大脑中动脉狭窄患者临床与神经影像学特点

Clinical and neuroimaging features of patients with middle cerebral artery stenosis

目的研究单侧大脑中动脉(MCA)狭窄患者的临床及神经影像学特点,并探讨其发病机制。方法采用颅脑磁共振血管成像(MRA)和颈动脉超声等检查,筛选单侧MCA狭窄患者30例,进一步行磁共振弥散加权成像(DWI)和数字减影血管造影(DSA)等检查,对其临床资料进行相关性分析。结果 30例患者中,表现为急性卒中23例,其中多发脑梗死16例,单发脑梗死7例;短暂性脑缺血发作(TIA)患者5例,其中2例可见多发腔隙灶,3例DWI未见异常;无症状MCA闭塞患者2例,DWI未见异常。结论 MCA狭窄患者可表现为多种梗死类型,动脉-动脉栓塞、主干斑块延伸以及血管狭窄所致低灌注可能是其共同发病机制,应根据病因制定个体化治疗方案。

Objective To study the clinical and neuroimaging features of patients with unilateral middle cerebral artery（MCA） stenosis and to investigate its mechanism.Methods 30 patients with unilateral MCA stenosis were screened by magnetic resonance angiography（MRA） and carotid ultrasound.Further examinations such as diffusion-weighted imaging（DWI） and digital subtraction angiography（DSA）were performed and the relationship between the results and their clinical data was analysed.Results Among the 30 patients,23 had acute stroke,5 had transient ischemic attack（TIA） and 2 were asymptomatic.Among the patients with acute stroke,16 had multiple acute infarcts and 7 had single acute infarcts.Among the patients with TIA,2 had multiple lacunars and the other 3 had no positive findings on DWI.2 asymptomatic patients had no positive findings on DWI.Conclusion Various stroke patterns may be present in the patients with MCA stenosis.The possible common stroke mechanism include artery-to-artery embolism,stem plaque strentching and hypopefusion resulting from stenosis.Individualized treatment should be formulated according to different pathogenesis.