十例急性超大面积大脑半球梗死患者影像学表现和临床特征分析及文献复习

Imaging Findings and Clinical Features of Ten Patients with Acute Ultra-large Area Cerebral Hemispheric Infarction and Literature Review

目的分析10例急性超大面积大脑半球梗死患者影像学表现及临床特征,并复习相关文献。方法选取2014年8月—2017年9月徐州市丰县人民医院收治的急性超大面积大脑半球梗死患者10例,回顾性分析其影像学表现及临床特征。结果既往史:高血压9例,心房颤动6例,脑梗死5例,高脂血症5例,冠心病4例,糖尿病2例。临床表现:急性意识障碍、昏迷10例。首次CT检查呈现阴性征象者2例;呈现阳性征象者8例,其中患侧脑沟变浅或消失8例,大脑半球区域性稍低密度模糊影6例,右侧大脑中动脉高密度影3例。随访期间,10例患者影像学检查均显示梗死灶最大累及患侧大脑半球85%~98%、恶性水肿加重、占位及脑疝征象,3例患者T2加权(T2WI)图像示右侧颈内动脉高信号征,3例患者CT图像示梗死灶少许出血。1例患者行大骨瓣切除减压术治疗,9例患者采用常规保守治疗。随访3 d^4周,10例患者均死亡。结论急性超大面积大脑半球梗死患者临床表现危重,预后极差,CT及磁共振成像(MRI)可明确诊断。

Objective To analyze the imaging findings and clinical features of10patients with acute ultra-large area cerebral hemispheric infarction,and review the related literatures.Methods From August2014to September2017,a total of10patients with acute ultra-large area cerebral hemispheric infarction were selected in the People's Hospital of Fengxian,Xuzhou,and the imaging findings and clinical features were retrospectively analyzed.Results Past medical history:9cases showed hypertension,6cases with atrial fibrillation,5cases with cerebral infarction,5cases with hyperlipidaemia,4cases with coronary heart disease,2cases with diabetes.Clinical features:all of the10patients performed as acute disturbance of consciousness and coma.The first CT examination results:2cases with negative signs;8cases with positive signs,thereinto8cases showed shallow or disappeared gyri in the affected side,6cases showed cerebral hemispheric slightly low-density fuzzy shadows,3cases with high-density shadows in the right middle cerebral artery.Imaging findings during the follow-up:all of the10patients showed infarction focus involved85%-98%cerebral hemisphere in the affected side,exacerbation of malignant edema,occupation lesions and cerebral hernia,besides,3cases showed increased signal intensity in the right internal carotid artery,3cases'CT imagings showed a little bleeding in the infarction focus.Therapeutic methods:1case received large-bone flap resection decompression,9cases received routine conservative treatment.During the follow up(3days to4weeks),all of the10patients died.Conclusion Acute ultra-large area cerebral hemispheric infarction is dangerous with severe clinical manifestations and poor tewifically prognosis,CT and MRI can confirm the diagnosis.