功能磁共振成像对急性脑梗死患者预后判断的价值

目的探讨功能磁共振成像(functional magnetic resonance imaging,fMRI)检测脑感觉运动皮质(sensorimotor cortex,SMC)区激活对于急性脑梗死患者预后的评估价值。方法对44例脑梗死患者在起病6～72 h内和14 d进行手被动运动模式的fMRI成像以及美国国立卫生院卒中量表(NIHSS)评分,在起病30 d和90 d时进行修正Barthel指数(modified Barthel index,MBI)评分和修正Rankin量表(modified Rankin scale,mRS)评分。结果 SMC激活组患者的NIHSS评分低于无激活组(6～72 h:9.5±2.1 vs 11.9±4.2,P=0.023;14 d:中位数:5 vs 10,P=0.01),脑梗死体积小于无激活组(P<0.05);14 d SMC激活组的30 d和90 d MBI、30 d mRS评分均优于无激活组(P<0.05),14 d SMC激活体积与14 d NIHSS、30 d和90 d的MBI、mRS评分值也有相关关系(P<0.05)。结论手被动运动激活SMC区的fMRI成像对急性脑梗死患者有预后评估价值,尤其起病14 d时SMC区的激活情况与患者预后密切相关。     

脑梗死急性期手运动功能中枢损伤的定量分析

目的:利用血氧水平依赖性磁共振功能成像(BOLD-fMRI)技术研究急性期脑梗死患者短期康复治疗前后的手运动中枢激活体积、强度的变化特征,从而探讨脑梗死患者急性期手运动功能康复的机制。方法:选择首次、单发脑梗死急性期患者16例,其中康复治疗组8例和常规治疗组8例,分别于治疗前及治疗第14天进行fMRI检查,并采用Fugl-Meyer运动功能评分(FM评分)进行患手运动功能评定,记录治疗前后常规治疗组和康复治疗组中枢激活的体积、强度;同时选择10名健康志愿者进行单次fMRI检查,确定相同运动任务刺激后脑功能区位置和兴奋体积、强度等方面的变化规律。结果:16例脑梗死患者治疗后对侧SMC(sensorimotor cortex,SMC)激活体积、强度及FM评分大于治疗前(P<0.05),康复治疗组治疗前后患手运动激活对侧SMC体积、强度、FM评分较常规治疗组明显改变(P<0.05)。结论:脑梗死急性期进行早期康复治疗可以引起患侧SMC区相应的变化,加速患肢功能的恢复。     

语义记忆脑功能区偏侧化的功能磁共振成像研究

目的 通过功能磁共振成像(fMRI)技术检测健康人脑语义记忆功能区的分布特点.方法 14名右利手健康志愿者进行配对词语联想学习记忆任务时行fMRI扫描,该任务可有代表性地反映受试者的语义记忆.实验采用组块设计并选用SPM99软件行数据分析和脑功能区定位,记录各激活脑区的像素值并计算偏侧化指数LI值.结果 经单样本t检验,阈值设为P＜0.005时,记忆编码时主要激活脑区为左枕叶和左额上中回,提取时主要激活左顶叶、左枕叶和左额中下回;而右半球在两阶段均较少激活.编码和提取激活脑区像素值LI值分别为0.81和0.73.结论 语义记忆的脑功能区有显著的左半球优势;记忆编码和提取阶段所激活的脑区有所差别,但均主要分布于左外侧裂语言区的周围.     

