恶性大脑中动脉综合征43例临床分析

目的探讨大脑中动脉主干梗死的病因、临床表现及疗效。方法对43例恶性大脑中动脉综合征临床表现、头颅CT、MRI、MRA、TCD、空腹血糖、血脂等危险因素进行分析。结果大脑中动脉主干梗死以栓塞多见,早期栓塞面积越大、血糖水平越高,预后越差。结论发现缺血性脑血管的危险因素,有利于预防恶性大脑中动脉综合征发生。     

36例大脑中动脉主干梗死治疗观察

目的探讨大脑中动脉主干梗死的有效治疗方法。方法对36例临床确诊的大脑中动脉主干梗死患者的临床资料给予回顾性分析。结果本病病死率高,易出现梗死后出血,扩容治疗加重神经功能损害,溶栓治疗增加出血风险。结论大脑中动脉梗死病情重,病死率高,急性期治疗以脱水、自由基清除剂、钙离子拮抗剂为主,调控血压和血糖,不宜扩容,慎用溶栓。     

大脑前动脉供血区梗死的临床特征

目的 探讨大脑前动脉(anterior cerebral artery,ACA)梗死的危险因素、病因、发病机制、临床表现和影像学特征.方法 回顾性分析急性ACA梗死患者的临床和影像学资料,总结其危险因素、病因、梗死灶分布和临床表现；比较栓塞组(心源性或颈动脉源性栓塞)和ACA粥样硬化组患者梗死灶分布和临床表现；分析ACA粥样硬化性梗死的发病机制.结果 58例ACA梗死,占同期住院急性脑梗死患者的6.9％,其中52例完整评估颅内外血管的患者纳入研究.最常见危险因素为高血压(80.8％)；病因分型中大动脉粥样硬化最常见共45例,占86.5％:其次为心源性栓塞5例,占9.6％,2例病因不确定,占3.8％.栓塞组(16/52,30.8％)和ACA粥样硬化组(30/52,57.7％)相比,ACA粥样硬化组梗死累及胼胝体发生率更高(26/30 vs.6/16,x2=9.705,P=0.002),意志减退/淡漠更常见(19/30 vs.5/16,x2=4.305,P=0.038)；而栓塞组梗死更易累及其他供血区(8/16 vs.2/30,x2=9.111,P=0.003).两组间其他临床表现差异无统计学意义(P＞0.05).30例ACA粥样硬化性梗死中A2段狭窄或闭塞有23例(76.7％)；发病机制包括局部分支闭塞12例,原位血栓性闭塞5例,动脉-动脉栓塞5例,局部分支闭塞合并动脉-动脉栓塞8例.结论 ACA梗死发病率低,高血压是其最主要的危险因素,运动障碍是最常见的临床表现.ACA粥样硬化是主要病因,A2段病变最多见,存在多种梗死发病机制.心源性或颈动脉源性栓塞易累及其他供血区,ACA粥样硬化性梗死累及胼胝体和意志减退/淡漠多见.     

基底动脉尖综合征32例临床分析

目的 探讨基底动脉尖综合征的病因、危险因素、临床表现、影像学改变及治疗预后,提高对该疾病的认识.方法 回顾性分析2006-01～2008-12我院收治的32例基底动脉尖综合征患者的临床表现及影像学等资料.结果 基底动脉尖综合征主要病因是血栓形成及栓塞,主要危险因素是高血压,临床主要症状是眼球运动及瞳孔异常和意识障碍,头颅磁共振显示梗死灶更多见于丘脑及中脑.结论 基底动脉尖综合征预后较差,早期诊断并全面综合治疗具有重要意义.     

基层医院救治基底动脉尖综合征39例体会

基底动脉尖综合征（TOBS）是以基底动脉顶端为中心的2cm直径范围内（即左右大脑后动脉、左右小脑上动脉和基底动脉主干顶端）由于栓塞或血栓形成导致中脑、丘脑、部分枕颞叶以及小脑上部的梗死,从而引起的一系列临床综合征。由于临床发病突然、病情危重、预后较差,在基层医院临床救治中存在一定的困难,现就我院2002-01-2010-12收治的39例进行总结如下。     

不同时机行去骨瓣减压术治疗恶性大脑中动脉脑梗死效果的比较

<正>恶性大脑中动脉梗死主要是血栓、栓子等导致的大脑中动脉主干完全闭塞,进而引起严重的脑水肿、脑疝。临床主要表现为头痛、呕吐、视乳头水肿、神经功能障碍甚至意识水平下降等,也是引起脑梗死患者死亡的主     

