动脉硬化性大脑中动脉狭窄或闭塞所致脑梗死类型

目的探讨动脉硬化性大脑中动脉狭窄或闭塞性疾病(MCAOD)所致脑梗死的类型。方法对50例经颅脑MRA或DSA确诊的症状性MCAOD患者进行研究,依据其头部弥散加权成像(DWI)和T2W的改变对脑梗死分型。结果50例患者共发现57条动脉硬化性大脑中动脉狭窄或闭塞,未发现病灶的有6(占12．0%)个大脑半球,多发性脑梗死和单发脑梗死分别见于13(占22．8%)个和38(占66．7%)个大脑半球。脑分水岭梗死、流域性脑梗死、半卵圆区脑梗死、多发性散在点状脑梗死(MSSI)、腔隙性脑梗死分别见于18(占31．6%)个、12(占21．1%)个、6(占10．5%)个、2(占3．5%)个和1(占1．8%)个大脑半球。结论MCAOD可引起各种类型的脑梗死,脑分水岭梗死约占1/3,动脉粥样硬化性血栓形成约占1/5,纹状体内囊梗死约占1/5,主要发病机制与动脉-动脉栓塞和低灌注有关。     

基底节区腔隙与非腔隙性脑梗死的颅内动脉造影及危险因素对比分析

目的:通过脑血管造影,分析基底节区腔隙与非腔隙性脑梗死患者的血管狭窄的比例与部位分布。方法:选择首次发病6小时内拟行动脉内溶栓治疗,并行脑磁共振(MRI)检查为基底节区脑梗死患者51例,依脑梗死的面积大小将患者分为腔隙梗死组(12例)和非腔隙梗死组(39例)。比较分析两组患者数字减影脑血管造影(DSA)结果及危险因素。结果:DSA结果显示:腔隙梗死组DSA检查未见明显异常9例,大脑中动脉(MCA)M1段狭窄2例(占16.7%),颈内动脉(ICA)颅外段狭窄1例(占8.3%)。非腔隙梗死组39例DSA检查均异常,共检出病变血管41支,血管病变部位为大脑中动脉M1段(53.6%)>颈内动脉颅内段(26.8%)>颈内动脉颅外段(17%)>大脑前动脉(2.4%)。非腔隙脑梗死组血管狭窄比例明显高于腔隙脑梗死组(p<0.05)。危险因素比较:腔隙和非腔隙脑梗死患者中患高血压比例均高于其它危险因素(91.7%,74.4%),但两组间比较无明显差异(p>0.05),比较两组间其它危险因素亦无明显差别(p>0.05)。结论:基底节区腔隙梗死患者DSA检查仅少数存在血管狭窄,多数无明确血管损害,梗死原因主要由小动脉病变引起;而非腔隙梗死患者绝大多数DSA有明确血管病变,大脑中动脉M1段是血管病变的主要部位。     

196例急性脑梗死DWI与MRA分析

目的探讨急性脑梗死的临床表现与DWI(磁共振扩散加权成像)、MRA(磁共振血管成像)之间的相关性。方法对196例急性脑梗死患者行DWI和MRA检查,对其影像学特征进行分析。结果196例患者在DWI病灶均显示为高信号。MRA显示:142例患者发现颅内大动脉狭窄或闭塞,狭窄的动脉分布为大脑中动脉、大脑后动脉、大脑前动脉、三级分支动脉、基底动脉、椎动脉、颈内动脉颅内段。48例腔隙性脑梗死发现血管狭窄或闭塞,且有16例发展成进展性脑梗死,34例腔隙性脑梗死在MRA上未见明显血管狭窄和闭塞,仅1例发生进展性脑梗死。结论急性脑梗死DWI检出阳性率100%,MRA检查最常受累的是大脑中动脉。腔隙性脑梗死病灶所处解剖区的供血大动脉易发生狭窄,且容易出现进展性卒中。     

大脑中脑动脉供血区急性脑梗死病灶类型与进展性脑梗死的关系

目的 探讨大脑中动脉供血区急性脑梗死病灶类型及其与进展性脑梗死的关系.方法 回顾性分析140例大脑中动脉供血区急性脑梗死患者病历资料及脑MRI、DWI、MRA影像资料,其中进展组71例,非进展组69例.结果 2组脑梗死类型均可见流域性脑梗死、分水岭脑梗死、纹状体内囊梗死、腔隙性梗死,进展组以分水岭脑梗死(45.1%)、纹状体内囊梗死(46.5%)为主,非进展组以流域性脑梗死(44.9%)为主,2组脑梗死病灶类型比较,差异有统计学意义(χ2=24.829,P<0.01).结论 大脑中动脉供血区急性分水岭脑梗死、纹状体内囊梗死易表现为进展性脑梗死.     

