无症状脑梗死临床特点及影像学诊断(附22例分析)

Differential diagnosis and clinical characteristics of silent brain infarction(22 cases reports attached)

目的分析无症状脑梗死的临床特点及其影像诊断。方法回顾性研究22例无症状脑梗死患者的头颅影像学资料,分析病灶的临床表现以及影像学表现,包括信号或密度、大小、部位和范围,总结与类似病变的鉴别经验。结果22例患者中临床表现为头晕或眩晕12例,头痛5例,一过性肢体无力或麻木3例,2例表现为言语不清或表达不清等。CT表现为基底节12例(55%),半卵圆区白质4例(18.2%),内囊3例(13.6%),丘脑、脑干及小脑2例(共9%),其它1例(4.2%)。其中单发病灶6例(27%)或多发病灶16例(73%),表现为类圆形或不规划小片状低密度灶,MR I表现为T1W1上低信号,T2W1高信号。类似病灶较多,影像学有时难以鉴别。结论非梗死特异性症状脑梗死影像学表现与症状性脑梗死相同,临床表现也无特点。诊断应以影像学为依据并注意与多发性硬化、脑腔隙和白质疏松鉴别。

Objective To study the imaging diagnosis and clinical characteristics of silent brain infarction （ SBI ）. Methods 22 eases of silent brain infarction were analyzed with their CT, MRI films as well as clinical symptoms, including their signals or density, size, position and areas of the lesion. Results Twelve of the 22 patients suffered from dizzy or spinning, 5 cases from headache,3 cases from weakness or coma of extremity now and then and 2 cases showed unclear language expression. CT findings indicated single or multi lesion with low density area which showed round or irregular shape at the site of basal nuclei （55%）,cerebral hemisphere（18.2%）, internal capsule （13.6%）, thalamus, brain stem as well as cerebellum （9%）. MRI findings showed low signal at T1W1 images and high signal at T2W1 images. Conclusion Silent brain infarction had the same symptoms as the symptomatic brain infarction. The diagnosis should depend on the imaging findings and observe the multiple sclerosis and brain lacunar. SBI should be treated and prevented as the symptomatic brain infarction.