纹状体内囊梗死的临床特点分析

目的探讨纹状体内囊梗死(striatocapsular infarction,SCI)的临床特点和与大脑中动脉局部病灶的关系。方法 5例发病在24h内入院的基底节区梗死患者,病灶直径>3cm,对其临床表现、发病72h内的头、颈部磁共振和磁共振血管成像、全脑血管造影表现进行分析。结果 5例梗死灶均局限在基底节区白质,无皮层受累,4例有早期运动进展;1例为病灶侧大脑中动脉夹层,3例病灶侧大脑中动脉主干中度以上狭窄。结论 SCI患者易发生早期运动进展,可能与病灶同侧大脑中动脉主干狭窄有关。     

大脑中动脉取栓术致大脑前动脉急性医源性栓塞的危险因素分析

目的研究大脑中动脉闭塞取栓术中发生大脑前动脉急性医源性栓塞的发生率和临床预后,并分析其发生的相关危险因素。方法回顾性分析59例于2012年10月至2018年5月进行大脑中动脉闭塞机械性取栓术患者的临床资料。依据术中是否发生大脑前动脉栓塞分为并发术中大脑前动脉栓塞组(10例)与无大脑前动脉栓塞组(49例),计算术中大脑前动脉栓塞的发生率,比较两组患者的预后指标,分析大脑前动脉栓塞发生的危险因素。结果本研究术中大脑前动脉急性医源性栓塞的发生率为16.9%。经多因素Logistic回归分析发现,取栓次数(P=0.034)和对侧大脑前动脉发育不良(P=0.038)是大脑前动脉栓塞发生的独立危险因素。两组患者术后7 d的NIHSS评分、患者取栓术后90d的mRS评分、术后脑出血发病率、术后90d病死率等预后指标,组间比较差异均无统计学意义(P0.05)。结论大脑中动脉闭塞术中取栓次数和对侧大脑前动脉发育不良是术中发生大脑前动脉急性医源性栓塞的独立预测因素,无论术中是否发生是大脑前动脉栓塞,其临床预后指标比较差异无显著性。     

Percheron动脉梗死三例临床分析

回顾分析3例Percheron动脉梗死患者临床资料,均存在脑血管病危险因素,临床表现为急性发病,伴不同程度意识障碍、反应迟钝、智力障碍、精神改变,无运动障碍,其中2例伴眼球运动障碍。MRI显示双侧丘脑和中脑对称性长T1、长T2信号,扩散加权成像(DWI)高信号;1例FLAIR成像呈现中脑"V字征";1例MRA显示右侧大脑后动脉主要由后交通动脉延伸,P1段发育不良,即胚胎型大脑后动脉。按照脑血管病治疗后临床症状均改善。提示典型临床表现、丘脑旁正中区对称性DWI高信号和FLAIR成像中脑"V字征"有助于早期诊断Percheron动脉梗死,单侧胚胎型大脑后动脉可能是Percheron动脉梗死的潜在先天性危险因素。     

房颤致脑栓塞60例临床分析

目的探讨房颤致脑栓塞的临床表现、栓塞部位特点、影像学特点、预后及防治。方法对60例房颤致脑栓塞患者的临床资料进行对比分析。结果房颤致脑栓塞症状重，最常见于颈内动脉系统，特别是大脑中动脉，栓塞面积大，出血性梗死多见，并发症严重，预后差。结论房颤是脑栓塞的最重要的致病因素。     

Association Between Prolonged Seizures and Malignant Middle Cerebral Artery Infarction in Children With Acute Ischemic Stroke

BackgroundMalignant middle cerebral artery infarct syndrome is a potentially fatal complication of stroke that is poorly understood in children. We studied the frequency, associated characteristics, and outcomes of this condition in children.MethodsChildren, aged two months to 18 years with acute middle cerebral artery infarct diagnosed at our center between January 2005 and December 2012 were studied. Associations with malignant middle cerebral artery infarct syndrome were sought, including age, seizures, neurological deficit severity (Pediatric National Institute of Health Stroke Severity Score), stroke etiology, fever, blood pressure, blood glucose, infarct location, infarct volume (modified pediatric Alberta Stroke Program Early Computed Tomography Score), and arterial occlusion. Death and neurological outcomes were determined.ResultsAmong 66 children with middle cerebral artery stroke, 12 (18%) developed malignant middle cerebral artery infarct syndrome, fatal in three. Prolonged seizures during the first 24 hours (odds ratio, 25.51; 95% confidence interval, 3.10 to 334.81; P = 0.005) and a higher Pediatric National Institute of Health Stroke Severity Score (odds ratio, 1.22; 95% confidence interval, 1.08 to 1.45; P = 0.006) were independently associated with malignant middle cerebral artery infarct syndrome. All children aged greater than two years with a Pediatric National Institute of Health Stroke Severity Score ≥8 and initial seizures ≥5 minutes duration developed malignant middle cerebral artery infarct syndrome (100%).ConclusionsMalignant middle cerebral artery infarct syndrome affects nearly one in five children with acute middle cerebral artery stroke. Children with higher Pediatric National Institute of Health Stroke Severity Scores and prolonged initial seizures are at greatly increased risk for malignant middle cerebral artery infarct syndrome. Children with middle cerebral artery infarcts warrant intensive neuroprotective management and close monitoring to enable early referral for hemicraniectomy surgery.     

