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1.
目的 研究小脑各动脉梗死的临床表现及MRI、MRA(DSA)特征。方法 对我院2001年6月1日~2003年5月31日2年间经MRI确诊的45例小脑梗死患进行临床及MRI观察。结果 小脑梗死占同期急性脑梗死的7.1%。主要危险因素为高血压、糖尿病、高脂血症、冠心病。88.9%首发头晕,11.1%首发意识障碍,82.2%急性起病,17.8%进展性起病,进展病程5~14天。可伴有颅神经受累等脑干损害。大部分小脑梗死患预后尚好。结论 应提高对小脑梗死临床表现及小脑各动脉灌注区MRI特征的认识,起源动脉(如椎动脉或基底动脉)粥样斑块延伸,或分支区域低灌注可能是引起后循环多条动脉灌流区梗死的主要原因。  相似文献   

2.
目的 探讨不同部位后循环梗死的临床特点.方法 根据MRI所示的梗死部位,将170例后循环梗死患者分为近段组(20例)、中段组(70例)、远段组(58例)和混合组(22例);分析各组的临床表现特点.结果 近段组最常见临床表现为恶心呕吐(70.0%)、眩晕(60.0%)、共济失调( 70.0%)和眼震(70.0%);中段组为言语不清(71.4%)、偏身肢体无力(77.1%)、偏身运动障碍(74.3%)和中枢性面舌瘫(77.1%);远段组为头晕头昏(48.3%)和偏身感觉障碍(48.3%);混合组为言语不清(63.6%)、恶心呕吐(63.6%)、偏身感觉障碍(54.5%)和共济失调(63.6%).交叉性损害及脑干综合征19例(11.2%).结论 后循环梗死最常累及中段和远段;不同部位梗死的常见临床表现不同;具有定位价值的交叉性损害及脑干综合征发生率低.  相似文献   

3.
脑梗死急性期伴发抑郁的临床分析   总被引:3,自引:0,他引:3  
目的 探讨脑梗死急性期伴发抑郁的发病率,与脑梗死部位的关系及治疗效果。方法 选择我科2001年1—12月脑梗死急性期住院患190例,对伴发抑郁的发病率,与脑梗死部位的关系及治疗效果进行分析。结果 伴发抑郁62例(发生率32.6%),其中大脑皮质梗死抑郁发生率(44.4%)较皮质下梗死抑郁发生率(29.5%)、小脑梗死抑郁发生率(14.3%)为高,且左半球梗死抑郁发生率(42.2%)较右半球梗死抑郁发生率(25.6%)高,其判别均有显性意义(P<0.01)。但早期诊断及时治疗,效果较好。结论 脑梗死急性期抑郁发生率较高,又与脑梗死部位有关,但早期对其诊治,预后较好。  相似文献   

4.
目的探讨不同病灶部位的影像学特征对进展性脑梗死的预测作用。方法收集2010年1月至2014年6月在合肥市第三人民医院神经内科住院的脑梗死患者,所有患者经头颅磁共振明确病灶部位,影像学分型分为:前循环皮质、基底节、放射冠和后循环梗死;再根据病情有无进展分为非进展性和进展性脑梗死。比较各影像学亚型脑梗死在非进展性和进展性脑梗死组间的分布差异,并分析梗死亚型与是否进展的相关性分析,然后进一步回归分析进展性脑梗死的危险因素。结果共150例患者入选,其中非进展性脑梗死99例,进展性脑梗死51例;其影像学分型中,发生在皮质为46例,放射冠25例,基底节47例,后循环32例。不同影像学亚型脑梗死在非进展性和进展性脑梗死组间分布存在显著差异(χ2=19.239,P=0.001),其中,进展性脑梗死发生在前循环皮质的几率显著高于非进展性脑梗死;前循环皮质梗死与是否进展性间的相关性分析,其R和P值分别为0.170、和0.026;进展性脑梗死危险因素的Logistic回归分析显示,梗死的影像学亚型与其有关(P=0.002),表现为前循环皮质梗死发生梗死进展的可能性较其它亚型显著增加,即使经年龄、血糖等相关因素校正后,此种趋势依然存在(P=0.014)。结论梗死部位与其是否进展密切相关,发生在前循环皮质的患者更容易出现病情进展。  相似文献   