丙泊酚Wada试验与功能磁共振在颞叶癫痫词汇记忆功能偏侧化评估中的应用

目的 比较丙泊酚Wada试验与功能磁共振(fMRI)在左颞叶癫痫患者术前记忆功能偏侧化预测中的一致性和敏感性. 方法 对广州军区广州总医院自2009年10月至2011年10月收治的8例左前颞叶切除的癫痫患者术前进行丙泊酚Wada试验和fMRI记忆功能偏侧化评估,结合韦氏记忆测验结果,比较两者记忆功能偏侧化评估的一致性与预测记忆变化的敏感性. 结果 fMRI词汇记忆半球、内侧颞叶功能偏侧化与Wada试验功能偏侧化判定的一致率分别为57.0％和71.4％,术后记忆商数、词汇匹配以及智力改变与fMRI词汇记忆内侧颞叶功能偏侧化指数呈显著相关(r=-0.314,P=0.037;r=-0.387,P=.013;r=0.116,P=0.020),与Wada试验功能偏侧化指数无相关性(r=-0.442,P=.077;r=-0.241,P=0.237;r=-0.070,P=0.107). 结论 丙泊酚Wada试验和fMRI记忆功能偏侧化评估一致性因感兴趣区选择方法不同而不同.相对于Wada试验,fMRI记忆功能偏侧化指数在预测患者术后词汇记忆下降的过程中敏感性更高.     

颞叶癫痫患者执行功能的功能磁共振研究

目的 探讨颞叶癫痫(temporal lobe epilepsy ,TLE)患者执行功能的脑功能状态及激活模式.方法 应用注意网络测试(attentional networks test,ANT)软件,对12例TLE患者及12名健康受试者进行执行功能行为学测试;应用组块式功能磁共振(functional magnetic resonance imaging ,fMRI)扫描,使用统计参数图(Statistical Parametric Mapping 2,SPM 2)软件分析fMRI数据.结果 与健康受试组比较,TLE患者组执行功能反应时间(RT)较慢[患者组:(158.9±50.2)ms;健康受试组:(112.4±28.3)ms, t=2.63,P<0.05].健康受试组执行功能fMRI显示激活脑区右侧半球偏侧化,位于右扣带回后部、颞下回、前额叶、海马、顶叶及左颞中回.TLE患者组右侧前额叶和右额叶 (激活体素:53,34 voxel P<0.01)等靠近中线脑区激活体素较小.健康受试组存在与反应时间正、负相关脑区(P<0.001),TLE组则仅存与反应时间正相关脑区(P<0.001).结论 TLE患者存在执行功能障碍,与上述脑区激活功能低下和失调控有关,这些脑区可能是TLE患者执行功能损害的形态学基础.     

脑功能区病变术前运动功能的评估

目的探讨功能磁共振成像（Functional Magnetic Resonance Imaging，fMRI）在脑运动区病变患者术前评估和手术设计中的作用。方法20例累及运动区的脑内占位病变患者，术前采用手握拳运动block激发模式，fMRI获取运动激活信号，术前分析病变与运动区的关系及功能重组织类型。结果病变位于中央前回前或后15例，fMRI均表现为病变对侧第一运动区（Primary Motor Area，M1）激活并向后或向前移位，病灶边缘与激活信号之间的最小距离为5～9mm，平均9．6mm。病变位于中央前回5例，表现为瘤周激活3例，运动前区激活并皮层弥散激活2例。结论fMRI有助于神经外科医师在术前对病变与功能区的关系及皮层功能重组织类型有较好的认识，对运动区病变术前评估和手术设计有重要指导价值。     

多语言任务功能磁共振指导国人语言区动静脉畸形切除手术

目的 观察针对中国人主要汉语语言区的多语言任务功能磁共振（functional MRI,fMRI）指导语言 区动静脉畸形（arteriovenous malformations,AVM）切除手术对术后语言功能的保护作用。 方法 前瞻性纳入首都医科大学附属北京天坛医院神经外科2017年12月-2019年12月收治的语言区 AVM患者31例,术前行多语言任务（包括同义字判断、单字朗读、听力理解）fMRI扫描。使用SPM12软件 明确各个任务的激活区并分析病变与激活区关系（包括二者之间的距离以及是否存在激活区右侧半 球重塑）,借助Brainlab导航系统指导手术,术前、术后一周采用西方失语症语言量表（western aphasia battery,WAB）评估患者语言功能。 结果 所有患者均得到有效语言区定位。同义字判断任务主要激活左侧半球额中回（24/31, 77.4%）,其中1例（3.2%）患者出现语言区右侧半球优势;单字朗读任务主要激活左侧半球额下回后 部（23/31,74.2%）,7例（22.6%）患者出现语言区右侧半球优势;听力理解任务主要激活左侧半球颞 上回后部（30/31,96.8%）,6例（19.4%）患者出现语言区右侧半球优势。病变距离语言区平均距离为 5.5±3.4 mm。术后WAB量表评分（38.51±2.84分）较术前（39.32±0.64分）无下降（P =0.135）,仅2例 （6.4%）患者术后出现语言功能障碍。 结论 术前采用针对国人主要汉语语言区的多任务fMRI行语言功能定位可有效保护语言功能。     