116例大脑中动脉病变患者脑梗死类型分布和脑灌注异常分析

目的 应用神经影像检查,分析大脑中动脉闭塞性疾病(MCAOD)患者梗死类型分布和脑灌注异常. 方法 对经CT血管造影(CTA)证实的116例MCAOD患者的CT平扫、CT灌注成像(CTP)和CTA的影像资料进行回顾性分析,确定其脑梗死类型分布和脑灌注改变. 结果 116例患者中,CTA共检出133条大脑中动脉(MCA)狭窄或闭塞,其中单侧者99例,双侧者17例.其中MCA闭塞25条,重度狭窄39条,中、轻度狭窄69条.CT或MRI显示腔隙性脑梗死(LIS)45例,各型分水岭脑梗死(CWSI)38例,流域性脑梗死26例,纹状体内囊梗死(SCI)10例,未检出梗死病灶14例.CTP显示MCA供血区内脑血流灌注异常96例,其中58例有MCA供血区的大范围血流灌注减低.未检出血流灌注异常者37例. 结论 由于MCA狭窄的部位、程度和发病机制的不同以及侧支循环的建立,MCAOD可造成不同类型的脑梗死和血流灌注异常.     

大脑中动脉粥样硬化性狭窄患者卒中类型分析

目的研究大脑中动脉粥样硬化性狭窄或闭塞(MCAOD)患者的卒中类型及其发病机制。方法经TCD和(或)MRA确诊的症状性MCAOD的患者,依据头部弥散加权核磁成像(DWI)所示梗死灶的特点进行分类,并与MCA狭窄程度进行相关性分析。结果84例症状性MCAOD患者中,73.8%的患者表现为多发性脑梗死,主要累及内交界区(53.6%)、半卵圆中心(29.1%)和皮层(22.6%)。皮层区域内梗死、交界区梗死、深部小梗死灶的发生率分别为46.4%、56.0%和44.0%,以多发小灶性梗死为主,很少引起MCA主干支完全梗死。且皮层支完全梗死、半卵圆中心梗死与严重MCA狭窄有关,而腔隙样梗死多见于轻度MCAOD患者。结论MCAOD患者可表现为各种梗死类型,以交界区梗死最常见,且多发性脑梗死为MCAOD患者最常见的表现类型,主要累及皮层下白质等部位,病灶以链型或弧线型分布为特点,动脉-动脉栓塞为其发病机制之一;深部小梗死多为孤立病灶,与MCA主干粥样硬化斑继发的血栓堵塞豆纹动脉入口有关。     

急性分水岭区脑梗死-凸面蛛网膜下腔出血三例

目的探讨颈动脉颅内或颅外段狭窄或闭塞导致后分水岭区凸面蛛网膜下腔出血(cSAH)与前循环急性脑梗死(ACI)的发病机制、影像学特征及治疗,以提高对该类型卒中的认识。方法报道3例颈动脉颅内或颅外段狭窄或闭塞导致cSAH患者的临床表现、CT和MRI所见及治疗。结果 3例患者临床表现以局灶性神经功能损害为主,且均存在动脉粥样硬化的危险因素,头颅CT显示病变对侧大脑皮质沟高密度影,并出现新发梗死灶。MRA证实例1病变侧颈动脉颅内及颅外段狭窄,例2病变侧大脑中动脉闭塞,例3病变侧颈动脉颅内段狭窄。结论颈动脉颅内或颅外段狭窄或闭塞导致的急性分水岭区ACI可以cSAH为首发表现。     

