恶性肿瘤相关性脑梗死的临床及影像分析

Analysis of clinical and imaging features of malignancy associated cerebral infarction

目的探讨恶性肿瘤相关性脑梗死的临床及影像学特点,以提高对该病的认识。方法收集经临床和病理证实的恶性肿瘤合并脑梗死24例,对患者的临床资料、实验室检查及头颅磁共振成像(MRI)进行回顾性总结分析。结果24例头颅MRI均表现为急性多发脑梗死,梗死灶大小及数目不等,累及多支动脉供血区。分布双侧前+后循环16例,双侧前循环6例,右侧前+后循环2例。15例行头颅磁共振血管成像(MRA),11例有脑动脉狭窄或闭塞。原发恶性肿瘤分别为肺癌10例,胃癌3例,胰腺癌2例,结肠癌1例,胆囊癌1例,肝内胆管细胞癌1例,卵巢癌1例,宫颈癌2例,食管癌2例,乳腺癌1例,其中9例符合隐匿性躯体恶性肿瘤。13例有卒中传统危险因素,9例为不明原因。18例脑梗死为首次发作,6例多次发作。20例行血浆D-二聚体检测,有18例增高。结论头颅MRI表现为累及多支脑动脉供血区、急性多发脑梗死伴有血浆D-二聚体显著升高是恶性肿瘤相关性脑梗死的较有特征性表现,可以作为隐匿性躯体恶性肿瘤的线索之一;在恶性肿瘤的诊治过程中动态监测血浆D-二聚体及头颅MRI,及时干预治疗,可减少恶性肿瘤相关性脑梗死的发生和复发。

Objective To explore the clinical and imaging characteristics of malignancy associated cerebral infarction.Methods Twenty-four patients with clinically and pathologically confirmed malignancy complicated with cerebral infarction were collected,and the clinical data,laboratory examination and cranial MRI of those patients were retrospectively analyzed.Results Cranial MRI of all 24 cases showed acute multiple cerebral infarctions with varying size and number,involving multiple arterial blood supply areas.The lesions were distributed in 16 cases with bilateral anterior and posterior circulation,6 cases with bilateral anterior circulation,and 2 cases with right anterior+posterior circulation.Fifteen cases underwent cranial MRA and 11 cases had cerebral artery stenosis or occlusion.The primary malignancies included 10 cases with lung cancer,3 cases with gastric cancer,2 cases with pancreatic cancer,1 case with colon cancer,1 case with gallbladder cancer,1 case with intrahepatic cholangiocarcinoma,1 case with ovarian cancer,2 cases with cervical cancer,2 cases with esophageal cancer,1 case with breast cancer,of which 9 cases were consistent with occult somatic malignancies.Thirteen cases had traditional risk factors of stroke and 9 had unknown causes.Eighteen cases with cerebral infarction were the first attack,and 6 cases had multiple attacks.Twenty cases underwent plasma D-dimer detection,and 18 cases′D-dimer increased.Conclusion The multiple arterial areas are involved in head MRI,and the acute multiple cerebral infarction accompanied by a significant increase in plasma D-dimer is a characteristic manifestation of malignancy-related cerebral infarction and can be used as a clue to occult somatic malignancie.Dynamic monitoring of plasma D-dimer and head MRI during the diagnosis and treatment of malignancy and timely intervention can reduce the occurrence and recurrence of malignancy associated cerebral infarction.