大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系

目的 探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系.方法 回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料.依据磁共振弥散加权成像(DWI)分为大脑中动脉深穿支小梗死组(小PAI组,直径≤3.20 cm)、大脑中动脉深穿支大梗死组(大PAI组,直径＞3.20 cm)、大脑中动脉深穿支+大脑中动脉皮质支梗死组(PAI+PI组)、大脑中动脉深穿支+分水岭梗死组(PAI+BZ组)、大脑中动脉深穿支+大脑中动脉皮质支+分水岭梗死组(PAI+PI+BZ组).比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率.结果 各组动脉狭窄检出率分别为16/87、9/11、17/17、11/12、23/25,小PAI组与其余4组相比差异有统计学意义(χ~2=21.780、48.065、30.567、55.523,P值均为0.000);各组动脉重度狭窄或闭塞检出率分别为1/87、2/11、12/17、9/12、21/25,小PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=56.505、55.465、79.283,P值均为0.000),大PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=7.337、7.425、11.633,P值分别为0.007、0.006、0.001);小PAI两亚组(2.00 cm＜直径≤3.20 cm亚组与直径≤2.00 cm亚组)动脉狭窄检出率差异无统计学意义(χ~2=0.253,P=0.615).结论 小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低;大PAI组、PAI+PI组、PAI+BZ组及PAI+PI+BZ组动脉狭窄检出率均较高,且PAI+PI组、PAI+BZ组、PAI+PI+BZ组动脉苇度狭窄或闭塞检出率均较高.     

Embolism in acute middle cerebral artery stenosis

OBJECTIVE: To investigate the frequency of middle cerebral artery (MCA) stenosis in a series of nonselected patients and the coexistence of microembolic signals with stenosis. METHODS: MCA stenosis was sought by transcranial Doppler (TCD) in 387 patients admitted consecutively with acute ischemic cerebrovascular disease within the first 48 hours of the onset of symptoms and again at 6 months. TCD monitoring for microembolic signals was performed on all patients with MCA stenosis. RESULTS: MCA stenoses were found in 29 patients (7%), although in only 20 patients (5%) was the stenosis symptomatic. Microembolic signals were detected in five of 14 symptomatic stenoses (36%) monitored at the acute phase, but none were found in the chronic phase or in asymptomatic stenosis. Despite one third of symptomatic patients having had a further source of emboli, microembolic signals were detected only distally to the MCA stenosis. In the symptomatic group, 25% of stenoses had completely disappeared 6 months after stroke. Microembolic signal detection at the acute phase was associated with the subsequent disappearance of the stenosis. CONCLUSIONS: The frequency of symptomatic MCA stenosis in acute ischemic stroke was 5% in the population studied. Many stenoses are transient, and microembolic signals are often detectable at the poststenotic segment in the acute phase. The origin of at least 25% of symptomatic acute MCA stenoses may be embolic rather than atherosclerotic.     

单侧大脑中动脉狭窄的脑磁共振灌注成像研究

目的探讨大脑中动脉(MCA)不同狭窄程度时的脑磁共振灌注加权成像(PWI)表现。方法对31例经DSA诊断为单侧MCA狭窄或闭塞患者行脑磁共振PWI检查,并对不同程度MCA狭窄状态下患侧和健侧大脑半球的脑灌注参数局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部平均通过时间(rMTT)、局部达峰时间(rTTP)进行定量分析。结果31例患者中,DSA诊断单侧MCA轻中度狭窄14例,其中脑灌注异常11例;患侧大脑半球rTTP较健侧显著延长(P0.01)。MCA重度狭窄或闭塞17例,均出现异常灌注;患侧大脑半球rTTP较健侧显著延长(P0.01),而患侧rCBF较健侧明显减少(P0.05),患侧rMTT健侧亦显著延长(P0.05)。结论通过脑灌注成像参数综合分析,磁共振PWI能准确评估MCA狭窄程度和脑组织血供情况,可为脑缺血的临床诊断提供重要价值。     