5.
目的:探讨脑CT在急性进展性脑梗死(APCI)变化特点,为临床早期诊断和治疗提供客观依据。方法:对103例发病2.5~24小时、急性脑梗死患者进行前瞻性研究,其中APCI患者32例,分析脑CT早期变化特点,并与71例非进展性脑梗死进行对比。结果:103例患者,70例脑CT出现异常(68.0%),其中进展组27例(84.4%)出现脑梗死早期表现,明显高于非进展组(43例,60.6%)。进展组患者病情进展至高峰时,脑CT显示,16例(50%)出现梗死体积增大,5例(15.6%)有出血性梗死,3例(9.4%)有新部位的梗死,8例(25%)梗死体积无明显变化。结论:脑CT可作为早期诊断APCI的预测指标,导致神经功能恶化的直接原因可能与梗死体积增大、出血性脑梗死和再梗死有关。  相似文献   

6.
目的研究后循环脑梗死的影像学表现、病因、危险因素、临床表现、责任病灶及预后的特点。方法收集自2007年9月至2010年3月在我院住院治疗的53例后循环脑梗死病例的临床资料,总结患者的临床症状和体征,分析其影像学表现、病因和危险因素,根据Caplan使用的后循环供血区分段标准,将患者分为近段组、中段组、远段组、混合组四组。所有患者的预后均进行改良Rankin残障量表(mRs)评估,了解患者的预后情况。结果后循环梗死最常见的症状为眩晕28例(52.8%),恶心、呕吐23例(43.4%),肢体瘫痪21例(39.6%),言语不利17例(32.1%);最常见的体征是中枢性面舌瘫31例(58.5%),运动障碍21例(39.6%),感觉障碍17例(32.1%)及共济失调15例(28.3%);最常见的危险因素包括高血压、糖尿病、吸烟、饮酒、心脏病变、脂代谢异常。其中中段组发病率最高21例(39.6%),其次为远段组13例(24.5%),混合组10例(18.9%),近段组9例(17.0%)。根据mRS评估,34.0%的患者预后不良。结论后循环梗死的临床表现复杂多变,最常见的病变部位在中段,特征性临床表现和临床综合征有助于后循环脑梗死的诊断,大部分患者预后良好。  相似文献   

7.
外伤性脑梗死42例临床分析   总被引:1,自引:0,他引:1  
目的总结分析外伤性脑梗死的临床特点。方法探讨本文42例外伤性脑梗死的病史、临床症状和体征、好发部位和类型、发病机制及治疗。结果本文42例外伤性脑梗死的主要临床表现为迟发性的不同程度的瘫痪、语言障碍、意识障碍,梗死病灶位于基底节区37例(88.1%),腔隙性梗死27例(64.3%)。结论此病是外伤后才出现临床表现,好发于基底节区,以腔隙性梗死居多,发病机制主要是脑血管损伤所导致血栓、痉挛、狭窄而引起缺血水肿。  相似文献   

8.
正探讨普通肝素微量持续泵入对进展性脑梗死患者神经功能缺损程度的改善作用,现报告如下。1资料与方法1.1一般资料选取我院2012-11—2014-11收治的进展性脑梗死患者87例,均符合相关诊断标准。随机将其分为对照组(39例)和观察组(48例),对照组男28例,女11例,年龄42~61岁,平均(54.10±5.42)岁;前循环梗死19例,大血管梗死10例,小血管梗死7例,后循环梗死3例。观察组  相似文献   

9.
目的 总结分析外伤性脑梗死的临床特点。方法探讨本文42例外伤性脑梗死的病史、临床症状和体征、好发部位和类型、发病机制及治疗。结果本文42例外伤性脑梗死的主要临床表现为迟发性的不同程度的瘫痪、语言障碍、意识障碍,梗死病灶位于基底节区37例(88.1%),腔隙性梗死27例(64.3%)。结论 此病是外伤后才出现临床表现,好发于基底节区,以腔隙性梗死居多,发病机制主要是脑血管损伤所导致血栓、痉挛、狭窄而引起缺血水肿。  相似文献   

