纹状体内囊梗死的MRI、SEP与临床

目的 应用形态性和功能性检查,结合临床特点探讨纹状体内囊梗死（ＳＣＩ）。方法 分析２７例ＳＣＩ患者的临床资料、核磁共振（ＭＲＩ）特点和体感诱发电位（ＳＥＰ）改变。结果 ２７例ＳＣＩ中,脑栓塞比例高,肢体瘫痪程度不等;ＭＲＩ示尾状核为主的前方型有自发性低下等精神症状,壳核为主的侧方型有失语等皮层症状;ＳＥＰ示Ｎ２０异常,且肌注纳络酮后Ｎ２０改善。结论 提高了ＳＣＩ作为脑梗死临床类型的认识水平。     

纹状体内囊梗死的临床特点分析

目的探讨纹状体内囊梗死(striatocapsular infarction,SCI)的临床特点和与大脑中动脉局部病灶的关系。方法 5例发病在24h内入院的基底节区梗死患者,病灶直径>3cm,对其临床表现、发病72h内的头、颈部磁共振和磁共振血管成像、全脑血管造影表现进行分析。结果 5例梗死灶均局限在基底节区白质,无皮层受累,4例有早期运动进展;1例为病灶侧大脑中动脉夹层,3例病灶侧大脑中动脉主干中度以上狭窄。结论 SCI患者易发生早期运动进展,可能与病灶同侧大脑中动脉主干狭窄有关。     

缺血性脑血管病梗死模式的分类及病因、发病机制研究进展

缺血性脑血管病的梗死模式具有多样性,根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类,多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。     

幕上皮层下梗死的病因及发病机制研究现状

幕上皮层下梗死是脑梗死一种重要的类型,明确这一概念并了解其分类及潜在的病因及发病机制,将有助于在临床上识别此类梗死,并针对可能的病因及发病机制进行有效地干预,从而改善其结局及预后,本文将探讨其分类、部分类型梗死的病因及发病机制。     

纹状体内注射6-羟基多巴制备帕金森病大鼠模型的实验研究

目的　研究纹状体内双靶点注射 6 -羟基多巴 (6 - OHDA)制备帕金森病大鼠模型的方法。方法　将2 2 0± 10 g雄性 Wistar大鼠随机分为 3组 :模型制备组 30只 ,假手术组 10只 ,正常对照组 10只。应用立体定向仪将6 - OHDA分两点注入大鼠右侧纹状体 ,每点 10 μg/5 μl。假手术组注射等量生理盐水。术后以阿朴吗啡检测旋转行为 ,平均每分钟逆时针旋转大于 7转者为成功模型。术后 2个月处死大鼠 ,行纹状体和黑质的 HE染色和 TH免疫组化染色 ,观察病理形态学变化。结果　 30只模型制作鼠中 ,共有 2 2只在阿朴吗啡多次注射后 ,恒定地转向左侧 ,每分大于 7转 ,为成功模型。光镜下 ,HE及 TH免疫组化染色可见模型组左侧黑质内有胞浆浓染、形状不一的 DA能神经元存在 ,数量较多 ,呈带状斜行排列。右侧 SNc区内 DA能神经元几乎消失 ,残存细胞萎缩。左右侧黑质内DA能神经元数目有显著差异 (P<0 .0 5 )。结论　纹状体内注射 6 - OHDA是一种有效的制备帕金森病模型的方法 ,模型制作成功率高。     

脑桥梗死不同病因机制的临床研究

目的 比较不同类型脑桥梗死的病因机制和临床特征。方法 选择脑桥梗死患者75例,分为基底动脉狭窄组9例和基底动脉无狭窄组66例,其中基底动脉无狭窄组又分为穿支病变组33例和小动脉病变组33例。比较各组的临床特征与影像学变化。结果 在各组的临床特征中,基底动脉狭窄组的糖尿病、冠状动脉粥样硬化性心脏病、合并其他颅内血管中重度狭窄、神经功能缺损进展发生率、入院美国国立卫生研究院卒中量表（NationalInstitutes of Health Stroke Scale,NIHSS）评分、出院NIHSS评分、出院改良Rankin量表（modified RankinScal e,mRS）评分≥3比例较其他组增高（P＜0.05）。穿支动脉病变组空腹血糖、餐后2 h血糖、糖化血红蛋白、入院收缩压、梗死灶大小、入院NIHSS、出院NIHSS评分、神经功能缺损进展、出院mRS评分比例高于小动脉病变组（P＜0.05）。结论 脑桥梗死存在不同的病因和发病机制。脑桥旁正中动脉梗死及合并基底动脉狭窄的脑桥梗死病变以动脉粥样硬化为主,病灶大,症状重,易发生进展,预后不良。     

