Transient Neurologic Deterioration after Total Removal of Parasagittal Meningioma Including Completely Occluding Superior Sagittal Sinus

In surgical planning of the parasagittal meningioma, invasion and occlusion of the superior sagittal sinus are important factors. When tumor is located within anterior 1/3, or when angiographic finding shows total occlusion of superior sagittal sinus, it is regarded that the ligation of superior sagittal sinus is safe. We report a case of parasagittal meningioma in 59-year-old male patient with complete occlusion of superior sagittal sinus which was confirmed by preoperative angiography, who developed temporary neurologic deterioration after superior sagittal sinus ligation and resection.     

Middle Cerebral Artery Atherosclerosis and Deep Subcortical Infarction: A 3T Magnetic Resonance Vessel Wall Imaging Study

Background

Deep subcortical infarction is a major subtype of stroke in middle cerebral artery (MCA) territory. This study aims to evaluate the relationship between characteristics of MCA plaque and features of deep subcortical infarction.

Topographic Patterns of Small Subcortical Infarcts Associated with MCA Stenosis: A Diffusion-Weighted MRI Study

BACKGROUND AND PURPOSE: Small subcortical infarcts (SSI, maximum lesion diameter < or =2.0 cm) are usually considered as infarcts caused by small vessel disease. However, SSI can also be associated with large artery occlusive disease such as middle cerebral artery (MCA) stenosis. We performed a prospective study to investigate the relationship between MCA stenosis and SSI distribution and further to investigate the mechanism of SSI caused by MCA stenosis. METHODS: Magnetic resonance angiography (MRA) and diffusion-weighed MRI (DWI) of consecutive acute ischemic stroke patients with recent SSI were studied. The distribution of acute infarcts on DWI was categorized as cortical infarct (CI), border zone infarct (BI), or perforating artery infarct (PAI). RESULTS: Totally, 93 cases were recruited, among which 12 had single SSI with MCA stenosis (group 1) and 26 patients had multiple SSI with MCA stenosis (group 2), while 55 patients without MCA stenosis had single SSI (group 3). For patients with single SSI and MCA stenosis, 6 had BI and 6 had PAI; for patients with multiple SSI and MCA stenosis, 25 had BI, 4 had PAI and 9 had CI (compared with group 1: P= .001); for patients with single SSI but without MCA stenosis, 20 had BI and 35 had PAI (compared with group 1: P= .58). CONCLUSION: Multiple acute infarcts along the border zone are the commonest pattern in small infarcts with MCA stenosis, especially among those with multiple acute infarcts. Our data suggest that hemodynamic compromise and artery-to-artery embolism may be both important factors for infarcts in patients with MCA stenosis.     

脑小血管病患者运动功能及影像特征与运动诱发电位的相关性研究

目的 探讨脑小血管病（cerebral small vessel disease,CSVD）患者运动功能及影像特征与经颅磁刺 激运动诱发电位（transcranial magnetic stimulation induced motor evoked potentials,TMS-MEP）的相关性。 方法 回顾性分析深圳市人民医院神经内科2018年1月-2019年8月住院的符合CSVD诊断标准且已 行TMS-MEP检查的患者。记录患者的性别、年龄和血管危险因素等临床资料及MEP相关电生理数据,包 括中枢运动传导时间（central motor conduction time,CMCT）和静息运动阈值（resting motor threshold, RMT）。评估并量化CSVD的影像学特征,包括近期皮质下小梗死（recent small subcortical infarct,RSSI）、 腔隙、扩大的血管周围间隙、脑白质高信号、脑微出血和脑萎缩。根据是否有肌力减退分为症状半球 组和非症状半球组。比较两组间的影像学特征及MEP特征,分析CSVD影像特征与MEP的相关性。 结果 研究共纳入202例CSVD患者,共404侧大脑半球。平均年龄64.0±10.6岁,男性135例（66.8%）。 症状半球组77侧（19.1%）,非症状半球组327侧（80.9%）。症状半球组中CMCT（P =0.005）和RMT （P＜0.001）高于非症状半球组。症状半球组RSSI数目多于非症状半球组（P＜0.001）。RSSI与CMCT （r =0.512,P =0.043）及RMT（r =0.730,P＜0.001）正相关。脑白质高信号、腔隙、扩大的血管周围间隙、 微出血及脑萎缩与CMCT、RMT均无相关性。 结论 RSSI与CMCT、RMT正相关,RSSI可能是导致CSVD相关运动障碍的主要影像学特征。     