Pure monoparesis of the leg due to cerebral infarctions: A diffusion-weighted imaging study

Pure monoparesis of the leg due to cerebral infarction is rare compared to that of the hand. The anterior cerebral artery (ACA) territory is the most common lesion site in leg monoparesis, but diffusion-weighted (DW) MRI has not commonly been used for lesion detection. The purpose of this study was to use DW MRI to evaluate the radiological correlation with lesion location in patients presenting with pure leg monoparesis. We retrospectively studied six cerebral infarct patients with pure leg monoparesis who had undergone DW MRI. Patients were scanned within 3 days of symptom onset. DW MRI identified lesions in the posterior limb of the internal capsule (PLIC) in two patients, in the corona radiata (two patients), in the subcortical white matter of the posterior frontal lobe (one patient), and in the frontal and parietal cortex, including the paracentral lobule and precuneus (one patient). The two patients with PLIC infarctions had characteristic linear infarction abnormalities along the long axis of the internal capsule. Corona radiata infarction were located posteriorly, and the two subcortical and cortical infarction were thought to be in the territory of the ACA. We thus concluded that in leg monoparesis due to infarctions, lesions may be located in the PLIC, corona radiata, or in the ACA territory. Recently, magnetic resonance tractography has shown that foot fibres of the corticospinal tract in the PLIC somatotopically may be posteromedial to hand fibres along the short axis of the internal capsule, rather than posterolateral along the long axis as has been thought. Thus, damage along the long axis of the PLIC by linear infarctions can cause pure monoparesis of the leg.     

高血压合并无症状性大脑中动脉狭窄患者的药物干预研究

目的探讨在降血压治疗的同时联合应用辛伐他汀和阿司匹林对高血压合并无症状性大脑中动脉狭窄患者的干预作用和脑血管事件的预防效果。方法177例高血压合并大脑中动脉狭窄患者,其中90例应用辛伐他汀(每晚20mg)和阿司匹林肠溶片(75mg/d)进行治疗(干预组),通过经颅多普勒超声检查分别观察治疗前及治疗后1～3年大脑中动脉收缩期血流速度峰值、搏动指数、阻力指数、频谱形态,同时检测治疗前后血压、血脂等项生化指标的变化,并与87例对照者进行比较。结果治疗第1年,干预组患者大脑中动脉收缩期血流速度峰值、搏动指数、阻力指数及频谱形态等与治疗前差异无统计学意义(P>0.05);随访至第2,3年,上述各项指标均改善(P<0.01),频谱形态明显好转。随访结束时,两组患者大脑中动脉上述指标间差异有高度统计学意义(均P<0.01),干预组患者脑血管事件发生率为11.11%(10/90),低于对照组的24.14%(21/87)(P<0.01)。结论在有效降低血压的同时,联合应用辛伐他汀和阿司匹林可稳定并延缓高血压患者大脑中动脉狭窄的进程,对降低脑血管事件的发生率具有良好的作用。     

Acute confusional states with right middle cerebral artery infarctions.

Three patients presenting predominantly with acute confusional states (ACS) are shown to have infarctions in the distribution of the right middle cerebral artery. It is suggested that the main deficit in ACS is in the function of selective attention. On the basis of cortical connections of homologous areas in the monkey brain, it is argued that this deficit arises from lesions in convergence areas for association cortex.     

Wall characteristics and mechanisms of ischaemic stroke in patients with atherosclerotic middle cerebral artery stenosis: a high-resolution MRI study

Objective:: To evaluate the characteristics of atherosclerotic middle cerebral artery (MCA) stenosis by high-resolution magnetic resonance imaging (HR-MRI) and determine the relationship between wall characteristics and infarction patterns.