腔隙性梗死的病因和发病机制的再认识

1838年Dechambre首先提出腔隙(lacune)的病理学概念.在上世纪的前半叶,对于腔隙的病因和机制(缺血性、出血性或炎症性)始终存在争论.现代的腔隙性梗死(lacunar infarct)的概念和认识主要依据于Fisher所开展的大量临床与病理研究.虽然对之认识已有50余年,但它与非腔隙性梗死的病因是否不同仍有争论.     

高分辨核磁共振对脑桥梗死不同病灶形态类型的病因机制研究

目的探讨急性孤立性脑桥梗死患者的梗死病灶形态与病因机制关系。方法回顾性纳入2016年3月～2019年2月广东省中医院收治的25例急性孤立性脑桥梗死患者,根据核磁共振弥散加权成像(DWI)梗死病灶形态类型分为脑桥旁中梗死(PPI)和脑桥深部小梗死(SDPI)。两组患者均在急性起病10 d内接受基底动脉的3. 0T高分辨核磁共振成像(HR-MRI)检查,依据HRMRI基底动脉管壁与穿支动脉的特点区分不同的梗死病因机制,分为分支动脉粥样硬化病(BAD)和腔隙性梗死(LI)。比较两种分型方法是否存在差异性。结果 DWI梗死灶形态分型显示,PPI组有15例(60. 0%),SDPI组有10例(40. 0%); HR-MRI的病因机制分型显示,BAD组有23例(92. 0%),其中15例均表现为脑桥旁正中梗死,8例表现为脑桥深部小梗死,LI组有2例(8. 0%);两种影像学分型比较,差异有统计学意义(P <0. 05)。结论 PPI与分支动脉粥样硬化所致的发病机制一致,SDPI需进一步接受高分辨核磁共振检查以明确梗死发病机制。     

脑分水岭梗死的临床特点及其发病机制研究

目的探讨脑分水岭梗死的临床特点及其发病机制。方法根据脑血管分布的影像学模板,回顾分析124例脑分水岭梗死患者的临床资料,确定并分析皮质分水岭梗死、皮质下型分水岭梗死和混合分水岭梗死3组患者的临床特征及病理生理机制。结果3组脑分水岭梗死患者的临床特征间差别无显著性意义(P＞0．05);皮质分水岭梗死的发病率与皮质下型分水岭梗死间差别有显著性意义(P＜0．001)。其中接受DSA检查的95例患者中,75．0%的皮质分水岭梗死有严重血管狭窄,60．7%皮质下型分水岭梗死有严重血管狭窄,9例混合分水岭梗死患者均有严重血管狭窄。结论分水岭梗死与脑动脉血管狭窄有密切的关系。     

脑穿支动脉病变梗死类型和神经影像学研究进展

大脑前动脉、大脑中动脉及后循环血管的穿支动脉,如豆纹动脉、脉络膜前动脉（anterior choroidal artery,AChA）和髓质动脉等,阻塞会导致脑深部缺血性病变。不同穿支动脉梗死类型不 同：豆纹动脉供血区域的梗死类型为腔隙性梗死、穿支动脉粥样硬化病型梗死和纹状体内囊梗死; AChA病变可导致AChA综合征;髓质分支梗死会导致半卵圆中心、放射冠部位的边界区梗死。7T二维 相位对比MRI、三维时间飞跃法MRA和三维快速自旋回波T1WI序列等神经影像学新技术有助于确定穿 支动脉早期病变,并可早期发现疾病的发生发展。     