Neurological deterioration in small vessel disease may be associated with increase of infarct volume

BACKGROUND AND PURPOSE: The mechanism of neurological deterioration in small vessel disease is unclear. We examined the relationship between neurological deterioration and change of infarct volume in acute small vessel disease. METHODS: We studied consecutive patients with acute supratentorial small vessel disease. Patients were classified into two groups (D: group with deterioration, N: group with no deterioration). We performed serial MRI studies, measured infarct volumes using NIH Image, and calculated the changes in infarct volume (Delta volume) between initial and follow-up diffusion-weighted imaging (DWI). RESULTS: Seventy-two patients (44 males, 68+/-11 years of age) were enrolled. Fifteen patients exhibited neurological deterioration (group D) and 57 patients did not (group N). Initial infarct volume was 0.66 cm3 in group D and 0.45 cm3 in group N (p=0.025). Infarct volumes on follow-up DWI were 1.41 cm3 and 0.72 cm3, respectively (p=0.001). The Delta volume in group D was larger than that in group N (0.76 cm3 vs 0.27 cm3, p=0.001). In order to differentiate D from N group, sensitivity specificity analysis yielded a cut-off value of Delta volume of 0.5 cm3 for differentiation of the two groups, which exhibited a sensitivity of 80% and specificity of 84%. Multivariate logistic regression analysis demonstrated that increase in infarct volume of over 0.5 cm3 (odds ratio; 18.0, 95% CI; 1.4 to 270, p=0.027) was independently associated with neurological deterioration in patients with acute small vessel disease. CONCLUSIONS: Enlargement of infarct volume may contribute to neurological deterioration in acute small vessel disease.     

Lenticulostriate artery combined with neuroimaging markers of cerebral small vessel disease differentiate the pathogenesis of recent subcortical infarction

Recent subcortical infarction (RSI) in the lenticulostriate artery (LSA) territory with a non-stenotic middle cerebral artery is a heterogeneous entity. We aimed to investigate the role of LSA combined with neuroimaging markers of cerebral small vessel disease (CSVD) in differentiating the pathogenic subtypes of RSI by whole-brain vessel-wall magnetic resonance imaging (WB-VWI). Fifty-two RSI patients without relevant middle cerebral artery (MCA) stenosis on magnetic resonance angiography were prospectively enrolled. RSI was dichotomized as branch atheromatous disease (BAD; a culprit plaque located adjacent to the LSA origin) (n = 34) and CSVD-related lacunar infarction (CSVD-related LI; without plaque or plaque located distal to the LSA origin) (n = 18). Logistic regression analysis showed lacunes (odds ratio [OR] 9.68, 95% confidence interval [CI] 1.71–54.72; P = 0.010) and smaller number of LSA branches (OR 0.59, 95% CI 0.36–0.96; P = 0.034) were associated with of BAD, whereas severe deep white matter hyperintensities (DWMH) (OR 0.11, 95% CI 0.02–0.71; P = 0.021) was associated with CSVD-related LI. In conclusion, the LSA branches combined with lacunes and severe DWMH may delineate subtypes of SSI. The WB-VWI technique could be a credible tool for delineating the heterogeneous entity of SSI in the LSA territory.     