多语言任务功能磁共振指导国人语言区动静脉畸形切除手术

目的 观察针对中国人主要汉语语言区的多语言任务功能磁共振（functional MRI,fMRI）指导语言
区动静脉畸形（arteriovenous malformations,AVM）切除手术对术后语言功能的保护作用。
方法 前瞻性纳入首都医科大学附属北京天坛医院神经外科2017年12月-2019年12月收治的语言区
AVM患者31例,术前行多语言任务（包括同义字判断、单字朗读、听力理解）fMRI扫描。使用SPM12软件
明确各个任务的激活区并分析病变与激活区关系（包括二者之间的距离以及是否存在激活区右侧半
球重塑）,借助Brainlab导航系统指导手术,术前、术后一周采用西方失语症语言量表（western aphasia
battery,WAB）评估患者语言功能。
结果 所有患者均得到有效语言区定位。同义字判断任务主要激活左侧半球额中回（24/31,
77.4%）,其中1例（3.2%）患者出现语言区右侧半球优势;单字朗读任务主要激活左侧半球额下回后
部（23/31,74.2%）,7例（22.6%）患者出现语言区右侧半球优势;听力理解任务主要激活左侧半球颞
上回后部（30/31,96.8%）,6例（19.4%）患者出现语言区右侧半球优势。病变距离语言区平均距离为
5.5±3.4 mm。术后WAB量表评分（38.51±2.84分）较术前（39.32±0.64分）无下降（P =0.135）,仅2例
（6.4%）患者术后出现语言功能障碍。
结论 术前采用针对国人主要汉语语言区的多任务fMRI行语言功能定位可有效保护语言功能。     

fMRI功能导航下切除汉语运动性语言区附近病变

目的探讨功能磁共振(functional magnetic resonance imaging,fMRI)导航在汉语运动性语言区附近病变手术中的应用价值。方法对43例大脑皮层运动性语言区附近病变患者,通过组块设计的汉语朗读任务,利用血氧水平依赖性功能磁共振成像(BOLD-fMRI)获得运动性语言区激活,利用磁共振弥散张量成像技术(diffusion tensori maging,DTI)获得白质纤维束走行,将结构影像、fMRI功能影像与DTI的各项异性系数(FA)图像同时传入导航系统,术中定位fMRI确定的语言区,在唤醒状态利用皮层电刺激技术进行语言区验证,避开运动性语言区在显微镜下切除病变。结果本组患者29例术前语言功能正常,14例有不同程度语言功能障碍。38例获得了有效的fM-RI语言区激活,进行了36例核心激活脑区与皮层电刺激比较:25例为重叠关系,11例为邻近关系。手术全切除17例,次全切除14例,大部份切除12例。术后语言功能8例较术前好转,31例无变化,4例出现短暂性运动性失语。结论汉语朗读任务所获得的fMRI运动性语言区激活具有良好的敏感性与准确性;fMRI导航手术可以提高汉语运动性语言区附近病变切除程度,减少术后运动性失语的发生。     

fMRI及DTI技术在成人工作记忆研究的初步探索

目的：联合应用脑功能磁共振成像（BOLD—fMRI）和弥散张量成像（DTI）两种磁共振技术,探索工作记忆功能激活部位与叶间白质纤维束的关系。方法：健康志愿者16名,以步进式视觉累加试验作为刺激模式,扫描获得fMRI激活图及各向异性（FA）图。将两者叠加,选取双侧额顶叶白质兴趣区测量其部分FA值。结果：①额顶叶皮质为工作记忆功能最主要的激活区;②脑的激活像素几乎均位于FA程度低的区域（P〈0．01）;③左额顶间白质FA值较对侧高（P〈0．02）。结论：联合应用fMRI和DTI技术提示成人工作记忆功能与额顶叶白质纤维髓鞘化程度密切相关。     

