Pons arterlerinin sulama alanlarına bağlı olarak, pons infarktları anteromediyal, anterolateral, tegmental, bilateral ve tek taraflı çoklu pons infarktları olmak üzere 5 alt tipe ayrıldı. Pons infarktları ayrıca üst, orta veya alt bölüm olacak şekilde segmental lokalizasyonuna ayrıldı. Hastaların tüm demografik özellikleri kayıt edildi.
Bulgular:
Retrospektif olarak incelenen 84 hasta içinden kriterlere uygun olan toplam 70 hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 63,2 ±1,19 (min:33 max: 88)idi. Ortalama NIHSS’u 3,98± 2,8 ve hastaların %70’i erkekti. Risk faktörleri değerlendirildiğinde ilk sırada %78,6 oranıyla HT vardı. . İnfarkt lokalizasyonuna göre; 38 hasta anteromedial (%54,3), 13 hasta anterolateral (%18,6), 11 hastada tegmental (%15,7), 7 hastada unilateral multiple (%10) ve 1 hastada bilateral (%1,4) gözlendi. İnfarktın En sık segmental yerleşimi 31 hasta ile orta ponsta (%44,3) idi. ( 25 hasta alt pons (%35,9 )ve 14 hasta üst ponsta (%20)).
Sonuç:
Çalışmamızda; 5 farklı anatomik paterne göre ayrılan izole pons infarktları en sık anteromedial bölgede (%54,3) gözlenmiş ve eşlik eden en yaygın vasküler risk faktörünün HT, HPL ve DM olduğu tespit edilmiştir.
Anahtar kelimeler: pons infarktı, pons, stroke, lokalizasyon

Kaynakça

  • 1- Ju Y, Hussain M, Asmaro K, et al. Clinical and imaging characteristics of isolated pontine infarcts: a one-year follow-up study. Neurological Research 2013, 35: 5, 498– 504.
  • 2- Saia V, Pantoni L. Progressive stroke in pontine infarction. Acta Neurol Scand 2009; 120: 213– 215.
  • 3- Kim JS, Lee JH, Im JH, Lee MC. Syndromes of pontine base infarction: a clinical-radiological correlation study. Stroke 1995; 26: 950– 955.
  • 4- Bassetti C, Bogousslavsky J, Barth A, Regli F. Isolated infarcts of the pons. Neurology 1996; 46: 165– 175.
  • 5- Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC. Basilar artery atherosclerotic disease is related to the subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 2009; 120: 88– 93.
  • 6- Déjerine J Sémiologie des affections du système nerveux.Paris: Masson Gubler A 1856 De l’hémiplegie alterne envisagée comme signe de lesion de la protubérance annullaire. Gaz Hébd Sci Méd 1914 5: 721– 723.
  • 7- Duret H Sur la distribution des artères nouricières du bulbe rachidien. Arch de Physiol Norm 1873 50: 88– 120.
  • 8- Stopford JSB Arteries of pons and medulla oblongata. J Anat Physiol 1916 50: 255–280.
  • 9- Foix C, Hillemand P Contribution á l’étude des ramolissements protubérantiels. Rev Méd (Paris) 1925 43: 287– 305.
  • 10- Lhermitte J, Trelles OJ L’artériosclerose du tronc basilaire et ses conséquences anatomo-cliniques. J Psychiat Neurol 1934 51: 91– 107.
  • 11- Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol 1968; 12 (1): 1– 15.
  • 12- Goldstein LB, Jones MR, Matchar D et al. Improving the reliability of stroke subgroup classification using Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke 2001; 32: 1091- 1098.
  • 13- Kumral E, Bayulkem G, Evyapan D. Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol 2002 249; 12: 1659– 1670.
  • 14- Kumar AD, Boehme AK, Siegler JE, Gillette M, Albright KC, Martin-Schild S Leukocytosis in patients with neurologic deterioration after acute ischemic stroke is associated with poor outcomes. Journal of Stroke and Cerebrovascular Diseases 2013 22: 7, e111– e117.
  • 15- Baran G, Gultekin YO, Baran O, Deniz C, Katar S, Yildiz GB, Asil T. Association between etiology and lesion site in ischemic brainstem infarcts: a retrospective observational study. Neuropsychiatr Dis Treat 2018; 14: 757– 766.
  • 16- Kataoka S, Hori A, Shirakawa T, Hirose G. Paramedian Pontine Infarction: Neurological/Topographical Correlation. Stroke 1997; 28: 809– 815.
  • 17- Kobayashi, J, Ohara, T, Minematsu K, Nagatsuka K, Toyoda K. Etiological mechanisms of isolated pontine infarcts based on arterial territory involvement. Journal of the Neurological Sciences 2014 339: 1-2, 113– 117.
  • 18- Caplan LR, Wityk RJ, Glass TA, et al. New England medical center posterior circulation registry. Ann Neurol 2004 Sep; 56: 3, 389- 98.
  • 19- Huang R, Zhang X, Chen W, Lin J, Chai Z, Yi X. Stroke Subtypes and Topographic Locations Associated with Neurological Deterioration in Acute Isolated Pontine Infarction. Journal of Stroke and Cerebrovascular Diseases 2016 25: 1, 206- 213.
  • 20- Vemmos KN, Spengos K, Tsivgoulis G, et al. Aetiopathogenesis and long-term outcome of isolated pontine infarcts. J Neurol 2005; 252: 212- 217.
  • 21- Gökçal E, Niftaliyev E, Baran G, Deniz Ç, Asil T. Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome. Acta Neurol Belg 2017 117: 3, 649– 654.
  • 22- Huang J, Qiu Z, Zhou P,et al Topographic location of unisolated pontine infarction. BMC Neurology 2019 19: 1

