出血型烟雾病患者72例的损伤模式

目的 探讨成年人出血型烟雾病(moyamoya disease,MMD)病灶分布模式.方法 从南京脑卒中注册系统中提取2004年1月至2010年2月间以出血事件为首发症状的成年人MMD住院患者72例.按出血原发部位的不同将患者分为4组:非丘脑性脑实质出血(脑叶和纹状体出血)、丘脑出血、原发脑室出血和自发蛛网膜下腔出血(subarachnoid hemorrhage,SAH).所有患者均行脑血管造影检查,根据造影结果 ,按改良的Morioka分级标准将出血侧脉络膜前动脉和后交通动脉(anterior choroidal artery and posterior communicating artery,AChA-PComA)分为3级:正常或轻度扩张、极度扩张和延长及未显影.分析出血病灶分布模式与AChA-PComA分级的关系.结果 在AChA-PComA正常或轻度扩张阶段,非丘脑性脑实质出血的比例最大(51.6%,16/31;Z=-3.266,P=0.001),且以纹状体出血最为常见(22.6%,7/31);在AChA-PComA极度扩张和延长阶段,脑室出血所占比例最大(58.8%,20/34;Z=-2.696,P=0.008);另外,后循环SAH同侧的AChA-PComA级别较前循环的高(Z=-4.655,P＜0.01);在AChA-PComA近端未显影阶段,后循环动脉瘤破裂相关的SAH是此阶段惟一的出血亚型(9.7%,7/72;x2=42.999,P＜0.01).结论 成年人出血型MMD脑卒中不同亚型与AChA-PComA形态有关,其造影显像特点可预测出血部位.

Abstract：

Objective To study the lesion patterns of hemorrhagic type of moyamoya disease (MMD) in adults. Methods Seventy-two consecutive cases of hemorrhagic type of MMD, confirmed by digital cerebral angiography in Jinling hospital between January 2004 and February 2010, were retrieved from the Nanjing Stroke Registry Program. MMD patients were classified according to the hemorrhagic sites into 4 types: non-thalamic parenchymal, thalamic, primary ventricular and subarachnoid. The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system: normal or mild to moderate dilation, severe dilation with abnormal extension and non-visualization. The relationship between lesion patterns and the angiographic findings was analyzed. Results In the stage of normal or mild to moderate dilation of AChA-PComA, non-thalamic parenchymal hemorrhage was the more frequent type (51.6%, 16/31 ;Z = -3.266,P =0.001 ), and there was a high incidence of intrastriatal hemorrhage occurred (22.6%, 7/31 ). In the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common ( 58.8%, 20/34 ;Z = -2.696 ,P =0.008). In addition, posterior circulation subarachnoid hemorrhage (SAH) was associated with a higher grade of AChA-PComA than anterior circulation SAH (Z = -4.655 ,P ＜ 0.01 ). Furthermore, posterior circulation SAH was the only type of SAH in the stage of non-visualization(9.7% ,7/72; x2 =42.999,P ＜0.01 ). Conclusion In adult patients with MMD, different subtypes of hemorrhagic stroke were associated with angiographic changes of AChA-PComA, and the angiographic characteristics may predict the location of hemorrhage.

Lesion patterns of 72 cases of hemorrhagic type of moyamoya disease

Objective To study the lesion patterns of hemorrhagic type of moyamoya disease (MMD) in adults. Methods Seventy-two consecutive cases of hemorrhagic type of MMD, confirmed by digital cerebral angiography in Jinling hospital between January 2004 and February 2010, were retrieved from the Nanjing Stroke Registry Program. MMD patients were classified according to the hemorrhagic sites into 4 types: non-thalamic parenchymal, thalamic, primary ventricular and subarachnoid. The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system: normal or mild to moderate dilation, severe dilation with abnormal extension and non-visualization. The relationship between lesion patterns and the angiographic findings was analyzed. Results In the stage of normal or mild to moderate dilation of AChA-PComA, non-thalamic parenchymal hemorrhage was the more frequent type (51.6%, 16/31 ;Z = -3.266,P =0.001 ), and there was a high incidence of intrastriatal hemorrhage occurred (22.6%, 7/31 ). In the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common ( 58.8%, 20/34 ;Z = -2.696 ,P =0.008). In addition, posterior circulation subarachnoid hemorrhage (SAH) was associated with a higher grade of AChA-PComA than anterior circulation SAH (Z = -4.655 ,P ＜ 0.01 ). Furthermore, posterior circulation SAH was the only type of SAH in the stage of non-visualization(9.7% ,7/72; x2 =42.999,P ＜0.01 ). Conclusion In adult patients with MMD, different subtypes of hemorrhagic stroke were associated with angiographic changes of AChA-PComA, and the angiographic characteristics may predict the location of hemorrhage.