中青年脑梗塞患者的临床与病理

Cerebral infarction in the middle aged and young adults: clinical and pathological study

目的探讨中、青年人脑梗塞的病因。方法将连续尸检确诊的脑梗塞病例中≤４５岁患者的脑标本常规处理，以动脉为重点行肉眼及光镜下观察，并分析有关临床资料。结果７２例患者中≤４５岁者７例，其中男６例，女１例。其中高血压、风湿性心脏病各２例，嗜烟、嗜酒各４例，病前１日酗酒１例。梗塞灶相关动脉闭塞处管壁５例发现粥样斑块，３例发现炎症（１例与粥样斑并存）。５例粥样斑块血栓形成均位于基底动脉，４例病后２日内死亡；未发现动脉硬化的２例为左侧大脑中动脉闭塞，病后存活１周以上。４例有脑疝形成。无一例发现明确的并发症。结论在中青年脑梗塞患者，早发性动脉粥样硬化是其重要病因之一，烟酒可能是其危险因素之一；动脉闭塞的部位是决定首次发病后存活时间的重要因素；脑源性死亡是致死的根本原因。

Objective To assess the pathogenic factors of cerebral infarction in the middle aged and young adults. Method Microscopic examination of the conventionally prepared autopsy brain specimens was made with particular attention to the arterial walls and lumens, and the relevant clinical materials were analysed. Results Among the 72 consecutive autopsy confirmed cases of cerebral infarction, seven cases (9.72%, six males and one female) were at or below the age of 45 years and were included in this study. In the seven cases there were two with hypertension, two with rheumatic heart disease, four smokers, four drinkers (one of them had an excessive drinking on the day before the onset of infarction), and one with the history of an ischemic stroke. The walls of the infarct related arterial segments were identified. The atheromatous plaque based thrombosis was observed in five cases. They all occurred in the basilar arteries, causing deaths within two days after the onset of the strokes in four cases. There were inflammatory changes in three cases, in one of which there were both inflammation and an atheromatous plaque. In the two cases without apparent atherosclerosis, there was occlusion of the left middle cerebral artery, which resulted in deaths 7 and 30 days after the onset of the strokes respectively. Four cases developed cerebral hernia. No other evident complication was found in any of the seven cases. Conclusions In the cases of cerebral infarction found among the middle aged and young adults, atherosclerosis appeared to be an important pathogenic cause. Heavy cigarette smoking and excessive drinking might be the relevant risk factors. The site of arterial occlusion in relation to the extent or severity of ischemic involvement might be the major factor influencing the survival duration after the first onset of brain infarction. The basic cause of the deaths seemed to be mainly due to the cerebral strokes rather than its complications.