Methods:: Thirty-six patients with acute ischaemic stroke due to MCA stenosis underwent diffusion-weighted magnetic resonance imaging (DWI) and HR MRI. Wall characteristics of MCA, including irregular surface, superior location, T2-hyperintense of plaques and positive remodelling (PR), were analysed. Characteristics of acute infarct on DWI were categorised according to the number (single or multiple infarcts) and the pattern of cerebral infarcts (cortical, border zone or perforating artery territory infarcts). The relationship between wall characteristics and infarction patterns was evaluated.

Results:: PR was observed in 20 patients, irregular surface plaque in 18 patients, superior location of plaques in 14 patients and T2-hyperintense foci in 13 patients. Seventeen patients had multiple acute cerebral infarcts and 13 showed single acute cerebral infarcts. Border zone infarcts were the most common (76.5%) among multiple acute infarcts. Penetrating artery infarcts (PAI) accounted for 76.9% of all single infarcts. Multiple infarcts were more frequently observed in patients with PR (P = 0.007) or plaque surface irregularity (P = 0.035). Single infarcts, especially PAI, were more prevalent in patients with superior plaque (P = 0.030). No statistically significant differences were observed between multiple and single infarcts in patients with T2-hyperintense lesions (P?=?0.638).

Conclusions:: PR or irregular surface plaques were associated with artery-to-artery embolism. Superior location of plaques was associated with PAI. HR-MRI provides insights into intracranial atherosclerosis in vivo, predictive of infarction patterns.     

单侧大脑中动脉中重度狭窄患者脑灌注与脑血管储备力的相关性研究

目的探讨单侧大脑中动脉(MCA)中重度狭窄患者脑灌注与脑血管储备力(CVR)的相关性。方法 31例单侧MCA中重度狭窄患者二氧化碳(CO2)吸入试验前后行CT灌注成像(CTP)检查,在基底节区、放射冠区及半卵圆中心层面选择感兴趣区,测量感兴趣区脑血流量、脑血容量、平均通过时间及达峰时间,以对侧为正常对照,分析患侧MCA供血区的脑灌注。计算双侧MCA区CVR,对脑灌注变化与患侧CVR进行相关性分析。结果 31例患者中有8例(25.81%)灌注正常,23例(74.19%)患侧存在低灌注。CVR正常者15例(48.39%),下降者16例(51.61%)。脑灌注变化与CVR存在等级相关(r=0.462,P=0.009)。结论单侧MCA中重度狭窄患者中存在脑灌注及CVR均正常者,脑灌注变化与其CVR具有正相关。     

Factors affecting haemorrhagic transformation in middle cerebral artery infarctions.

OBJECTIVE: Haemorrhagic transformation (HT) affects treatment and prognosis in patients with acute ischaemic stroke. The factors affecting haemorrhagic transformation in infarcts due to occlusion of middle cerebral artery (MCA) stem or branch were investigated. MATERIALS AND METHODS: Of 412 patients who were followed in our clinic between January 2001 and December 2001 with acute ischaemic stroke, 86 patients with occlusion in MCA stem or branch were enrolled in this study. These patients were divided into 2 groups, those with HT (n = 35) and without HT (n = 51). Age, sex, systemic arterial hypertension, diabetes mellitus, blood glucose level in the acute period, renal and liver function tests, systolic and diastolic arterial blood pressure in the acute period, previous cerebrovascular disease, leukoaraiosis, modified Rankin Disability Score (mRDS) and stroke subtype were evaluated. RESULTS: High blood glucose level in the acute period and presence of leukoaraiosis on cranial computerized (CCT) tomography were detected as risk factors in development of HT. HT was seen more frequently in MCA stem infarction than branch infarction. mRDS were worse in the group with HT. In multivariate analysis, there were independent relationships between mean blood glucose level on admission, mRDS, presence of diabetes mellitus, and MCA stem infarction and development of haemorrhagic transformation in patients with MCA territorial infarction.     

