从卒中到VD的动态CT分析

目的 :研究血管性痴呆 (VD)的发病机制。方法 :选择首次发病的卒中患者 16 7例 ,分别在首次发病、每次复发及 5年时进行动态头颅CT扫描及智能测定。按 5年时是否痴呆分为血管性痴呆组 (VD组 ,95例 )及无痴呆血管病组 (对照组 ,72例 )。将两组资料进行对比分析 ,并行统计学处理。结果 :1年时VD发生率为 31.73% ,2年5 0 .17% ,5年 5 6 .89% ,VD组发作次数多、病灶体积增大、病灶数目增多、病变部位由单侧→双侧、左侧病变增大、皮层下病变增大多见 ,脑萎缩相关指标提示皮质下萎缩明显 ,但白质疏松面积改变两组差别无显著性。结论 :血管性痴呆多发于卒中首次发病后 1～ 2年内 ,VD发生率与发作次数、病灶体积、病灶数目增加及病变部位改变 (如单侧→双侧 ,左侧病变扩大 ,丘脑或角回病变等 )最相关 ,其次为皮层下脑萎缩的快速发展 ,而白质疏松改变与VD关系较小。首次卒中后 2年内积极有效防治有助于减少VD的发生。

Study of Followup CT Scans from Stroke to Vascular Dementia

Objective: To study the pathogenesis of vascular dementia. Methods: Followup CT scans and IQ measurement in 167 first stroke patients had been performed for five years. All patients were devided into two groups VD group which included 95 cases who evolved vascular dementia (VD) and control group which included 72 stroke patients without dementia. The side, location, volume and amount changes of the lesions,the area of the white matter lesions (leuco araiosis) and the quanitative indexes of cerebral atrophy between the two groups were compared. Results: 56.89% of the patients evolved dementia and 50.17% of them occurred in two years after first onset. More lesions and larger volumes especially in subcortical lesions were observed in VD group. Most of the VD patients with unilateral lesions were changed to bilateral lesions. Subcortical cerebral atrophy was more serious in VD group. There was not significant difference statistically on leuco-araiosis area changes between the two groups. Conclusion: Vascular dementia after stroke occurs largely in two years after the first onset. The occurrence of VD correlates with the relapse of stroke,the lesion volume,amount and location changes from unilateral to bilateral or left lesion enlargement. Rapid subcortical cerebral atrophy is the secondary factor of VD development. Leuco araiosis seems to be not related to it. The effective treatment of stroke in two years after the first onset will be conducive to reduce the occurrence of VD.