Central motor conduction studies in internal capsule and corona radiata infarction

Clinical and evoked-potential studies in internal capsule and corona radiata infarction are lacking. We report the results of a clinical and central motor conduction time (CMCT) study in 16 patients with internal capsule and 17 with computed tomography (CT)-proven corona radiata infarction. Patient’s outcome was defined at the end of 3 months on the basis of the Barthel Index score. Four patients with type A capsular infarction (middle third of posterior limb of internal capsule) all had severe weakness, while 2 also had persistently unrecordable CMCT and poor outcome. Twelve patients with type B internal capsular infarction (genu, anterior limb, anterior or posterior third of posterior limb) had a milder degree of weakness, and CMCT was recordable in 9. At 3 months’ follow-up, however, CMCT was recordable in all 12 patients. All of these patients had a partial (n = 4) or complete (n = 5) recovery. Thirteen patients with type A corona radiata infarction (middle third of corona radiata) had more pronounced weakness, and CMCT was unrecordable in all of these patients except 1 on initial examination. Follow-up after 3 months was possible in 8 patients, and CMCT became recordable in 3. One of these patients had complete, 3 partial, and 4 poor recovery. In type B corona radiata infarction (anterior or posterior third of corona radiata), the clinical signs and CMCT did not follow a regular pattern. Clinical and CMCT abnormalities in internal capsular infarction followed a more predictable pattern compared with those in corona radiata infarction. A less predictable pattern of weakness and CMCT change in corona radiata infarction may be attributed to a less definite organisation of motor pathways compared with the internal capsule. Received: 13 January 1997 Received in revised form: 5 June 1997 Accepted: 27 June 1997     

Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients: a preliminary study

Constraint-induced movement therapy (CIMT) is a physical rehabilitation regime that has been previously shown to improve motor function in chronic hemiparetic stroke patients. However, the neural mechanisms supporting rehabilitation-induced motor recovery are poorly understood. The goal of this study was to assess motor cortical reorganization after CIMT using functional magnetic resonance imaging (fMRI). In a repeated-measures design, 4 incompletely recovered chronic stroke patients treated with CIMT underwent motor function testing and fMRI. Five age-matched normal subjects were also imaged. A laterality index (LI) was determined from the fMRI data, reflecting the distribution of activation in motor cortices contralateral compared with ipsilateral to the moving hand. Pre-intervention fMRI showed a lower LI during affected hand movement of stroke patients (LI = 0.23+/-0.07) compared to controls (LI unaffected patient hand = 0.65+/-0.10; LI dominant normal hand = 0.65+/-0.11; LI nondominant normal hand = 0.69+/-0.11; P < 0.05) due to trends toward increased ipsilateral motor cortical activation. Motor function testing showed that patients made significant gains in functional use of the stroke-affected upper extremity (detected by the Motor Activity Log) and significant reductions in motor impairment (detected by the Fugl-Meyer Stroke Scale and the Wolf Motor Function Test) immediately after CIMT, and these effects persisted at 6-month follow-up. The behavioral effects of CIMT were associated with a trend toward a reduced LI from pre-intervention to immediately post-intervention (LI = -0.01+/-0.06, P = 0.077) and 6 months post-intervention (LI = -0.03+/-0.15). Stroke-affected hand movement was not accompanied by mirror movements during fMRI, and electromyographic measures of mirror recruitment under simulated fMRI conditions were not correlated with LI values. These data provide preliminary evidence that gains in motor function produced by CIMT in chronic stroke patients may be associated with a shift in laterality of motor cortical activation toward the undamaged hemisphere.     

