动脉硬化性大脑中动脉狭窄或闭塞所致脑梗死类型

Cerebral Infarction Patterns Related to Isolated Atherosclerotic Middle Cerebral Artery Diseases

目的探讨动脉硬化性大脑中动脉狭窄或闭塞性疾病(MCAOD)所致脑梗死的类型。方法对50例经颅脑MRA或DSA确诊的症状性MCAOD患者进行研究,依据其头部弥散加权成像(DWI)和T2W的改变对脑梗死分型。结果50例患者共发现57条动脉硬化性大脑中动脉狭窄或闭塞,未发现病灶的有6(占12．0%)个大脑半球,多发性脑梗死和单发脑梗死分别见于13(占22．8%)个和38(占66．7%)个大脑半球。脑分水岭梗死、流域性脑梗死、半卵圆区脑梗死、多发性散在点状脑梗死(MSSI)、腔隙性脑梗死分别见于18(占31．6%)个、12(占21．1%)个、6(占10．5%)个、2(占3．5%)个和1(占1．8%)个大脑半球。结论MCAOD可引起各种类型的脑梗死,脑分水岭梗死约占1/3,动脉粥样硬化性血栓形成约占1/5,纹状体内囊梗死约占1/5,主要发病机制与动脉-动脉栓塞和低灌注有关。

Objective To evaluate the infarction patterns in patients with an isolated atherosclerotic middle cerebral artery stenotic or occlusive disease(MCAOD).Methods Patients with acute cerebral ischemia due to isolated MCAOD under- went diffusion weighted imaging(DWI).The MCA stenosis or occlusion were diagnosed by Magnetic Resonance Angiography (MRA)and digital subtraction angiography(DSA)when feasible.Results Fifty-seven atherosclerotic MCA stenoses or oc- clusions were observed in 50 patients(all had MRA,and 15/50 had DSA).Among the 57 cerebral hemispheres,no infarction was found in 6(10.5%)hemispheres,multiple cerebral infarctions were in 13(22.8%),and a single infarction was in 38 (66.7%).The subtypes were watershed infarcts in 18(31.6%),4 of the 18 showed internal watershed infarctions coexisted with cortical watershed infarcts,2 of them with multiple scatted spotty infarcts(MSSI).Striato-capsular infarcts were seen in 12(21.1%);territorial infarcts in 12(21.1%);semioval infarcts in 6(10.5%);MSSI in 2(3.5%)and a lacunar in- farct in 1(1.8%).Conclusion The results suggest that a variety of infarct patterns can occur in patients with MCAOD.Wa- tershed infarction accounts for about one third,atherosclerotic thrombosis infarcts and striatocapsular infarcts occupy approximate- ly one fifth respectively.The artery to artery small cerebral embolism and low perfusion are important mechanisms of cerebral in- farcts in patients with MCAOD,