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.     

A case of juvenile cerebral infarction caused by bilateral anterior cerebral artery dissection]

A 38-year-old man was admitted to our hospital with headache, dysarthria and paraparesis. Brain CT and diffusion MRI disclosed cerebral infarction at bilateral anterior cerebral artery (ACA) territories. His symptoms and signs deteriorated in several days despite intensive antithrombotic therapy, resulting in right hemiparesis, akinetic mutism, memory disturbance, change of personality, urinary incontinence, forced grasping, and starting delay of speech and motion. Cerebral angiography demonstrated occlusion with contrast pooling at the right ACA A2 portion. Stenosis and dilatation were found at left ACA A2 portion. An intimal flap was also demonstrated on serial angiography. This case was diagnosed as cerebral infarction caused by dissection of bilateral ACA. Although no definite primary arteriopathy was demonstrated, bilateral dissection could be occurred simultaneously.     

Posterior cerebral artery infarction from middle cerebral artery infarction

BACKGROUND: While it is known that posterior cerebral artery (PCA) infarction may simulate middle cerebral artery (MCA) infarction, the frequency and localization of this occurrence are unknown. OBJECTIVE: To determine the frequency of PCA infarction mimicking MCA infarction and the territory of the PCA most commonly involved in this simulation. DESIGN: We studied 202 patients with isolated infarction in the PCA admitted to our stroke center to determine the frequency of PCA infarction simulating MCA infarction, the involved PCA territory, and the patterns of clinical presentation. RESULTS: We found 36 patients (17.8%) with PCA ischemic stroke who had clinical features suggesting MCA stroke. The PCA territory most commonly involved was the superficial PCA territory (66.7%), followed by the proximal PCA territory (16.7%) and both the proximal and the superficial PCA territories (16.7%). The principal stroke mechanism was cardioembolic (54.1%) in the superficial PCA territory, lacunar (46.2%) in the proximal PCA territory, and undetermined (40.2%) in both the proximal and the superficial territories. Among the 36 patients, the most common clinical associations were aphasia (13 patients), visuospatial neglect (13 patients), and severe hemiparesis (7 patients). CONCLUSIONS: Posterior cerebral artery infarction simulating MCA infarction is more common than previously thought. Early recognition of the different stroke subtypes in these 2 arteries may allow specific management.     

Orgasmic headache and middle cerebral artery dissection

A patient with a 20 year history of primary orgasmic headache is described who, after suffering an unusually severe episode of orgasmic headache was found to have a middle cerebral artery dissection. This unusual association of primary and secondary orgasmic headache emphasises the need for a thorough diagnostic examination when the orgasmic headache differs from that of previous episodes or is associated with neurological symptoms.     

Hemicraniectomy for middle cerebral artery infarction

The space-occupying so-called “malignant” middle cerebral artery infarction is—besides acute basilar artery occlusion—the most devastating form of ischemic stroke. Until recently, there was no proven treatment. In 2007, results from randomized controlled trials provided evidence for the benefit of early hemicraniectomy with respect to mortality after 3 months. This review focuses on current treatment options for malignant ischemic brain infarction, especially hemicraniectomy. Moreover, major unsolved problems and open questions regarding the disease are discussed, and perspective is given on future clinical studies.     

以三偏征为临床表现的大脑后动脉区梗死

目的 分析大脑后动脉区梗死所致三偏征的临床特点。方法 对11例表现三偏征的大脑后动脉区梗死患者的临床和影像资料进行总结并分析其特点。结果 PCAI的三偏征患者中，偏盲及偏身感觉障碍明显且恢复较差，多数偏身运动障碍恢复快，常伴有头痛。结论 对有上述三偏征的患者应考虑PCAI所致，影像学检查可帮助明确诊断。     

"Malignant" middle cerebral artery territory infarction

The pathology, clinical course, outcome, diagnosis, treatment and prognosis of dramatic malignant middle cerebral artery territory infarction were presented. About 10% of stroke patients suffer from malignant middle cerebral artery territory infarction, mainly due to brain edema and herniation. This syndrome causes high mortality. The newest conservative and surgical treatment was presented.     

The blood-brain barrier to protein tracers in focal cerebral ischemia and infarction caused by occlusion of the middle cerebral artery

Summary A study was made on the blood-brain barrier (BBB) to protein tracers in focal cerebral ischemia and infarction caused by permanent or temporary occlusion of the middle cerebral artery (MCA) in the rhesus monkey.Permanent occlusion of the MCA for 1–48 hrs only exceptionally caused extravasation of intravenously injected Evans blue, but temporary occlusion for 4 hrs followed by recirculation for 2 hrs frequently caused exudation of the tracer, particularly in the grey matter of the MCA territory. Reduction of the collateral supply during MCA occlusion of less than 4 hrs did not cause extravasation of the tracer.If the temporary MCA occlusion caused no or only microscopical brain necrosis, no extravasation of the dye could be detected, irrespective of the survival time of the animal. Monkeys with medium-sized subcortical infarcts and survival times between 3 days and 3 weeks showed exudation of evans blue in 50% of the cases, whereas almost all animals with large cortical and subcortical infarcts showed abnormal blue staining in parts of the lesions. All animals examined 23 days or later after the MCA occlusion did not show any changes of the BBB. Extravasation of the tracer during the first 3 weeks after MCA occlusion is therefore related to thesize of the resulting brain necrosis, but restitution of the BBB occurs thereafter irrespective of infarct size.