Deterioration of hemiparesis after recurrent stroke in the unaffected hemisphere: Three further cases with possible interpretation

BACKGROUND: The concept of neural reorganization after brain damage is already well established, and many previous studies have successfully reported the translocation of the neural activation in the motor-related cortices during motor tasks using functional imaging modalities. Several primate and human studies have suggested the formation of newly reorganized tracts in the ipsilesional or contralesional hemisphere, but the mechanism for the formation of these tracts is still largely unknown. METHODS: Three acute stroke patients who presented with abrupt deterioration of their right-sided hemiparesis due to the infarcts following a recurrent stroke in the originally unaffected hemisphere were studied using magnetic resonance imaging (MRI), MR angiography and single-photon emission CT. The relationship between the neurological symptom on admission and the precise location of the new infarct was carefully investigated from the perspective of reorganization. RESULTS: Diffusion-weighted MRI showed a new subcortical infarct in the right hemisphere contralateral to the initial stroke in all patients. These new lesions involved the thalamus, globus pallidus or corona radiata, sparing the area of the internal capsule. T2-weighed MRI on admission showed an old infarct in the left middle cerebral artery territory, which had caused the original right-sided hemiparesis. CONCLUSION: It is proposed that the 'extrapyramidal' motor pathway in the unaffected hemisphere is associated with poststroke neural reorganization.     

BOLD-fMRI方法探讨尤瑞克林治疗急性脑梗死的疗效及其作用机制

目的 通过血氧水平依赖功能磁共振成像(BOLD-fMRI)的方法 观察尤瑞克林治疗急性脑梗死的疗效及其作用机制. 方法 将23例急性脑梗死患者按随机数字表法分成对照组(11例)和治疗组(12例),对照组给予常规治疗,治疗组在常规治疗的基础上加用尤瑞克林,疗程均为12～14d.观察治疗前后BOLD-fMRI影像和患侧手食指肌力评分和美国国立卫生研究院卒中量表(NIHSS)评分的变化. 结果 治疗后,治疗组息侧感觉运动皮层(SMC)激活频率和激活体积较治疗前明显增加(11/12 vs 4/12;199.58±169.41 vs 105.17±197.23),且治疗前后激活体积之差明显大于对照组(94.42±51.57 vs 16.09±106.61),差异有统计学意义(P<0.05);治疗后,治疗组患侧食指肌力评分和NIHSS评分较治疗前明显改善(2.67±1.44 vs 1.25±1.48;4.92±2.94 vs 10.42±3.80),且治疗前后NIHSS评分之差明显大于对照组(5.50±1.31 vs 3.18±2.48),差异有统计学意义(P<0.05). 结论 促进脑功能区SMC的激活恢复可能是尤瑞克林治疗脑梗死的一个重要机制.     

Cerebral infarction accompanied by dysgeusia--a clinical study on the gustatory pathway in the CNS]

Dysgeusia was investigated in 11 patients with thalamic infarction and 13 patients with corona radiata infarction to locate the gustatory pathways based on the sites of the lesions. Dysgeusia was present in 4 out of 11 patients with thalamic infarction and 3 out of 13 patients with corona radiata infarction. The dysgeusia was contralateral to the lesion in all these patients. Cheiro-oral syndrome was observed as a complication in 2 patients each from both groups. The responsible lesion was located on the medial side of the ventral posterolateral (VPL) nucleus and the ventral posteromedial (VPM) nucleus in the patients with thalamic infarction who developed dysgeusia, and was located posteriorly to the corona radiata in the other group. In the patients without gustatory disturbance, on the other hand, the lesions showed no such spread. These findings suggest that the gustatory pathway ascends contralaterally in the cerebral hemisphere and that the pathway from the thalamus projects to the cerebral cortex via the posterior part of the corona radiata. It is also suggested that the pathways in the thalamus and corona radiata are very close to the sensory fibers from the mouth and hands projecting to the sensory area.     

