脑分水岭梗死的临床表现及病因研究

Clinical manifestations and etiology of cerebral watershed infarction

目的探讨脑分水岭梗死(CWI)的临床表现及病因,为诊断及防治CWI提供依据方法分析60例CWI患者的症状和体征,CT、MRI改变,临床分型和病因。结果60例CWI患者的症状体征与病因及病变部位有关。CT/MRI的密度或信号改变与其它类型的脑梗死相同。单侧CWI 33例,双侧CWI 27例。皮层前型16例,皮层后型17例,皮层下型27例。以低血压起病者21例,其中双侧CWI 15例,单侧CWI 6例;以脑血管器质性病变为主因者28例,其中颈动脉狭窄或闭塞11例,颈动脉粥样硬化斑块形成8例,双侧CWI 11例,单侧CWI 17例。单侧脑血管器质性病变者CWI常与病变血管同侧。CWI多有血液成分的异常(如精尿病、高脂血症、高粘血症)。结论CWI临床表现取决于病变部位及病因;CWI主要病冈足低血压、颈动脉狭窄或闭塞或动脉粥样硬化斑块形成、血液成分异常(如糖尿病、高脂血症、高粘血症)。

Objective To investigate the clinical manifestations and the etiology of cerebral watershed infarction （CWI）, so as to provide the evidences for the diagnosis and treatment and prevention of CWI. Methods The clinical symptoms and signs and the CT/MRI characteristics and the clinical types and the etiology of 60 CWI cases were investigated. Results In the 60 CWI cases, the clinical symptoms and signs were associated with the causes and the regions of CWI; the density or signal changes of CT/MRI were the same as those of other cerebral infarction types; 33 cases were unilateral CWI, 27 cases were bilateral CWI; 16 cases were precortical type, 17 cases were postcortical type, and 27 cases were subcortical type. In the 21 CWI cases where the earliest sign was hypotension, 15 cases were bilateral CWI, and 6 cases were unilateral CWI. In the 28 CWI cases where the main etiology was cerebral vascular pathological changes, 11 cases had carotid artery stenosis or carotid artery occlusion, and 8 had atherosclerotic plaque of carotid artery; 11 cases were bilateral CWI, and 17 cases were unilateral CWI. The cases with unilateral cerebral vascular pathological changes usually developed CWI at the same lateral. The patients with CWI almost possessed the abnormality of blood constituent （diabetes, hyperlipemia and increased blood viscosity）. Conclusion The clinical manifestations of the CWI cases were determined by the regions and the causes of CWI. The main causes were hypotension, carotid artery stenosis or occlusion, or atherosclerotic plaque of carotid artery, and the abnormality of blood constituent.