The Topographical Localization of The Isolated Pontine Infarcts

Yıl 2022, Cilt: 17 Sayı: 1, 152 - 155, 21.03.2022
https://doi.org/10.17517/ksutfd.779050

Öz

Objective: Isolated pontine infarcts (IPI) are seen commonly and known to be without any other serebral infarcts.
Material and methods: The patients who are hospitalized between August 1 2019- March 1 2020 in xxxx Education and Research Hospital with isolated pontine infarcts (IPI) were analyzed retrospectively.
Depending on the distribution area of the pons arteries, pons infarcts are divided into 5 subtypes: anteromedial, anterolateral, tegmental, bilateral and unilateral multiple pons infarcts. The infarcts are also determined segmentally: upper, middle and lower.
Results: 70 patients out of 80 are included in this study. The mean age is 64.5±1.19 (min:33 max: 88). The mean NIHSS is 3.98±2.8. 70% of the patients are male. The most common risk factor is hypertension (78.6%). 38 patients has anteromedial IPI (54.3%), 13 patients has anterolateral IPI (18.6%), 11 patients
has tegmental IPI (15.7%), 7 patients has unilaterally multifocal IPI (10%) and 1 patient has bilateral IPI(1.4%). The most common segmental location is found to be in middle pons (44.3%) while 25 of them in the lower pons (35.9% )and 14 of them in the upper pons (20%).
Conclusion: We found out anteromedial infarcts are the most common localization in this study (54.3%). The most common risk factors are found to be HT, HPL and DM.