10.
目的观察以双耳听力下降为首发症状的脑梗死患者,探讨其病灶分布特点及血管形态异常之间的关系。方法对3例以双耳听力下降为首发症状的脑梗死患者行头MR(包括T1WI、T2WI、DWI、MRA)、TCD、BAEP检查。结果 3例患者均为后循环多灶性梗死,最常累及的部位是小脑、脑桥,均有双侧椎动脉或基底动脉起始段严重狭窄或闭塞,双侧内听动脉均受累。结论以双耳听力下降为首发症状的脑梗死均符合多灶性后循环缺血的特点,血管形态异常是其重要病理基础和致病因素,预后差。  相似文献   

11.
Multiple acute infarcts in the posterior circulation.   总被引:7,自引:0,他引:7       下载免费PDF全文
OBJECTIVE--to evaluate clinical, radiological, and prognostic features of patients with multiple acute infarcts in remote arterial territories of the posterior circulation. DESIGN--Data analysis from a prospective acute stroke registry in a community based primary care centre using a standard protocol including MRI and MRA. RESULTS--In three and a half years, 27 of the 236 patients (11%) with posterior circulation stroke had multiple acute infarcts in the posterior circulation as shown by gadolinium enhancement on MRI. Eighteen patients had multiple infratentorial and supratentorial infarcts including the cerebellum and posterior cerebral artery territory, with coexisting brainstem involvement in seven patients. Fourteen patients had a rostral basilar artery syndrome and cerebellar signs; four patients had a visual field defect with cerebellar signs. Causes were vertebral (six) or basilar (four) artery atheromatosis, and cardioembolism (four). Seven patients had multiple acute infarcts in the posterior circulation of the cerebellum and lower brainstem. Brainstem and cerebellar signs were found in most patients (five); aetiologies were small vessel disease (four), cardioembolism (one), and vertebral artery dissection (one). Two patients with large artery atheromatosis had multiple acute infarcts in the posterior circulation in the brainstem and posterior cerebral artery territory. One month after stroke more than 25% of the patients were dependent or had died. There was no difference in the outcome between the three groups, and recovery was linked to the size of infarcts rather than to a high number of infarcts. CONCLUSIONS--multiple acute infarcts in the posterior circulation usually involve the cerebellum. Simultaneous brainstem and posterior cerebral artery territory infarcts sparing the cerebellum are uncommon. They can be suspected clinically before neuroimaging, mainly when supratentorial and infratentorial infarcts coexist. This may be important, because different patterns of infarction are associated with different causes of stroke.  相似文献   

12.
目的 观察多灶性后循环缺血患者的病灶分布和血管形态异常的特点,评估患者出院时的近期预后及其与病灶分布和血管形态的关系.方法 对34例经过MR/所证实的多灶性后循环缺血患者行主动脉弓及全脑血管DSA,全面分析病灶分布及血管形态异常的特点;同时对患者出院时的近期预后用改良Rankin分级(MRS)评分表进行评估,分析病灶分布及血管形态异常与近期预后的关系.结果 多灶性后循环缺血患者最常被累及的部位是脑桥(22例),最常被累及的区段是中段+远段(12例);34例患者中有26例(76.5%)DSA显示出血管形态异常,最常被累及的动脉是椎动脉起始段(14例)和颅内段(13例)及基底动脉(7例);出院时7例患者(20.6%)存在预后不良,其中6例(17.6%)为重度残疾,1例(2.9%)死亡.近中远段同时受累和基底动脉受累的患者表现出预后不良.结论 血管形态异常是多灶性后循环缺血的重要病理基础和致病因素,病灶区段的分布和数目及血管受累部位是决定预后的关键因素.  相似文献   

