脑梗死后皮质层状坏死的临床和影像特点

Clinical and imaging characteristics of cortical laminar necrosis after cerebral infarction

目的观察脑梗死后皮质层状坏死(CLN)的临床表现和影像特点,并分析其可能机制。方法本研究为前瞻性观察性研究,纳入2019年10月-2021年10月住院治疗的急性脑梗死后CLN患者38例为CLN组,同期脑梗死后无CLN的42例为对照组,分析其临床和影像学特点。结果所纳入的脑梗死后CLN患者在脑梗死发病后(5 d±3 d)出现不同程度的神经功能的加重,以认知功能加重明显,两组差异有统计学意义(P<0.001),后认知障碍逐渐改善,梗死后(6 m±7 d)时两组差异有统计学意义(P<0.05);在脑梗死发病后(5 d±3 d)DWI、Flair上可见沿皮质脑回分布的高信号,此时CLN区域脑血流灌注为高灌注,高灌注可持续至脑梗死后(1 m±3 d),后转化为等或低灌注。结论脑梗死后皮质层状坏死多在梗死后(5 d±3 d)出现,伴随认知功能加重和CLN区域脑血流高灌注,认知功能较前逐渐改善,仍低于正常认知水平。

Objective To investigate the dynamic changes of clinical manifestations and imaging features of cortical stratified necrosis(CLN)after cerebral infarction,and to analyze its possible mechanisms.Methods The present study was a prospective observational study involving 38 patients with CLN after acute cerebral infarction who were hospitalized from October 2019 to October 2021,and 42 patients with cerebral infarction during the same period.The clinical and imaging characteristics of CLN patients were analyzed and the possible mechanisms were discussed.Results The included CLN patients had neurological aggravation at(5±3)days after the onset of cerebral infarction,especially cognitive aggravation and the difference between the two groups was statistically significant(P<0.001).The cognitive impairment gradually improved.The difference between the two groups was statistically significant(P<0.05).There was high signal distribution along the cortical on DWI and Flair at(5±3)days after cerebral infarction.At this time,cerebral blood perfusion in CLN region was hyper-perfusion,which lasted until 1 month±3 days after cerebral infarction,and then changed to equal or hypo-perfusion.Conclusion Cortical laminar necrosis mostly appeared(5±3)days after infarction,accompanied by cognitive function aggravation and high cerebral blood flow perfusion in CLN region,cognitive function gradually improved,but it was still lower than the normal cognitive level.