小脑前下动脉梗死的临床及影像学特点

目的探讨小脑前下动脉（AICA）梗死的临床及影像学特点。方法回顾性分析32例患者的临床资料。结果AICA梗死绝大多数以眩晕、小脑性共济失调为首发表现，第Ⅷ对颅神经受累是其特征性表现。MRI上表现为桥脑外下侧或（和）小脑中脚区域的梗死。AICA梗死预后较好，但有可能进展为基底动脉梗死。结论AICA梗死的诊断主要依靠MRI，预后较好。     

高血糖并脑干梗死的磁共振特点、分型及发病机制的探讨

目的 比较高血糖脑梗死患者与血糖正常脑梗死患者危险因素及核磁共振(MR)影像学特点,并根据MR影像学特点进行分型,分析分型与预后的关系、高血糖对脑干梗死的影响,并探讨脑干梗死的发病机制. 方法 应用1;1配比的病例对照研究方法 ,对比高血糖组与正常血糖组脑梗死患者的危险因素、MRI影像学特征;采用mRS评分对脑干梗死患者预后进行比较. 结果 根据MR影像学特点将脑干梗死分为5型;中脑型、桥脑型、延髓型、全脑干型、脑干腔梗型,其中中脑型再分3个亚型、桥脑5个亚型、延髓型3个亚型.高血糖组脑干梗死发生率比正常血糖组高,差异有统计学意义(P<0.05);高血糖组收缩压、纤维蛋白原、甘油三酯、总胆同醇、低密度脂蛋白水平、合并高血压发生率较正常血糖组高,差异均有统计学意义(P<0.05),而舒张压及高密度脂蛋白水平两组差异无统计学意义(P0.05);脑干梗死人群高血糖组与正常血糖组相比,甘油三酯、纤维蛋白原、总胆固醇、高密度脂蛋白、低密度脂蛋白、高血压例数、高血压病程、收缩压、舒张压均无统计学意义(P0.05);高血糖脑梗死组脑干梗死人群与非脑干梗死人群相比,空腹血糖、餐后2h血糖、糖化血红蛋白均无统计学意义(P0.05).脑干梗死mRS评分2～5的占50.4%,0～1分占49.6%. 结论 高血糖与脑干梗死关系密切,提示高血糖对后循环穿支血管的影响更大,更易导致脑干梗死的发生;脑干梗死致残率较高.     

Therapeutic imaging window of cerebral infarction revealed by multisequence magnetic resonance imaging An animal and clinical study

In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes (T2-weighted imaging [T2WI], T2FLAIR, and diffusion-weighted imaging [DWI]) following cerebral infarction. The pathological changes were divided into three phases: early cerebral infarction, middle cerebral infarction, and late cerebral infarction. In the early cerebral infarction phase (less than 2 hours post-infarction), there was evidence of intracellular edema, which improved after reperfusion. This improvement was defined as the ischemic penumbra. In this phase, a high DWI signal and a low apparent diffusion coefficient were observed in the right basal ganglia region. By contrast, there were no abnormal T2WI and T2FLAIR signals. For the middle cerebral infarction phase (2-4 hours post-infarction), a mixed edema was observed. After reperfusion, there was a mild improvement in cell edema, while the angioedema became more serious. A high DWI signal and a low apparent diffusion coefficient signal were observed, and some rats showed high T2WI and T2FLAIR signals. For the late cerebral infarction phase (4-6 hours post-infarction), significant angioedema was visible in the infarction site. After reperfusion, there was a significant increase in angioedema, while there was evidence of hemorrhage and necrosis. A mixed signal was observed on DWI, while a high apparent diffusion coefficient signal, a high T2WI signal, and a high T2FLAIR signal were also observed. All 86 cerebral infarction patients were subjected to T2WI, T2FLAIR, and DWI. MRI results of clinic data similar to the early infarction phase of animal experiments were found in 51 patients, for which 10 patients (10/51) had an onset time greater than 6 hours. A total of 35 patients had MRI results similar to the middle and late infarction phase of animal experiments, of which eight patients (8/35) had an onset time less than 6 hours. These data suggest that defining the "therapeutic time window" as the time 6 hours after infarction may not be suitable for all patients. Integrated application of MRI sequences including T2WI, T2FLAIR, DW-MRI, and apparent diffusion coefficient mapping should be used to examine the ischemic penumbra, which may provide valuable information for identifying the "therapeutic time window".     