13.
Patients with a lacunar stroke syndrome may have cortical infarcts on brain imaging rather than lacunar infarcts, and patients with the clinical features of a small cortical stroke (partial anterior circulation syndrome, PACS) may have lacunar infarcts on imaging. The aim was to compare risk factors and outcome in lacunar syndrome (LACS) with cortical infarct, LACS with lacunar infarct, PACS with cortical infarct, and PACS with lacunar infarct to determine whether the clinical syndrome should be modified according to brain imaging. As part of a hospital stroke registry, patients with first ever stroke from 1990 to 1998 were assessed by a stroke physician who assigned a clinical classification using clinical features only. A neuroradiologist classified recent clinically relevant infarcts on brain imaging as cortical, posterior cerebral artery territory or lacunar. Of 1772 first ever strokes, there were 637 patients with PACS and 377 patients with LACS who had CT or MRI. Recent infarcts were seen in 395 PACS and 180 LACS. Atrial fibrillation was more common in PACS with cortical than lacunar infarcts (OR 2.3, 95% confidence interval (95% CI) 0.9-5.5), and in LACS with cortical than lacunar infarcts (OR 3.9, 1.2-12). Severe ipsilateral carotid stenosis or occlusion was more common in PACS with cortical than lacunar infarcts (OR 3.5, 1.3-9.5); and in LACS with cortical than lacunar infarcts (OR 3.7, 1.1-12). In conclusion, patients with cortical infarcts are more likely to have severe ipsilateral carotid stenosis or atrial fibrillation than those with lacunar infarcts irrespective of the presenting clinical syndrome. Brain imaging should modify the clinical classification and influence patient investigation.  相似文献   

14.
Headache in transient or permanent cerebral ischemia. Dutch TIA Study Group   总被引:2,自引:0,他引:2  
We studied headache features in 3,126 patients with acute cerebral or retinal ischemia. Headache occurred in 18% of these patients (in 16% of all patients with transient ischemic attacks, in 18% of patients with reversible ischemic neurologic deficits, and in 19% of patients with minor strokes) and was mostly continuous in all types of attacks. Headache was present in 16% of patients with monocular visual symptoms. The occurrence of headache was not related to the mode of onset, mode of disappearance, or duration of the attack. Patients with headache more often were known to have heart disease. Headache was less frequent in patients with small deep infarcts, who were more often hypertensive, and in patients with infarcts in the anterior circulation; headache was more frequent in patients with cortical infarcts and in patients with infarcts in the posterior circulation. Patients with a relevant small deep infarct on computed tomographic scan and accompanying headache relatively often reported symptoms compatible with cortical ischemia, such as language disorders or a visual field defect. We conclude that headache is a frequent accompanying symptom in patients with acute cerebral and retinal ischemia and that the occurrence of headache is partly related to the underlying cause of the ischemic lesion.  相似文献   

15.
Ischemic stroke occurring after coronary artery bypass grafting (CABG) has been attributed to various factors. Little is known about the perioperative course and radiological topography of CABG-associated strokes. In this study the clinical and computed tomography features of 25 patients with ischemic stroke following coronary artery bypass grafting were evaluated. Four patients awakened with focal signs, and 21 developed an ischemic stroke 1 to 22 days after surgery. All 4 patients with early stroke had prolonged episodes of operative hypotension. Three of these patients had multiple subcortical and cortical infarcts. Of the 21 patients with late-onset ischemic stroke, 19 had single-territory infarcts (middle cerebral artery territory, N = 12; posterior cerebral artery territory, N = 4; anterior cerebral artery territory, N = 3). Two patients had multiple territory infarcts in the anterior and posterior circulation. No watershed infarcts were found in any of the 25 patients. New-onset atrial fibrillation and location of ischemic stroke in a single vascular territory were more common in patients who had an ischemic stroke after an asymptomatic interval. Duplex sonographic findings of the carotid arteries and oculoplethysmography (OPG) were available for 13 patients. Only 1 patient had an ipsilateral carotid stenosis. Of 21 patients who underwent postoperative two-dimensional echocardiography (with additional transesophageal echocardiography in 4), 2 had a left ventricular thrombus. These findings support the concept that post-CABG stroke is likely embolic.  相似文献   

