大脑中动脉粥样硬化性狭窄患者卒中类型分析

Stroke pattern analysis in patients with middle cerebral artery occlusive disease

目的研究大脑中动脉粥样硬化性狭窄或闭塞(MCAOD)患者的卒中类型及其发病机制。方法经TCD和(或)MRA确诊的症状性MCAOD的患者,依据头部弥散加权核磁成像(DWI)所示梗死灶的特点进行分类,并与MCA狭窄程度进行相关性分析。结果84例症状性MCAOD患者中,73.8%的患者表现为多发性脑梗死,主要累及内交界区(53.6%)、半卵圆中心(29.1%)和皮层(22.6%)。皮层区域内梗死、交界区梗死、深部小梗死灶的发生率分别为46.4%、56.0%和44.0%,以多发小灶性梗死为主,很少引起MCA主干支完全梗死。且皮层支完全梗死、半卵圆中心梗死与严重MCA狭窄有关,而腔隙样梗死多见于轻度MCAOD患者。结论MCAOD患者可表现为各种梗死类型,以交界区梗死最常见,且多发性脑梗死为MCAOD患者最常见的表现类型,主要累及皮层下白质等部位,病灶以链型或弧线型分布为特点,动脉-动脉栓塞为其发病机制之一;深部小梗死多为孤立病灶,与MCA主干粥样硬化斑继发的血栓堵塞豆纹动脉入口有关。

Objective To investigate stroke patterns of symptomatic MCA occlusive disease and further to understand the pathogenesis of stroke. Methods 84 acute ischemic stroke patients with MCAOD performed DWI. According to the lesions on DWI,acute infarction patterns were categorized as cortical territory infarction,border zone infarction and perforating artery infarction. They were divided into single infarction and multiple infarction dependent on the number of lesion on DWI. Results It showed that cortical territory infarcts,border zone infarcts and deep small infarcts were 46.4%,56%,44.0% respectively. Among them,73.8% patients showed multiple infarctions. The incidence of a particular stroke pattern was clearly dependent on the degree of stenosis. The patients with MCA stem total occlusion and severe stenosis were susceptive to had cortical branch infarction and centrum semiovale infarction. Conclusion Any infarcts pattern may occur in MCAOD patients. The most common stroke pattern of MCAOD patients is multiple infarction,which usually involvng internal border zone and centrum semiovale with chain-like or arciform shape distribution. It’s pathogenesis is artery-artery emboli. Deep small infarcts are frequently associated with MCA stem stenosis,which induced occlusion of the origin of the lenticulostriate artery.