急性多发性皮层下小范围脑梗死是否由栓子机制导致?

Are multiple acute small subcortical infarctions caused by embolic mechanisms?

Objective: To seek evidence of potential embolic sources or other stroke mecha nisms in patients who, on chance observation, had several apparently recent smal l subcortical infarcts on diffusion weighted magnetic resonance imaging (DWI). M ethods: Patients presenting with stroke and multiple hyperintense subcortical in farcts visible on DWI were identified prospectively. Detailed clinical and radio logical assessments were done independently and blinded to each other. Results: Of 10 patients with multiple hyperintense subcortical infarcts on DWI, a definit e embolic source was identified in only one. Most patients were hypertensive and smoked. The DWI appearance suggested that the subcortical lesions had occurred within several weeks rather than at exactly the same time. Most patients also ha d significant white matter hyperintensities and four had microhaemorrhages. Conc lusions: Embolic sources were not identified in most patients but they did have systemic vascular risk factors and brain imaging features of “small vessel dise ase.”A more generalised intrinsic process affecting many small cerebral vessels contemporaneously could explain multiple acute small subcortical infarcts. Whit e matter hyperintensities, microhaemorrhages, and multiple small subcortical inf arcts may share a common pathophysiological mechanism such as a diffuse cerebral microvascular abnormality which requires further exploration.