133例腔隙性脑梗死患者DSA结果及临床特点分析

Clinical characteristics and digital subtraction angiography features of lacunar infarction： an analysis of 133 cases

目的 探讨腔隙性脑梗死患者的临床表现、影像学资料及DSA特点.方法 南方医科大学珠江医院神经内科自2002年5月至2008年4月共收治经头颅CT或MR证实并行DSA检查、初次出现临床症状的腔隙性脑梗死患者133例,回顾性分析患者的临床表现、影像学资料及DSA特点.结果 133例患者中临床表现为纯运动性卒中42例（31.6%）,感觉运动性卒中36例（27.1%）;CT/MR检查共发现梗死灶283个,梗死灶位于内囊78个（27.6%）,放射冠＋半卵圆中心121个（91.0%）;DSA结果显示颅内大血管病变44例（101处）,其中大血管狭窄38例（95处,其中责任血管34处,非责任血管61处）,烟雾病6例,单发颅内动脉动脉瘤1例.DSA阳性患者中以纯运动性卒中（21例）和感觉运动性卒中（10例）居多,梗死部位以内囊（23个）和放射冠＋半卵圆中心（31个）居多,44例患者存在至少1个脑血管病高危因素.结论 腔隙性脑梗死的病因多样,部分患者易出现颅内大血管狭窄,以纯运动性卒中和感觉运动性卒中最多,基底节和放射冠梗死灶为主,多存在脑血管病高危因素.

Objective To discuss the clinical manifestations, imaging data and DSA findings of lacunar infarction （LI）. Methods One hundred and thirty-three patients, admitted to our hospital from May 2002 to April 2008, were chosen in our study; these patients with first onset as LI were confirmed by Head CT or MR; the clinical manifestations and imaging data were retrospectively analyzed; DSA was also performed on these patients and DSA findings were concluded. Results One hundred and thirty-three patients were clinically manifested as pure motor hemiplegia （PMH, n=42, 31.6%） and sensorimotor stroke （SMS, n=36, 27.1%）. Two hundred and eighty-three lesions were noted by CT/MR examinations, including 78 locating at the endocyst （27.6%） and 121 locating at the corona radiate＋greater oval center （91.0%）. Forty-four patients were noted as having 101 intracranial vessel lesions by DSA, including 38 patients with angiostenosis, 6 with Moyamoya and 1 with single intracranial aneurysm; of the patients with angiostenosis, 95 lesions （34 in the offending vessels and 61 in other vessels） were found. Among the DSA （＋） patients, PMH （n=21） and SMS （n=10） were mainly noted with their lesions locating at the endocyst （n=23） and the corona radiate＋greater oval center （n=31）; At least 1 high-risk factor such as hypertension, diabete, hyperlipemia, coronary heart disease and arial fibrillation was found in 44 patients. Conclusion The pathogeneses of LI are various. Main artery infarction may co-exist in some cases. PMH and SMS are common with their lesions frequently locating at basal ganglia area and corona radiate of the cerebral hemisphere. High risk factor exists in most patients with cerebrovascular diseases.