基于MRI和DSA的ICA、MCA狭窄或闭塞患者发生不同供血区脑梗死的对比分析

目的 探讨颈内动脉(ICA)、大脑中动脉(MCA)狭窄或闭塞引发脑梗死的部位及特点。方法 选取2013年1月～2016年2月本院诊治的98例经头颅磁共振加权成像(DWI)和数字减影血管造影(DSA)确诊的ICA或MCA狭窄或闭塞引发脑梗死患者进行回顾性研究,根据患者起病1周内的DWI确诊梗死部位,对比ICA和MCA狭窄或闭塞引发脑梗死的部位和特点。结果 ICA组患者的完全性前循环脑梗死率(36.00%)显著高于MCA组的12.50%(P<0.05); ICA组的腔隙性脑梗死发生率(26.00%)显著低于MCA组的52.08%(P<0.05); ICA组和MCA组患者的PI、PAI、LTI供血区脑梗死发生率无明显差异(P>0.05); MCA组患者的BZI供血区脑梗死发生率(62.50%)显著高于ICA组的26.00%(P<0.05); ICA组患者的单发性脑梗死发生率(70.00%)显著高于MCA组患者的(47.92%)(P<0.05)。结论 ICA狭窄以单发性脑梗死多见,MCA以多发性脑梗死多见,MCA狭窄或闭塞患者的分水岭梗死发生率高于ICA狭窄或闭塞患者。     

大脑中动脉区梗死的DWI特点及与其供血动脉狭窄的关系

目的 探讨大脑中动脉(MCA)区脑梗死磁共振扩散加权成像(DWI)成像病灶分布特点及与其供血动脉狭窄程度的关系.方法 回顾性的分析经颅脑磁共振成像(MRI)的DWI序列诊断的急性脑梗死,选择病灶位于MCA分布区,且完善其供血动脉检查,包括头颈部CTA,或颅脑MRA加颈部血管超声的患者108例,排除心源性栓塞、特殊血管病变导致的脑梗死.将梗死按照部位分为腔隙型梗死(SSSI)、皮层下梗死(SI)和混合型梗死(MI),供血动脉分为正常、轻度(50％)、重度(50％)和闭塞.比较不同类型梗死组的供血动脉狭窄的发生率.结果 各种梗死类型的发生率之间差异无统计学意义(x2=1.08,P＞0.05).单纯MCA病变者53例(53/108,49.1％),单纯ICA病变者28例(28/108,25.9％),单纯MCA病变高于单纯ICA病变(x2=12.35,P＜0.01).同侧血管正常者以LI类型的梗死多见,而单纯ICA病变者以MI类型的梗死多见(x2=10.22;10.54,P＜0.01);三种梗死类型在单纯MCA病变患者中差异无统计学意义(x2=0.25,P＞0.05);在单纯MCA病变者中,SI梗死类型多见于MCA闭塞患者(x2=7.45,P＜0.05).LI梗死类型多见于MCA轻度或重度狭窄患者(x2=6.39,P＜0.05).结论 结合DWI和相应血管检查对于明确MCA区动脉粥样硬化性脑梗死的病因和机制有一定帮助.基底节区的腔隙梗死,相应血管检查正常提示小血管病的可能大;MCA存在一定狭窄则可能是穿支受累造成;ICA病变多累及皮层,包括皮层型分水岭区梗死;而不同程度的MCA病变其梗死形态没有本质区别,皮层下梗死更多见MCA闭塞患者.     

基于CISS分型的急性脑梗死患者临床与影像学研究

目的使用中国缺血性卒中亚型(Chinese ischemic stroke subclassification,CISS)对急性脑梗死(acute cerebralinfarction,ACI)患者进行分型,分析急性脑梗死的临床与影像学特点。方法回顾性分析123例缺血性脑卒中患者的影像学资料,依据CISS对其进行分型,包括对LAA亚型发病机制的分析。观察有无脑供血动脉的狭窄,狭窄的位置、程度,并对比分析进展性卒中和非进展性卒中的影像学特点。结果 123例缺血性脑卒中患者中59例(47.97%)存在LAA,其中颈内动脉狭窄14例(11.38%),大脑中动脉狭窄29例(23.58%),基底动脉狭窄9例(7.32%);55例(44.72%)出现卒中进展。进展性卒中与非进展性卒中相比,大脑中动脉狭窄、基底动脉狭窄的差异有统计学意义(P<0.01)。进展性卒中组人群的分水岭脑梗死、大动脉狭窄或闭塞发生率显著高于非进展卒中组人群(P<0.001)。结论大动脉狭窄是急性脑梗死的原因之一,分水岭脑梗死或许可以成为进展性卒中的预测指标之一。     