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Zusammenfassung Die Bluthirnschranke (BHS) für Proteintracer bei focaler cerebraler Ischämie und bei Hirninfarkten infolge dauerndem oder passagem Verschluß der A. cerebri media (ACM) wurde beim Rhesusaffen untersucht.Dauernder Verschluß der ACM für 1–48 Std verursachte nur ausnahmsweise einen Austritt von i.v. injiziertem Evansblau, während vorübergehende Klemmung von 4 Std Dauer gefolgt von Wiederdurchblutung durch 2 Std häufig einen Austritt der Markierungssubstanz, vor allem in den grauen Anteilen des Versorgungsgebietes der ACM bewirkte. Drosselung der Kollateralversorgung während Verschlusses der ACM für weniger als 4 Std verursachte keinen Austritt des Tracers.Wenn der passagere Verschluß der ACM keine oder nur eine histologisch faßbare Hirngewebsnekrose verursachte, so war unabhängig von der Überlebenszeit des Tieres kein Farbstoffaustritt nachweisbar. Affen mit mittelgroßen subcorticalen Infarkten und Überlebenszeiten zwischen 3 Tagen und 3 Wochen zeigten Evansblauaustritte in 50% der Fälle, während fast alle Tiere mit großen corticalen und subcorticalen Infarkten eine abnorme Blaufärbung von Teilen der Läsionen aufwiesen. Keines der Tiere, die 23 Tage oder länger nach Verschluß der ACM untersucht wurden, zeigte Störungen der BHS. Der Austritt des Tracers während der ersultierenden Hirngewebsnekrose, doch ist die darauffolgende Restitution der BHS-Funktion unabhängig von der Größe des Infarkts.

     

Labyrinthine infarction caused by vertebral artery dissection: consideration based on MRI

Journal of Neurology -     

Topography of cerebral infarction associated with carotid artery dissection

Because the pathogenesis of cerebral ischaemia in internal carotid artery dissection (ICAD) is controversial we studied the topography of cerebral infarction that results from ICAD according to pathophysiology of embolic and haemodynamic stroke. Sixty-four patients with 67 ICADs diagnosed by angiography, Doppler duplex sonography and magnetic resonance imaging (MRI) were studied prospectively during the past decade. According to current pathophysiological concepts, cortical territorial infarcts and large subcortical lenticulostriate infarcts revealed by CT or MRI were classified as embolic, while smaller infarcts in the subcortical junctional zone and infarcts in the cortical borderzone between the middle (MCA) and anterior cerebral artery were interpreted as haemodynamic infarcts. Of the 67 dissections 37 (55%) were associated with brain infarcts, of which territorial MCA infarcts of variable size accounted for 60%. These were combined with infarcts of the anterior and posterior cerebral artery in 5%; 8% of the patients had complete MCA infarction. Large lenticulostriate infarcts were present in 11%. Haemodynamic infarcts involved the subcortical junctional zone in 16% but never the anterior cortical borderzone. Although different abnormal Doppler findings indicated haemodynamically significant carotid obstruction in all symptomatic ICADs, only the characteristic high-resistance Doppler signal was significantly associated with the occurrence of brain infarction (in 66%,P < 0.01). The angiographic features of ICAD did not correlate with the incidence or with the topography of cerebral infarction. Patterns of infarction in ICAD indicate a predominantly embolic causation probably due to thrombus formation in the dissected carotid artery in the presence of severe haemodynamic obstruction, as demonstrated by Dopppler sonography.Presented in part at the 3rd European Stroke Conference, Stockholm, May 1994     

急诊血管内支架置入术治疗颈动脉夹层导致急性脑梗死的疗效分析

目的 探讨急诊血管内支架置入术治疗颈动脉夹层导致急性脑梗死的疗效。方法 回顾性分析2015年6月-2019年6月于宜昌市中心人民医院就诊的52例颈动脉夹层导致急性脑梗死患者的临床资料; 入组患者根据治疗方式分为血管内支架置入组(20例)和药物治疗组(32例); 分别记录患者年龄、性别、是否有高血压病、糖尿病等基本情况,比较2组患者颅内出血发生率、脑卒中复发率等情况,并随访其美国国立卫生研究院卒中量表(NIHSS)及改良 Rankin量表(mRS)评分及评估血管内支架置入治疗的有效性。结果 2组患者年龄、性别、高血压病、糖尿病、治疗前NIHSS评分比较无明显差异(P>0.05)。血管内支架置入组并发症发生率为30%,高于药物治疗组的18.6%,但2组比较无明显差异(P>0.05)。血管内支架置入组治疗7 d后的NIHSS评分为(2.5±3.2)分,90 d后随访mRS 0～2分患者占80%(16/20); 药物治疗组治疗7 d后的NIHSS评分为(5.4±3.5)分,90 d后随访mRS 0～2分患者占50%(16/32),2组比较均有明显差异(P<0.05)。结论 急诊血管内支架置入术可改善颈动脉夹层导致的急性脑梗死患者的近期及远期预后     

Dense middle cerebral artery sign: an indicator of poor outcome in middle cerebral artery area infarction.

Thirteen patients with a dense appearance of the horizontal part of the middle cerebral artery (MCA) "dense middle cerebral artery sign" in CT scans taken within 24 hours after onset of ischaemic stroke had considerably poorer prognosis than controls with stroke, but without the sign. A hyperdense appearance of the MCA is known to be associated with thromboembolism, but dense middle cerebral artery sign is also an early warning of a large infarction, brain oedema and poor prognosis in infarction in the MCA area.