脑白质区域非腔隙性梗死灶与颅内外血管狭窄关系的探讨

Investigate of correlation between non-lacunar infarcts in the white matter of brain and intracranial or extracranial vessels stenosis

目的探讨脑白质区域非腔隙性梗死灶与颅内外血管狭窄的关系。方法对30例脑白质区域非腔隙性梗死患者的头颅MRI以及主动脉弓、全脑数字减影血管造影(DSA)检查资料进行分析。结果本组MRI示12例单侧基底节区片状异常信号中,DSA表现为一侧颈内动脉(ICA)起始部闭塞或高度狭窄9例,一侧大脑中动脉(MCA)M1段高度狭窄2例,无明确血管病变1例。6例基底节以及侧脑室旁白质区域病灶中,一侧ICA起始部闭塞或高度狭窄3例,一侧ICAC5段闭塞1例,一侧MCAM1段闭塞2例。4例侧脑室旁或半卵圆中心白质区域病灶中,一侧ICAC6段闭塞1例,一侧MCAM1段高度狭窄2例,无明确血管病变1例。8例皮质下上型或皮质下侧型分水岭脑梗死患者中,一侧ICA起始部闭塞或高度狭窄6例,双侧ICA起始部闭塞1例,一侧MCAM1段高度狭窄1例。结论脑白质区非腔隙性梗死灶的发生与ICA系统大血管的狭窄或闭塞有密切的关系。

Objective To investigate the correlation between non-lacunar infarcts in the white matter of brain and intracranial or extracranial vessels stenosis. Methods Brain magnetic resonance imaging （ MRI ） and digital subtraction angiography （DSA） were performed in 30 patients with non-lacunar infarcts in the white matter of brain and the results were analyzed. Results Of 12 cases with focal non-lacunar infarcts in the area of basal ganglion, 9 cases were shown occlusion or highly stenosis of proximal segments of unilateral internal carotid artery （ ICA ） in DSA, 2 cases were shown highly stenosis of M1 segment of middle cerebral artery （ MCA）, and 1 case was normal. Of 6 cases with focal non-lacunar infarcts in the area of basal ganglion and lateral periventricular white matter, 3 cases were shown occlusion or highly stenosis of proximal segments of unilateral ICA in DSA, 1 case was shown occlusion of C,5 segment of unilateral ICA, and 2 cases were shown occlusion of M1 segments of MCA. Of 4 cases with focal non- lacunar infarcts in periventricular white matter or centrum ovale, 1 case was shown occlusion of C5 segment of unilateral ICA, 2 cases were shown highly stenosis of M1 segments of MCA, and the other one was normal. Of 8 cases with subcortical superior border infarction （ SSBI ） or subcortical lateral border infarction （ SLBI ）, 6 cases were shown occlusion or highly stenosis of proximal segments of unilateral ICA, 1 case was shown occlusion of proximal segments of bilateral ICA, and 1 case was shown occlusion of M1 segment of MCA. Conclusion There are strong correlations between focal non-lacunar infarcts in the areas of basal ganglion or lateral periventricular white matter and the stenosis or occlusion of large arteries of ICA system.