急性分水岭区脑梗死-凸面蛛网膜下腔出血三例

Acute watershed cerebral infarction-subarachnoid hemorrhage in 3 cases

目的 探讨颈动脉颅内或颅外段狭窄或闭塞导致后分水岭区凸面蛛网膜下腔出血(cSAH)与前循环急性脑梗死(ACI)的发病机制、影像学特征及治疗,以提高对该类型卒中的认识。方法 报道3例颈动脉颅内或颅外段狭窄或闭塞导致cSAH患者的临床表现、CT和MRI所见及治疗。结果 3例患者临床表现以局灶性神经功能损害为主,且均存在动脉粥样硬化的危险因素,头颅CT显示病变对侧大脑皮质沟高密度影,并出现新发梗死灶。MRA证实例1病变侧颈动脉颅内及颅外段狭窄,例2病变侧大脑中动脉闭塞,例3病变侧颈动脉颅内段狭窄。结论 颈动脉颅内或颅外段狭窄或闭塞导致的急性分水岭区ACI可以cSAH为首发表现。

Objective To explore the pathogenesis, imaging features and treatment of acute cerebral infraction (ACI) in the posterior watershed area of convex subarachnoid hemorrhage( cSAH) and anterior circulation caused by carotid artery intracranial or extracranial segment stenosis or occlusion, so as to improve the understanding of this type of stroke. Method We reported clinical manifestations, CT and MRI findings and treatment of 3 patients with cSAH caused by intracranial or extracranial stenosis or occlusion of the carotid artery. Results The mainly clinical manifestations of the 3 patients were focal neurological dysfunction, and all of them had risk factors of atherosclerosis. Cranial CT showed high density of the lesion to the cortical groove of the lateral brain, and new infarction occurred.Further MRI examination demonstrated case 1 of intracranial and extracranial stenosis of the carotid artery, case 2 of middle cerebral artery occlusion, and case 3 of intracranial stenosis of the carotid artery. Conclusion Acute watershed cerebral infarction caused by intracranial or extracranial carotid artery stenosis or occlusion may be the first manifestation of convex subarachnoid hemorrhage.