磁共振对颈内动脉狭窄与闭塞患者卒中解剖模式诊断价值的初步探讨

摘要】 目的 研究单侧动脉粥样硬化性颈内动脉狭窄与闭塞的急性缺血性卒中患者在磁共振上的病灶模式,探讨颈内动脉病变引起卒中的发病机制。 方法 利用数字减影脑血管造影定位动脉粥样硬化性颈内动脉重度狭窄（≥70%）或闭塞而无同侧大脑中动脉闭塞性病变。利用常规磁共振成像（magnetic resonance imaging,MRI）和液体衰减翻转恢复（fluid-attenuated inversion recovery,FLAIR）序列研究颈内动脉闭塞性病变引起缺血性卒中的形态学表现。有潜在心源性栓子患者除外。 结果 94例患者中,颈内动脉重度狭窄（≥70%）45例,颈内动脉闭塞49例。磁共振上缺血病灶的局部解剖模式分为4种：区域梗死、皮质下梗死、边缘带梗死、弥散小梗死。颈内动脉闭塞组中区域梗死的发生率较颈内动脉狭窄组高（47% vs 22%;P<0.05）;颈内动脉狭窄组中边缘带梗死的发生率较颈内动脉闭塞组高（42% vs 22%;P<0.05)。 结论 动脉粥样硬化性颈内动脉闭塞患者多见于区域梗死,而颈内动脉重度狭窄（≥70%）患者多见于边缘带梗死。     

Cause of cerebral infarction in the carotid territory. Its relation to the size and the location of the infarct and to the underlying vascular lesion

Seventy-three patients with acute nonhemorrhagic stroke in the carotid territory were investigated for the cause of the stroke: middle cerebral artery (MCA) occlusion/stenosis or internal carotid artery (ICA) occlusion/stenosis; embolus from the heart and extra-cranial arteries or thrombosis. The study is prospective and consecutive comprising stroke patients below the age of 75 years, admitted in the acute state i.e. within 3 days after stroke onset. Excluded were patients with intracerebral hematoma, subarachnoid hemorrhage, vertebrobasilar stroke and patients in whom another severe disease was present. Cerebral angiography and CT-scan were performed in all patients within one and two days after admission. CT-scan was repeated 2 weeks and 6 months later. Forty percent had MCA occlusion, none had MCA stenosis, 12% had ICA occlusion, 14% had severe ICA stenosis (half of these were associated with MCA occlusion) and 41% were without significant MCA/ICA lesions. Twenty-seven percent had large infarcts with a diameter greater than 3 cm; 34% had medium-sized infarcts with a diameter between 3 and 1.5 cm; 21% had small infarcts with a diameter less than 1.5 cm; 18% had no identifiable infarct on CT-scan. MCA occlusion was responsible for 62% of the large or medium-sized infarcts. ICA occlusion or severe ICA stenosis were responsible for only 27% of the large or medium-sized infarcts. Only 11% of the patients with small or no infarct on CT-scan had significant MCA/ICA lesion.(ABSTRACT TRUNCATED AT 250 WORDS)     

颈内和大脑中动脉狭窄与闭塞的梗死类型及卒中机制的研究

目的 研究单侧动脉粥样硬化性MCA/ICA狭窄与闭塞的急性缺血性脑卒中患者在DWI上的梗死类型及发病机制.方法 起病48h内DWI诊断的急性脑梗死伴有动脉粥样硬化性MCA/ICA狭窄与闭塞的131例患者,有潜在心源性栓子患者除外.急性期DWI上梗死病灶分为：（1）单发病灶（小的穿动脉梗死灶;大的穿动脉梗死灶,皮层支梗死,大面积梗死,分水岭梗死）;（2）多发梗死病灶.结果 131例患者,ICA51例,MCA80例.ICA出现最多的梗死类型：穿支动脉伴分水岭梗死,但与MCA比较,皮层支伴分水岭梗死具有统计学意义（8/51,P=0.001）.MCA以穿支动脉伴皮层支梗死最多,且与ICA比较,具有统计学意义（12/80,P=0.003）.MCA中任何皮层支梗死与狭窄程度无关,ICA中任何分水岭梗死与狭窄程度相关.结论 颈内和大脑中动脉狭窄与闭塞在DWI上的梗死类型有明显的不同,提示有着不同的卒中发病机制.     