腔隙性梗死的影像学评估对照研究

目的对照研究CT与磁共振在腔隙性梗死诊断中的临床意义。方法选取安阳市肿瘤医院2013-02—2015-07收治的腔隙性梗死患者80例,所有患者行CT与磁共振检查,对诊断结果进行分析对比。结果病理检查检出病灶385例,磁共振检查共检出病灶360个(93.5%),CT检测出153个(39.7%),病灶位置包括丘脑、小脑、颞叶、基底节、额叶、枕叶、顶叶、脑干,磁共振检查病灶检出率明显高于CT(P0.05);两种检测方法的检出率对比差异有统计学意义(P0.05)。两种检查方法病灶大小对比差异有统计学意义(χ2=8.134,P0.05);两种检查方法检查时间、病灶大小、检查费用对比差异有统计学意义(P0.05);磁共振检查主要呈小片斑块状,T1、T2长信号,DWI加深,T2FLAIR高信号,CT检查影像主要呈低密度小片状、斑点状显影。结论 CT与磁共振均可用于腔隙性梗死诊断,但磁共振早期诊断价值以及病灶检出率明显优于CT检查,能够明确反映病灶的位置、大小及数量,便于后期及时有效治疗,值得在临床实践中推广应用。     

Spectrum of medial medullary infarction: clinical and magnetic resonance imaging findings

Among 4200 consecutive patients admitted to three hospitals with acute ischemic stroke, we found only 11 patients in whom magnetic resonance imaging (MRI) had proved that they had medial medullary infarction (MMI). In our centers, patients with MMI were less than 1 % of those with vertebrobasilar stroke. The infarcts documented by MRI were unilateral in 10 patients and bilateral in one. On clinico-topographical analysis there were four clinical patterns: (1) Classical Dejerine's syndrome was the most frequent, consisting of contralateral hemiparesis, lemniscal sensory loss and ipsilateral lingual palsy in 7 of the eleven patients. (2) Pure hemiparesis was present in 2 patients; (3) Sensorimotor stroke was present in 1 patient with contralateral hemiparesis, hypesthesia and mild decrease in pain sensation without lingual palsy; (4) Bilateral MMI syndrome in 1 patient, accompanied by tetraparesis, bilateral loss of deep sensation, dysphagia, dysphonia and anarthria. Presumed causes of MMI were intrinsic branch penetrator artery disease with concomitant vertebral artery stenosis in 6 of the 11 patients, vertebral artery occlusion in 2, dolichoectatic vertebrobasilar arteries in 2, a source of cardiac embolism in 1. Prognosis at 3 months was favorable in 8 patients, but the patient with bilateral MMI syndrome had persisting motor deficit causing limitation of daily activities, and 2 died from systemic causes. The classical triad of acute MMI facilitates the diagnosis, although the recognition of this syndrome in patients with incomplete manifestations can be difficult and occurs more frequently than commonly thought. Moreover, vertebral artery atherosclerosis and branch atheromatous disease of the penetrating arteries are the main causes of medullary infarction. Received: 21 February 2001, Received in revised form: 22 February 2001, Accepted: 17 May 2001     

Migraine-related stroke: brain infarction in superior cerebellar artery territory demonstrated by nuclear magnetic resonance

We report 4 cases of migraine-related stroke in young females. Two patients were taking oral contraceptives and one was pregnant. The results of the computerized tomography of the brain were negative in 3 patients and partially positive in one, while NMR showed ischemic lesions in the posterior fossa in each case. We would like to highlight the value of NMR in the assessment of migraine associated with prolonged focal neurologic deficiencies when the clinical examination revealed brain stem or cerebellar signs and the peculiar localization of the ischemic lesion that corresponded in all 4 cases to the area irrigated by the superior cerebellar artery. An hormonal factor is suspected as the precipitating event of this complication in 3 of these patients.     