Functional cortical changes of the sensorimotor network are associated with clinical recovery in multiple sclerosis

OBJECTIVE: To assess the early cortical changes following an acute motor relapse secondary to a pseudotumoral lesion in MS patients, the longitudinal cortical functional correlates of clinical recovery, and the evolution over time of cortical reorganization. METHODS: FMRI during the performance of a simple motor task were obtained from 12 MS patients (after a clinical attack involving the motor system secondary to a pseudotumoral lesion) and 15 matched controls. In six patients and five controls, a longitudinal fMRI study was also performed. RESULTS: In patients, at baseline, the primary sensorimotor cortex (SMC) of the ipsilateral (contralesional) hemisphere was significantly more active during task performance with the impaired than the unimpaired hand. During task performance with the unimpaired hand, the ipsilateral cerebellum and several motor areas in the contralateral hemisphere were significantly more active. Pseudotumoral lesion volume was correlated with activation of the primary SMC bilaterally (r = -0.86 and -0.85) and the nine-hole peg test score with activation of the primary SMC of the affected hemisphere (r = 0.88). A recovery of function of the primary SMC of the affected hemisphere was found in the four patients with clinical improvement. In the two patients without clinical recovery, there was a persistent recruitment of the primary SMC of the unaffected hemisphere. CONCLUSIONS: Pseudotumoral MS lesions affecting the motor system can determine short-term cortical changes characterized by the recruitment of pathways in the unaffected hemisphere. The regain of function of motor areas of the affected hemisphere seems to be a critical factor for a favorable recovery.     

侧脑室体旁放射冠区脑梗塞的临床和CT对照分析

报告经头颅CT扫描证实的侧脑室体旁放射冠区脑梗塞84例,其中腔隙性脑梗塞(Lacunae infarction,LI)59例,分水岭梗塞(Watershed infarction,WI)25例。结合文献就两者的病因,临床特征和放射冠区传导束的排列情况进行了讨论,结果发现高血压是二者共同的、主要的病因,放射冠区锥体束的排列顺序与躯体存在定位关系。     

Hemodynamic impairment as a stimulus for functional brain reorganization.

We used functional magnetic resonance imaging to investigate whether hemispheral hemodynamic impairment can play an independent role in the functional reorganization of motor-related activity in the brain. Fourteen patients with large vessel occlusion but no infarct performed a simple motor task with the hand contralateral to the occluded vessel. Statistical parametric maps of regional activity were generated to compare the distribution of motor-related activity among patients with that of control subjects. Patients were classified into normal or abnormal cerebral hemodynamics on the basis of intracerebral vasomotor reactivity using transcranial Doppler and carbon dioxide inhalation. Controls and patients with normal vasomotor reactivity showed typical motor activity in contralateral motor areas. When the 9 patients with abnormal vasomotor reactivity were compared with the 14 control subjects in a single analysis, unique motor activation was identified in ipsilateral motor regions in the nonhypoperfused hemisphere. In a confirmatory analysis, blood oxygen level-dependent (BOLD) signal intensity was averaged in prespecified motor regions of interest. A significant group by hemisphere interaction was identified, driven by higher ipsilateral and lower contralateral hemisphere BOLD signal in patients with abnormal vasomotor reactivity compared with controls (F=12.40, P=0.002). The average ipsilateral motor region signal intensity was also significantly higher in the subgroup of patients with abnormal vasoreactivity and no TIA compared with controls (P=0.04). Our results suggest that hemodynamic impairment in one hemisphere, even in the absence of any focal lesion or any symptoms can be associated with a functional reorganization to the opposite hemisphere.     