Kaynakça

  • 1- Ju Y, Hussain M, Asmaro K, et al. Clinical and imaging characteristics of isolated pontine infarcts: a one-year follow-up study. Neurological Research 2013, 35: 5, 498– 504.
  • 2- Saia V, Pantoni L. Progressive stroke in pontine infarction. Acta Neurol Scand 2009; 120: 213– 215.
  • 3- Kim JS, Lee JH, Im JH, Lee MC. Syndromes of pontine base infarction: a clinical-radiological correlation study. Stroke 1995; 26: 950– 955.
  • 4- Bassetti C, Bogousslavsky J, Barth A, Regli F. Isolated infarcts of the pons. Neurology 1996; 46: 165– 175.
  • 5- Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC. Basilar artery atherosclerotic disease is related to the subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 2009; 120: 88– 93.
  • 6- Déjerine J Sémiologie des affections du système nerveux.Paris: Masson Gubler A 1856 De l’hémiplegie alterne envisagée comme signe de lesion de la protubérance annullaire. Gaz Hébd Sci Méd 1914 5: 721– 723.
  • 7- Duret H Sur la distribution des artères nouricières du bulbe rachidien. Arch de Physiol Norm 1873 50: 88– 120.
  • 8- Stopford JSB Arteries of pons and medulla oblongata. J Anat Physiol 1916 50: 255–280.
  • 9- Foix C, Hillemand P Contribution á l’étude des ramolissements protubérantiels. Rev Méd (Paris) 1925 43: 287– 305.
  • 10- Lhermitte J, Trelles OJ L’artériosclerose du tronc basilaire et ses conséquences anatomo-cliniques. J Psychiat Neurol 1934 51: 91– 107.
  • 11- Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol 1968; 12 (1): 1– 15.
  • 12- Goldstein LB, Jones MR, Matchar D et al. Improving the reliability of stroke subgroup classification using Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke 2001; 32: 1091- 1098.
  • 13- Kumral E, Bayulkem G, Evyapan D. Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol 2002 249; 12: 1659– 1670.
  • 14- Kumar AD, Boehme AK, Siegler JE, Gillette M, Albright KC, Martin-Schild S Leukocytosis in patients with neurologic deterioration after acute ischemic stroke is associated with poor outcomes. Journal of Stroke and Cerebrovascular Diseases 2013 22: 7, e111– e117.
  • 15- Baran G, Gultekin YO, Baran O, Deniz C, Katar S, Yildiz GB, Asil T. Association between etiology and lesion site in ischemic brainstem infarcts: a retrospective observational study. Neuropsychiatr Dis Treat 2018; 14: 757– 766.
  • 16- Kataoka S, Hori A, Shirakawa T, Hirose G. Paramedian Pontine Infarction: Neurological/Topographical Correlation. Stroke 1997; 28: 809– 815.
  • 17- Kobayashi, J, Ohara, T, Minematsu K, Nagatsuka K, Toyoda K. Etiological mechanisms of isolated pontine infarcts based on arterial territory involvement. Journal of the Neurological Sciences 2014 339: 1-2, 113– 117.
  • 18- Caplan LR, Wityk RJ, Glass TA, et al. New England medical center posterior circulation registry. Ann Neurol 2004 Sep; 56: 3, 389- 98.
  • 19- Huang R, Zhang X, Chen W, Lin J, Chai Z, Yi X. Stroke Subtypes and Topographic Locations Associated with Neurological Deterioration in Acute Isolated Pontine Infarction. Journal of Stroke and Cerebrovascular Diseases 2016 25: 1, 206- 213.
  • 20- Vemmos KN, Spengos K, Tsivgoulis G, et al. Aetiopathogenesis and long-term outcome of isolated pontine infarcts. J Neurol 2005; 252: 212- 217.
  • 21- Gökçal E, Niftaliyev E, Baran G, Deniz Ç, Asil T. Progressive deficit in isolated pontine infarction: the association with etiological subtype, lesion topography and outcome. Acta Neurol Belg 2017 117: 3, 649– 654.
  • 22- Huang J, Qiu Z, Zhou P,et al Topographic location of unisolated pontine infarction. BMC Neurology 2019 19: 1
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Eylem Özaydın Göksu 0000-0001-8851-3094

Şennur Delibaş Katı 0000-0002-7174-3077

Alparslan Melik Kayıkçi 0000-0002-2955-9890

Fatma Genç 0000-0002-6062-3694

Fatma Kurtuluş 0000-0002-8772-6087

Yayımlanma Tarihi 21 Mart 2022
Gönderilme Tarihi 11 Ağustos 2020
Kabul Tarihi 28 Eylül 2020
Yayımlandığı Sayı Yıl 2022 Cilt: 17 Sayı: 1

Kaynak Göster

AMA Özaydın Göksu E, Delibaş Katı Ş, Kayıkçi AM, Genç F, Kurtuluş F. İzole Pons İnfarktlarının Topografik Lokalizasyonu. KSÜ Tıp Fak Der. Mart 2022;17(1):152-155. doi:10.17517/ksutfd.779050