Factors predictive of fatality in massive middle cerebral artery territory infarction and clinical experience of decompressive hemicraniectomy

To determine the factors predictive of fatality in massive middle cerebral artery (MCA) territory infarction and outcome of decompressive hemicraniectomy, 62 patients who were retrospectively verified with first event massive MCA infarctions were enrolled in this study. Amongst them, 21 received decompressive hemicraniectomy during hospitalization. Clinical data between early and late hemicraniectomy groups were also compared. Significant deterioration occurred in 40 cases, 21 of whom received decompressive hemicraniectomy. The other 19 received conservative treatment. The mortality rate of these 40 cases between decompressive hemicraniectomy and conservative treatment was 29% (six of 21) and 42% (eight of 19), respectively. Factors that predicted fatalities in our massive MCA infarction patients with or without decompressive hemicraniectomy were total scores of baseline GCS at the time of admission, associated with coronary artery diseases, and significant deterioration during hospitalization. This study confirms the lifesaving procedure of hemicraniectomy that prevents death in patients deteriorating because of cerebral edema after infarction, although it may produce severe disability with an unacceptably poor quality of life in survival. Despite high mortality and morbidity, decompressive hemicraniectomy to prevent cerebral herniation when significant deterioration is demonstrated are essential for maximizing the potential for survival.     

分水岭脑梗死的临床研究及磁共振特征分析

目的探讨分水岭脑梗死(CWSI)的临床特征、治疗、头部磁共振成像(MRI)及磁共振血管成像(MRA)特征和临床应用价值。方法对我院48例分水岭脑梗死患者回顾分析。结果治愈26例,显著进步12例,好转8例;恶化、死亡各1例;MRI显示皮质前型8例,皮质后型14例,皮质下型24例,混合性2例;MRA显示颈内动脉狭窄或闭塞17处,大脑前动脉或闭塞10处,中动脉狭窄或闭塞8处,大脑后动脉6处,椎基底动脉6处。结论全身血压下降、颈内动脉等脑主干动脉狭窄或闭塞引起分水岭区域血液动力学障碍、血流改变以及微栓塞、Willis环完整性是主要发病原因,磁共振成像对分水岭脑梗死能提供更多的影像学信息。     

Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study

We studied clinicopathological correlations between magnetic resonance imaging (MRI) appearances of postmortem brains and pathological findings in 12 patients to identify simple criteria with which to distinguish lacunar infarctions from enlarged Virchow-Robin spaces. In vivo MRI was also available for 6 of the 12 patients. We focused on small, silent, focal lesions including lacunar infarctions and enlarged Virchow-Robin spaces that were confirmed pathologically. From a total of 114 lesions, enlarged Virchow-Robin spaces were most often found in the basal ganglia and had a round or linear shape. Lacunar infarctions also were most frequent in the basal ganglia, but 47% of these were wedge-shaped. In the pathological studies, excluding lesions from the lower basal ganglia region, enlarged Virchow-Robin spaces were usually smaller than 2 × 1 mm. The shapes and sizes of the lesions determined by MRI (in vivo and postmortem) concurred with the pathological findings, except that on MRI the lesions appeared to be about 1 mm larger than found in the pathological study. When lesions from the lower basal ganglia and the brain stem regions are excluded, the sensitivity and specificity for discriminating enlarged Virchow-Robin spaces from lacunar infarctions are optimal when their size is 2 × 1 mm or less in the pathological study (79%/75%, respectively), 2 × 2 mm or less in both of the MRI studies: postmortem (81%/90%), and in vivo (86%/91%). In conclusion, we were able to differentiate most lacunar infarctions from enlarged Virchow-Robin spaces on MRI on the basis of their location, shape and size. We stress that size is the most important factor used to discriminate these lesions on MRI. Received: 14 February 1997 Received in revised form: 12 September 1997 Accepted: 1 October 1997     

小脑前下动脉梗死的临床特征及病因探讨(附22例报告)

目的 分析小脑前下动脉(AICA)梗死的临床表现及MR改变，并探讨AICA梗死形成的原因。方法 对22例AICA梗死患者的临床表现、MRI及MRA进行分析。结果 AICA梗死的主要累及小脑中脚和(或)脑桥外下方，其症状体征以眩晕及共济失调为主，可合并多组颅神经受累，以Ⅷ对颅神经受累最具特征性。MRA上单纯AICA梗死单侧者，基底动脉(BA)显示良好，双侧AICA梗死及合并其它小脑梗死者BA未显影或显示狭窄。结论 AICA梗死的诊断主要依靠MRI，MRA对判定病因及预后有重要意义。