Pathophysiological study of corona radiata infarcts by clinically available diagnostic methods

The authors evaluated 18 patients who presented with corona radiata infarction, one of the 'water-shed infarctions', on CT and/or MRI to determine its etiology and pathophysiology using cerebral angiography, single-photon emission computed tomography (SPECT), and tests of hemostatic function including hematocrit, platelet aggregation and adhesiveness. On angiography, 8 of these 18 patients had ulcerative lesions in the common carotid artery bifurcation with or without minimal stenosis and exhibited no or a minimal area of hypoperfusion localized to the corona radiata on SPECT. In these, microembolism from the lesions at the common carotid bifurcation seemed play an important role in the genesis of corona radiata infarction. In 7 of the remaining 10 patients, cerebral angiography showed occlusive lesions of the internal carotid artery around its origin in 3, more than 90% stenosis of the internal carotid artery in 1, severe stenosis of the M1 segment of the middle cerebral artery in 2, and M1 occlusion in 1. In 5 of these 7, SPECT demonstrated a larger area of hypoperfusion than the corona radiata in the involved hemisphere. In the remaining 2, SPECT demonstrated a hypoperfusion area localized to the corona radiata. In all 7, the hematocrit was elevated. A collateral blood supply was visualized in 5 of 7 on cerebral angiography. In these 7 patients, hemodynamic disturbance was considered to contribute to the pathogenesis of infarction in the corona radiata. In the final three patients, cerebral angiography showed significant occlusive lesions in the main trunk of the cerebral arteries.(ABSTRACT TRUNCATED AT 250 WORDS)     

133例腔隙性脑梗死患者DSA结果及临床特点分析

目的 探讨腔隙性脑梗死患者的临床表现、影像学资料及DSA特点.方法 南方医科大学珠江医院神经内科自2002年5月至2008年4月共收治经头颅CT或MR证实并行DSA检查、初次出现临床症状的腔隙性脑梗死患者133例,回顾性分析患者的临床表现、影像学资料及DSA特点.结果 133例患者中临床表现为纯运动性卒中42例(31.6%),感觉运动性卒中36例(27.1%);CT/MR检查共发现梗死灶283个,梗死灶位于内囊78个(27.6%),放射冠+半卵圆中心121个(91.0%);DSA结果显示颅内大血管病变44例(101处),其中大血管狭窄38例(95处,其中责任血管34处,非责任血管61处),烟雾病6例,单发颅内动脉动脉瘤1例.DSA阳性患者中以纯运动性卒中(21例)和感觉运动性卒中(10例)居多,梗死部位以内囊(23个)和放射冠+半卵圆中心(31个)居多,44例患者存在至少1个脑血管病高危因素.结论 腔隙性脑梗死的病因多样,部分患者易出现颅内大血管狭窄,以纯运动性卒中和感觉运动性卒中最多,基底节和放射冠梗死灶为主,多存在脑血管病高危因素.

Abstract：

Objective To discuss the clinical manifestations, imaging data and DSA findings of lacunar infarction (LI). Methods One hundred and thirty-three patients, admitted to our hospital from May 2002 to April 2008, were chosen in our study; these patients with first onset as LI were confirmed by Head CT or MR; the clinical manifestations and imaging data were retrospectively analyzed; DSA was also performed on these patients and DSA findings were concluded. Results One hundred and thirty-three patients were clinically manifested as pure motor hemiplegia (PMH, n=42, 31.6%) and sensorimotor stroke (SMS, n=36, 27.1%). Two hundred and eighty-three lesions were noted by CT/MR examinations, including 78 locating at the endocyst (27.6%) and 121 locating at the corona radiate+greater oval center (91.0%). Forty-four patients were noted as having 101 intracranial vessel lesions by DSA, including 38 patients with angiostenosis, 6 with Moyamoya and 1 with single intracranial aneurysm; of the patients with angiostenosis, 95 lesions (34 in the offending vessels and 61 in other vessels) were found. Among the DSA (+) patients, PMH (n=21) and SMS (n=10) were mainly noted with their lesions locating at the endocyst (n=23) and the corona radiate+greater oval center (n=31); At least 1 high-risk factor such as hypertension, diabete, hyperlipemia, coronary heart disease and arial fibrillation was found in 44 patients. Conclusion The pathogeneses of LI are various. Main artery infarction may co-exist in some cases. PMH and SMS are common with their lesions frequently locating at basal ganglia area and corona radiate of the cerebral hemisphere. High risk factor exists in most patients with cerebrovascular diseases.