Prognostic relevance of ultra-early doppler sonography in acute ischaemic stroke: a prospective multicentre study

BACKGROUND: Ischaemic stroke can result from a temporary or permanent occlusion of intracranial arteries. In the hyperacute stage of the disease cerebrovascular ultrasound can be used to determine the vascular pathology, but the significance of very early findings on ultrasound is unclear. The present study aimed to assess the prognostic value of doppler ultrasonography within the first hours after stroke for functional outcome. METHODS: In a prospective multicentre design, patients with clinical signs of ischaemic anterior-circulation stroke were examined by doppler ultrasonography of the intracranial and extracranial arteries. Patients were separated into three groups according to the findings: normal middle-cerebral artery (MCA); branch occlusions; or a main-stem occlusion. The primary endpoint was functional outcome at 3 months. Logistic regression was used to test the association between the ultrasound diagnosis and functional outcome. RESULTS: 361 patients were identified with moderate to severe clinical deficits (National Institutes of Health Stroke Scale score 5-25). Of these, 121 (34%) had a normal MCA, 176 (48%) had branch occlusions, 7 (2%) had severe MCA stenosis, and 57 (16%) had a main-stem occlusion. 50 of the 57 (88%) patients with main-stem occlusion were dead or dependent 3 months after stroke. An occlusion of the main stem of the MCA within 6 h after stroke was an independent predictor for poor outcome (p=0.0006). 50% of patients with ultrasonographic diagnosis of branch occlusions and 63% with normal MCA had a good outcome. Combination of CT scan without early signs of infarction and a normal MCA resulted in a predictive value of 71% for a good functional outcome. INTERPRETATION: Cerebrovascular ultrasonography provides additional functional prognostic information in the hyperacute stage of ischaemic stroke. The technique is practical in a well-resourced unit, can be used to identify patients with high risk for poor functional outcome, and thus would be an appropriate investigation for future trials.     

大脑中动脉供血区梗死灶形态与可能发病机制的回顾性研究

目的 探索大脑中动脉(MCA)供血区的梗死灶形态与脑卒中可能发病机制之间的关系.方法 回顾性分析了148例连续的急性缺血性脑卒中患者,所有患者均为颈内动脉(ICA)系统脑梗死,DWI显示相应MCA供血区责任病灶,根据血管及心脏检查将患者分为ICA病变组、MCA病变组、ICA+MCA病变组、心源性栓塞组(CE组)及检查结果阴性组(NR组).将梗死灶形态分为单发和多发,前者按部位分为:穿动脉梗死灶(PAI)、皮质支梗死灶(PI)、分水岭梗死灶(BZ)、大面积梗死灶.结果 MCA供血区的梗死灶形态可分为12种;不同病变所致脑卒中的梗死灶形态存在差异(χ2=55.88,P=0.004).但在MCA组、ICA组、MCA+ICA组及CE组中,未发现各自特异的梗死灶形态,仅PAI更多见于MCA组;与NR组相比,ICA组患者中更多出现PAI伴PI(7/27,χ2=6.61,P<0.05),而MCA组和CE组均未见特征性的梗死灶形态.动脉狭窄的程度与梗死灶形态亦存在一定关联,重度ICA病变更多地表现为PAl伴PI(5/16,χ2=7.32,P<0.05);而重度MCA病变则好发PAI伴BZ(4/30,χ2=5.59,P<0.05)及PAI伴PI和BZ(6/30,χ2=6.41,P<0.05).结论 MCA供血区内的梗死灶形态与其颅内动脉病变之间存在一定的关系,揭示脑卒中发生的不同机制,可能与动脉-动脉栓塞、灌注不良有关;我们以检查结果阴性患者为对照比较,尚不能完全揭示MCA供血区内的梗死灶形态和与脑卒中的不同机制之间的相关性.     

Borderzone hemodynamics in cerebrovascular disease

To investigate the possible existence of chronic selective hemodynamic impairment in the arterial borderzone regions of the brain, we used positron emission tomography (PET) to measure regional mean vascular transit time (rt, equal to the ratio of regional cerebral blood volume to cerebral blood flow) and regional oxygen extraction fraction (rOEF) in 32 patients with either severe internal carotid artery stenosis or occlusion and 11 normal controls. Twenty-four of the patients had had TIAs or amaurosis fugax from 1 to 60 days before PET; all had normal brain CT. We used a stereotactic localization method to locate the anterior and posterior borderzone regions of the middle cerebral artery (MCA) territory. We then calculated ratios of each borderzone to the ipsilateral MCA territory for both rt and rOEF. There was no significant difference from control ratios in any patient subgroup including those with greater than or equal to 75% stenosis or occlusion, those with or without contralateral greater than or equal to 50% stenosis, or those with abnormal hemodynamics in the MCA territory. We therefore found no evidence for selective borderzone hemodynamic impairment in this group of patients with severe carotid artery disease.     