"Malignant" middle cerebral artery territory infarction

The pathology, clinical course, outcome, diagnosis, treatment and prognosis of dramatic malignant middle cerebral artery territory infarction were presented. About 10% of stroke patients suffer from malignant middle cerebral artery territory infarction, mainly due to brain edema and herniation. This syndrome causes high mortality. The newest conservative and surgical treatment was presented.     

Unexpected air embolism during an aneurysmal operation in supine position--a case report and a speculation about its pathogenesis]

The occurrence of air embolism in supine position operation is extremely rare. We reported a case of air embolism during the operation of a ruptured middle cerebral artery aneurysm in supine position. A 58-year-old woman was admitted to our hospital in semicomatous state. A CT scan revealed diffuse subarachnoid hemorrhage. Cerebral angiogram showed a middle cerebral artery aneurysm. Massive pinkish foamy sputum and butterfly shadow on chest x-ray strongly suggested an association of neurogenic pulmonary edema (NPE). Barbiturate therapy and controlled ventilation with positive end-expiratory pressure (5cmH2O) were started. Her airway pressure was about 35cmH2O. Decrease of pinkish foamy sputum and an improvement of chest x-ray findings on the next day encouraged us to perform a clipping operation. Just before a clip application, air bubbles were observed to pass through the middle cerebral artery under the microscope. Subsequently cardiac standstill was brought out. Fortunately, she was resuscitated, and a clip application was finished. A postoperative CT scan revealed an infarction in the middle cerebral artery area. A postoperative cerebral angiogram showed occlusion of a temporal branch of the right middle cerebral artery, P1 portion of the left posterior cerebral artery, and the right superior cerebellar artery. We speculated that high endotracheal pressure brought out pulmonary alveolar rupture, and in spite of supine position operation massive air, which flowed into systemic circulation from ruptured alveoli, caused cerebral infarction and cardiac arrest. We consider that unrecognized air embolism might be the one of the factors influencing the prognosis of severe subarachnoid hemorrhage, especially in the cases associated with neurogenic pulmonary edema.     

两种线栓法制作小鼠大脑中动脉栓塞模型的比较

目的通过颈总动脉和颈外动脉两种栓塞途径插入线栓在小鼠身上建立短暂性大脑中动脉栓塞（MCAO）模型，比较分析两种模型实验动物的术后存活率、行为学、梗死体积、脑水肿程度以及神经细胞凋亡情况，从而筛选出更为可行有效的脑梗死模型建立方法。 方法42只C57BL/6雄性小鼠，体质量20~22 g，按照随机数字表法分为假手术组（6只）、MCAO模型颈外动脉插线组（18只，颈外组）、MCAO模型颈总动脉插线组（18只，颈总组）。颈外组从颈外动脉剪口插入线栓栓塞大脑中动脉起始部制备小鼠大脑中动脉栓塞模型，颈总组从颈总动脉剪口插入线栓栓塞大脑中动脉起始部制备小鼠大脑中动脉栓塞模型，假手术组结扎与模型组同侧颈总动脉相同，但不插入线栓。颈外组和颈总组缺血1 h、假手术组颈总动脉结扎1 h，其后拔出线栓解除结扎，同时再灌注24 h，其后采用Longa神经功能评分，灌流取脑TTC染色，计算梗死体积并测出脑组织含水量，观察神经细胞凋亡情况，从而进行比较分析。 结果颈外组和颈总组小鼠均出现脑卒中表现、神经功能评分升高、出现脑水肿、有明显梗死体积以及神经细胞凋亡，假手术组未出现与之相对的明显表征。颈总组与颈外组相比，梗死体积和脑水肿程度接近，神经细胞凋亡数量基本一致，差异无统计学意义（P>0.05）；颈总组相对颈外组，神经功能评分较高，死亡率较高，差异具有统计学意义（P<0.05）。 结论两种栓塞途径所造成的脑梗死比较结果一致，但考虑到部分实验需要长期给药观察，颈外动脉栓塞途径实验动物存活率更高，所以推荐采用颈外动脉插线方法制作大脑中动脉栓塞模型。     

Local embolism from vertebral artery occlusion

Basilar artery territory stroke may result from embolism arising from the site of vertebral artery occlusion. This stroke mechanism (local embolism) has been well documented in the middle cerebral artery territory from extracranial internal carotid artery disease but not fully appreciated in the vertebral basilar circulation. We report two patients whose clinical presentation indicated major basilar artery territory infarction documented by angiography to be the result of vertebral artery occlusion and artery-to-artery embolism. Vertebral artery occlusion has often been associated with a benign course, but under certain circumstances embolism to the basilar artery may complicate the outcome.     