16.
目的通过全脑血管造影(DSA)观察后循环脑梗死患者的供血动脉形态学特点,根据供血动脉异常情况制定治疗方案,评估其预后与供血动脉异常的关系。方法对128例经头颅MRI检查诊断为后循环脑梗死的患者行DSA检查,全面分析其供血动脉形态学特点,同时针对DSA结果制定治疗方案,选择单纯药物治疗103例(其中重度供血动脉狭窄放弃支架治疗7例),药物+支架成形术治疗25例,随访1年对其预后进行分析。结果 DSA示椎-基底动脉系统供血动脉异常者60.9%,46例患者病后1年预后不良(35.9%),其中死亡20例(15.6%),严重残障26例(20.3%)。对于重度供血动脉狭窄进行支架成形术治疗及DSA发现有明显代偿者预后良好;7例重度供血动脉狭窄(椎动脉3例、基底动脉4例)放弃支架治疗者复发后循环脑梗死6例,其中3例死亡,3例重度残疾。结论供血动脉形态学异常是后循环脑梗死的重要病理基础,与患者的预后明显相关,DSA是评价脑供血动脉异常的金标准,对于后循环脑梗死可以采取药物治疗,对于重度供血动脉狭窄积极采取药物+支架成形术治疗可以取得明显疗效,通过DSA检查发现脑供血动脉代偿良好者预后良好。  相似文献   

17.
Multiple large and small cerebellar infarcts   总被引:2,自引:0,他引:2       下载免费PDF全文
To assess the clinical, topographical, and aetiological features of multiple cerebellar infarcts,18 patients (16.5% of patients with cerebellar infarction) were collected from a prospective acute stroke registry, using a standard investigation protocol including MRI and magnetic resonance angiography. Infarcts in the posterior inferior cerebellar artery (PICA)+superior cerebellar artery (SCA) territory were most common (9/18; 50%), followed by PICA+anterior inferior cerebellar artery (AICA)+SCA territory infarcts (6/18; 33%). One patient had bilateral AICA infarcts. No infarct involved the PICA+AICA combined territory. Other infarcts in the posterior circulation were present in half of the patients and the clinical presentation largely depended on them. Large artery disease was the main aetiology. Our findings emphasised the common occurrence of very small multiple cerebellar infarcts (<2 cm diameter).These very small multiple cerebellar infarcts may occur with (13 patients/18; 72%) or without (3/18; 22%) territorial cerebellar infarcts. Unlike previous series, they could not all be considered junctional infarcts (between two main cerebellar artery territories: 51/91), but also small territorial infarcts (40/91). It is suggested that these very small territorial infarcts may be endzone infarcts, due to the involvement of small distal arterial branches. It is possible that some very small territorial infarcts may be due to a microembolic process, but this hypothesis needs pathological confirmation.  相似文献   

18.
BACKGROUND: Stroke due to internal carotid artery dissection is considered to have a good prognosis. OBJECTIVE: To determine whether the prognosis of internal carotid artery dissection is worse than classically reported by comparing the characteristics of patients who had an acute ischemic stroke admitted to a population-based primary care center with internal carotid artery occlusion due to either dissection (DO) or atherothrombosis (AO). PATIENTS AND METHODS: Among 3502 patients admitted to our population-based primary care center, DO (n = 73) was diagnosed by angiography or magnetic resonance imaging, while AO (n = 81) was diagnosed by angiography. The characteristics of patients with DO or AO were compared using univariate and multivariate analysis. RESULTS: Patients with DO were younger (mean [SD] age, 44.6 [10] vs. 60.1 [10] years, P<.001), had fewer vascular risk factors, and presented more frequently with global middle cerebral artery territory involvement (42% vs. 17%, P<.05) and less frequently with watershed infarcts (3% vs. 19%, P<.05) than patients with AO. Unexpectedly, patients with DO were noted to have more severe clinical impairment, with an increased frequency of decreased consciousness, and a poorer outcome at 1 month. Multivariate analysis showed that the independent factors associated with DO were age younger than 55 years, nonsmoker, no history of hypertension, headache at presentation, and global aphasia. CONCLUSIONS: Patients with DO are younger and are initially seen with fewer risk factors than patients with AO, but their clinical features and prognosis are worse. Large infarcts involving the whole middle cerebral artery territory that may be due to the lack of collateral circulation are responsible for the bad prognosis of patients with DO.  相似文献   

19.
Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years.  相似文献   

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