大脑中动脉狭窄患者脑血管储备能力与缺血性卒中事件的随访研究

目的观察大脑中动脉(MCA)狭窄患者脑血管储备能力(CVR)与缺血性卒中发生的关系及其危险因素的随访研究。方法连续纳入2014年2月~2016年9月在广州医科大学附属第三医院荔湾医院神经内科门诊或住院就诊行经颅多普勒超声(TCD)检查者中发现MCA狭窄患者的临床资料及脑血管储备能力(CVR),并进行为期1 y的随访,观察患者发生缺血性卒中的情况。结果 (1)共纳入212例患者,其中31例(14.6%)在随访期间发生缺血性卒中(卒中组);(2)卒中组患者CVR为(12.6±4.8)%,明显低于非卒中组(19.3±4.5)%,两者差异有统计学意义(P0.05);(3)卒中组中MCA轻度、中度、重度狭窄者分别为6例(19.4%)、11例(35.5%)、14例(45.2%),与非卒中组比较差异有统计学意义(P0.05);(4)经Logistic回归分析显示CVR是缺血性卒中事件的独立危险因素。结论在MCA狭窄的患者中CVR高、狭窄程度低的缺血性卒中事件发生风险低,且CVR是缺血性卒中的独立危险因素。     

动脉溶栓治疗急性大脑中动脉脑梗死(附16例报告)

目的分析急性大脑中动脉脑梗死动脉溶栓的疗效。方法对16例经脑血管造影证实为大脑中动 脉急性脑梗死的患者进行了动脉溶栓治疗。手术结束前通过脑血管造影了解大脑中动脉再通情况。术后即刻和 24 h后分别行头颅CT检查了解有无颅内出血(intracerebral hemorrhage,ICH)。术后第90 d采用Barthel指数(Bar- thel index,BI)对患者牛活状态进行评估。结果平均治疗持续时间为71min。16例患者中完全再通13例,部分再 通3例。症状性颅内出血2例,死亡1例。术后第90d,生活状态优者13例,良者2例,死亡1例。结论动脉溶栓 能够明显提高大脑中动脉的再通,改善患者的预后。     

大脑中动脉狭窄脑梗死颅内血流动力学及侧支循环研究

目的 探讨大脑中动脉(MCA)狭窄或闭塞的脑梗死患者颅内血流动力学改变和侧支循环的代偿及神经功能缺损的关系.方法 通过经颅多普勒(TCD)检查,计算双侧大脑前动脉(ACA)、大脑后动脉(PCA)峰流速及其比值(RVACA、RVPCA),并与正常对照组比较.结果 共观察38例单侧MCA狭窄或闭塞的脑梗死患者.(1)病例组ACA、PCA血流速度代偿性增快,以ACA代偿为主(76.3%);(2)病例组RVACA明显较对照组高﹙P<0.01﹚;(3)MCA主干及皮层支梗死患者的RVACA明显较对照组及深穿支梗死组高﹙P<0.01,P<0.05﹚;MCA重度狭窄或闭塞脑梗死患者的RVACA较对照组及中度狭窄组高﹙P<0.05﹚;(4)病例组RVACA及RVPCA与NIHSS呈负相关(P<0.01﹚.结论 皮质软脑膜侧支吻合血管开放成为MCA狭窄或闭塞脑梗死侧支循环的主要途径,其代偿程度与预后相关.     

Bilateral middle cerebral artery infarctions following mild varicella infection: a case report

We report a two-year and one-month-old immunocompetent boy who developed aphasia and right hemiparesis eight months after mild varicella with only a few vesicles. Magnetic resonance images and angiography demonstrated mixed acute and old infarctions of the bilateral middle cerebral arteries. VZV-DNA was detected on polymerase chain reaction analysis of cerebral spinal fluid (CSF). He was treated with intravenous acyclovir and edaravone, and his speech and motor functions had almost recovered after two months. Cerebral lesions of the bilateral middle cerebral artery territories and virus DNA detection from CSF are rare in VZV-related vasculopathy and suggest incomplete immunoresponse to varicella in this patient.