Autoradiographic determination of cerebral glucose content, blood flow, and glucose utilization in focal ischemia of the rat brain: influence of the plasma glucose concentration

Focal cerebral ischemia was produced by occlusion of the middle cerebral artery in rats. Cerebral blood flow measured with [14C]iodoantipyrine was severely reduced in the lateral portion of neostriatum. This area of dense ischemia was sharply demarcated against the surroundings. The adjacent cortex was perfused at one-third of normal, whereas blood flow in the medial neostriatum was only slightly reduced. This pattern of perfusion was independent of the plasma glucose concentration of the animal. In contrast, the glucose utilization calculated from the 2-[3H]deoxyglucose accumulation depended on the plasma glucose concentration. Enhanced glucose utilization was evident in the border areas surrounding the ischemic focus in normoglycemic animals. Neither acutely nor chronically diabetic animals had such an increase of metabolism in the borderzone. Moderately hyperglycemic rats had a narrow rim of enhanced glucose utilization immediately surrounding the ischemic core, whereas animals with plasma glucose values above 22 mmol/L had no such rim. In mild hypoglycemia (2-4 mmol/L), the glucose utilization was slightly enhanced in the border areas, but during severe hypoglycemia (less than 2.5 mmol/L), the glucose utilization declined gradually toward the ischemic core. Glucose content, and thereby the lumped constant (measured by 3-0-[14C]methylglucose) showed little regional variation, except in the ischemic core. These findings indicate that blood flow alterations after occlusion of the middle cerebral artery in rats are not influenced by the plasma glucose utilizations. In contrast, glucose utilization depends on a combination of plasma glucose concentration and blood flow instead of blood flow per se.     

Transcranial Doppler sonography monitoring of local intra-arterial thrombolysis in acute occlusion of the middle cerebral artery.

BACKGROUND AND PURPOSE: The aim of this study is to report on the use of transcranial Doppler ultrasonography as a noninvasive diagnostic monitoring tool during local intra-arterial thrombolysis in a patient with acute embolic occlusion of the middle cerebral artery. CASE DESCRIPTION: We describe a 41-year-old woman with mitral valve stenosis suffering from embolism of the middle cerebral artery. Local thrombolysis was performed with tissue plasminogen activator at a dosage of 0.05 mg/kg/hr. Progress of the thrombolysis was monitored by transcranial Doppler. The steps of recanalization could be ascertained by transcranial ultrasound showing a hemodynamically relevant residual stenosis after the first 120 minutes and complete patency of the M1 segment of the middle cerebral artery 180 minutes later. One branch of the middle cerebral artery still showed a filling defect. CONCLUSIONS: Our report demonstrates the potential usefulness of transcranial Doppler monitoring during thrombolysis of a proximal occlusion of the middle cerebral artery for guiding the treatment by assessing the reperfusion of the obstructed artery.     

Hypodense middle cerebral artery with fat embolus

A 44-year-old man developed a right middle cerebral artery territory stroke due to a large fat embolism after an aortic valve repair. We briefly review the phenomenon of fat embolism and discuss the salient radiographic (CT) finding in this case – a “hypodense artery sign.”     

Blunt traumatic dissection in common carotid artery with serial morphological changes detected by carotid ultrasonography in the acute phase]

A 68-year-old man was admitted to our hospital with left hemiparesis, unilateral spatial neglect, and anosognosia at nine hours after blunt neck trauma. Carotid ultrasonography and angiography revealed occlusion of the right common carotid artery. A second ultrasonographic examination detected a double lumen, intimal flap, and a movable thrombus at the occlusion site, with reversed flow in the external cerebral artery and antegrade flow in the internal cerebral artery. Magnetic resonance angiography showed occlusion of the M1 distal section of the right middle cerebral artery. We diagnosed dissection of the right common carotid artery and artery-to-artery embolism from the thrombus in the dissecting common carotid artery. We started anticoagulation on the second hospital day. The patient was able to walk independently at discharge. The finding of carotid dissection on ultrasonography varied during the acute phase. We observed a mural thrombus in the true lumen and vessel recanalization. Treated only by anticoagulants without surgical therapy, the patient had a good outcome without reattack or hyperperfusion syndrome.