纹状体内囊梗死34例患者临床和影像特征

目的 分析纹状体内囊梗死(SCI)的临床和影像特征并探讨其发病机制.方法 回顾分析34例SCI患者的临床及影像资料.将患者分为皮质型SCI(CSCI)和非皮质型SCI(NCSCI)2组,进行临床和影像资料的对比分析.结果 CSCI 23例,NCSCI 11例.CT血管成像共检出大脑中动脉和颈内动脉狭窄或闭塞25例.CT脑灌注成像检出26例大脑中动脉供血区内血流灌注减低,其中19例累及广泛的大脑中动脉供血区.CSCI患者中检出上述动脉狭窄或闭塞21例,明显高于NCSCI患者中的4例(χ~2=3.27,P=0.020),CSCI患者中检出MCA供血区内血流减低区21例,明显高于NCSCI患者中的5例(χ~2=8.62,P=0.007).结论 SCI有临床和影像特征,大部分由于MCA原位病变所致.动脉病变和其造成的灌注减低是发生皮质症状的重要原因.     

大脑后动脉偏侧优势对同侧大脑中动脉病变卒中严重程度及预后的影响

目的探讨同侧大脑后动脉偏侧优势(posterior cerebral artery laterality,PCAL)对同侧大脑中动脉(middle cerebral artery,MCA)M1段严重狭窄或闭塞后急性卒中患者梗死范围、卒中严重程度和短期预后的影响。方法于2010年1月-2015年11月,前瞻性连续性纳入郑州大学第一附属医院MCA M1段严重狭窄(狭窄率70%~90%)或闭塞的161例急性缺血性卒中患者,根据患者有无PCAL分组,比较两组临床基线资料及3个月随访改良Rankin量表(modified Rankin scale,mRS)评分的差异。结果 161例患者中共76例PCAL阳性,85例PCAL阴性。PCAL阳性组既往卒中者少(P=0.021),基于弥散加权成像的Alberta卒中项目早期CT评分(diffusion weighted imaging-Alberta Stroke Programme Early CT Score,DWI-ASPECTS)更高(P=0.045),出院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分更低(P=0.009),3个月mRS评分更低(P=0.002),临床短期预后更好,差异有显著性。多因素Logistic回归分析可见,入院NIHSS评分[OR(odds ratio)1.266,95%CI(confidence interval)1.139~1.407,P0.01]是预后不良的预测因子,PCAL阳性(OR 0.355,95%CI 0.146~0.864,P=0.022)是预后良好的预测因子。结论 MCA M1段严重狭窄或闭塞的急性缺血性卒中患者,PCAL阳性者梗死范围更小,短期临床预后更好。     

Middle cerebral artery occlusive disease: The New England medical center stroke registry.

To analyze the clinical features, vascular lesions, and infarct distribution in Asian and white patients with middle cerebral artery (MCA) territory ischemia, we studied age, sex, race, risk factors, angiographic, and neuroimaging findings among patients in the New England Medical Center Stroke Registry. We included patients with well-defined intrinsic occlusive lesions of the MCAs and patients with embolic MCA territory infarcts. Among 695 patients in the stroke registry, 89 (12.8%) qualified. They had 28 MCA intrinsic stenoses, 17 MCA embolic occlusions (cardiogenic or unknown origin), and 44 carotid artery (CA) stenoses or occlusions. MCA intrinsic disease patients were more often Asians and women, and more often had hypertension. Asians were older than whites. Coronary artery disease (27%), peripheral vascular disease (20.5%), and smoking (39%) were more common in CA disease patients. The most common site of MCA intrinsic stenosis (78%) and embolic occlusion (59%) was the mainstem MCA. Infarcts in patients with MCA intrinsic disease mostly involved the striatocapsular area (61%). Infarcts in patients with MCA embolic occlusion (75%) and CA disease (43%) most often involved the parietal lobe. In our hospital, most patients with MCA intrinsic disease are Asians and women and have hypertension and striatocapsular infarctions. Asian patients are usually older than white patients. The most common site of vascular lesions is the mainstem MCA.