高凝状态相关性非单一动脉供血区多发急性脑梗死的临床特点和微栓子监测

Clinical manifestations and microemboli signals in patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories

目的研究高凝状态相关性非单一动脉供血区多发急性脑梗死的临床和影像学特点、微栓子监测,探讨其可能的发病机制。方法收集就诊于我院神经内科的高凝状态相关性非单一动脉供血区多发急性脑梗死患者的临床资料、实验室检查、头MRI、TCD微栓子监测,总结分析其特点。结果共收集22例患者。均以局灶性神经功能缺损急性起病,包括偏瘫、失语、偏身感觉障碍、构音障碍、偏盲、皮质盲。高凝状态相关性基础疾病如下:系统性恶性肿瘤10例,高同型半胱氨酸血症(中重度,HCY>50μmol/L)5例,肾病综合征2例,抗磷脂综合征2例,溃疡性结肠炎1例,真性红细胞增多症1例,阵发性睡眠性血红蛋白尿症1例。18例在卒中发病后高凝状态相关性基础疾病才被首次确诊。DWI示多发急性梗死灶,不符合单一动脉供血区,累及双侧前循环或前后循环,病灶累及大脑半球脑叶皮层/皮层下22例,深部12例,小脑10例,脑干2例。22例行微栓子监测者10例阳性。结论对于非单一动脉供血区多发急性脑梗死,要注意筛查高凝状态相关性基础疾病,高凝状态和微栓塞可能都参与其发病机制。

Objective To investigate the clinical features and TCD-detected microembolic signals in patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, and to explore the possi- ble underlying mechanisms. Methods A retrospective review was conducted on all clinical, laboratory, radiological and TCD monitoring records from patients with hypercoagulability related multiple acute cerebral infarcts within non-single arterial territories, who admitted to the neurology department in our hospital. Results The data from twenty-two cases were finally included in this study. All patients presented with acute-onset localized neurological dysfunction, e.g. hemi- paresis, aphasia, hemiparesthesia, dysarthria, hemianopsia and cortical blindness. Their hypercoagulability related diseas- es included 10 cases of systemic malignancy, 5 moderate to severe hyperhomocystynemia （HCY 〉 50μmol/L）, 2 nephrot- ic syndrome, 2 antiphospholipid syndrome, 1 ulcerative colitis, 1 polycythemia vera,1 paroxysmal nocturnal hemoglobin- uria. In 18 cases, the hypercoagulability related diseases were diagnosed after their initial stroke onset. DWI showed mul- tiple disseminated acute cerebral infarcts in non-single arterial territories involving bilateral anterior or anterior plus pos- terior cerebral circulation simultaneously. Foci involved lobar cortex/subcortex of cerebral hemisphere in 22 cases, deep cerebral hemisphere in 12 cases, cerebellum foci in 10 cases, brainstem foci in 2 cases. TCD revealed microembolic sig-nals in ten of 22 patients monitored. Conclusions Patients with multiple acute cerebral infarcts involving non-single arte- rial territories, should be screened for hypercoagulability as in that hypercoagulability and microembolism might be in- volved in the etiology of cerebral infarction.