首发缺血性卒中患者无症状性腔隙性梗死严重程度的相关因素分析

目的 分析与无症状性腔隙性梗死严重程度相关的危险因素,并评价无症状性腔隙性梗死与缺血 性卒中病因亚型的相关性。 方法 连续选取791例7天以内首次发病的非心源性缺血性卒中患者。收集患者的人口学信息和血管 病的危险因素,评价患者的头颅磁共振成像包括无症状性腔隙性梗死的数量、脑白质疏松的严重程 度、缺血性卒中的病因亚型以及急性梗死灶的分布特征,并通过多元Logistic回归分析其与无症状性 腔隙性梗死相关的危险因素。 结果 296例患者（37.4%）伴无症状性腔隙性梗死。单因素分析发现：高龄、高血压、入院时血压 较高、糖尿病、脑出血病史、Fazekas评分≥3分、小动脉闭塞性卒中、单发梗死灶、无小的皮层梗死灶、 无分水岭梗死和流域性梗死与无症状性腔隙性梗死患病相关。多元Logistic回归发现：男性、高血压、 较高的舒张压、糖尿病、脑出血病史、Fazekas评分≥3分、小动脉闭塞性卒中是无症状性腔隙性梗死 患病的危险因素。 结论 首发非心源性缺血性卒中患者无症状性腔隙性梗死的患病率较高。伴无症状性腔隙性梗死 的首发非心源性缺血性卒中患者常有较重的脑白质疏松,并且所患缺血性卒中以小动脉闭塞性卒中 常见。     

不伴基底动脉狭窄的脑桥旁正中梗死部位与发病机制的关系

目的探讨不伴基底动脉狭窄的脑桥旁正中梗死(PPI-BAS)部位与发病机制的关系。方法回顾性分析脑桥旁正中梗死(PPI)患者150例,将PPI-BAS按梗死部位分为累及脑桥腹侧表面组(vPPI-BAS)及未累及脑桥腹侧表面组(dPPI-BAS),以伴基底动脉狭窄的脑桥旁正中梗死(PPI+BAS)为对照,比较其年龄、性别、吸烟、饮酒、高脂血症、高同型半胱氨酸血症、冠心病、糖尿病、颅内颈内动脉系狭窄(ICAS)、颅外动脉粥样硬化(EAAS)、基底动脉高信号、梗死灶层面数≥2层、早期神经功能恶化(END)、高血压、腔隙性脑梗死(LI)和脑白质疏松(LA)是否有差异。结果 150例患者中dPPI-BAS组41例(27.3%),vPPI-BAS组65例(43.3%),PPI+BAS组44例(29.3%),三组之间年龄、性别、吸烟、饮酒、高脂血症、高同型半胱氨酸血症差异无统计学意义(P0.05),三组之间冠心病、糖尿病、高血压、LA分级、LI分级、ICAS、EAAS、基底动脉高信号、梗死灶层面数≥2层及END的差异有统计学差异(P0.05)。vPPI-BAS组与PPI+BAS组各因素之间差异均无统计学差异(P0.05)。与PPI+BAS组比较,dPPI-BAS组冠心病、糖尿病、ICAS、EAAS、基底动脉高信号、梗死灶层面数≥2和END的发生率低,而高血压、LA、LI的发生率高(P0.05)。vPPI-BAS组与dPPI-BAS组比较,vPPI-BAS组ICAS、EAAS、梗死灶层面数≥2层和END发生率高,dPPI-BAS组高血压、LA和LI发生率高(P0.05)。多因素logistic回归分析结果显示:LA分级是dPPI-BAS的独立危险因素。结论 vPPI-BAS多由动脉粥样硬化机制引起,dPPI-BAS多由小血管病机制引起。     

皮质下血管性认知障碍患者弥散张量成像和脑血流量的研究

目的明确脑小血管病(cerebral small vessel disease,CSVD)患者白质完整性、脑血流量及其认知障碍之间的关系。方法连续招募严格定义的CSVD患者58例,分为无认知障碍(no cognitive impairment,NCI)11例、血管性轻度认知障碍(vascular mild cognitive impairment,VaMCI)29例和血管性痴呆(vascular dementia,VaD)18例三组,评定脑室旁(periventricular,PV)及放射冠(corona radiate,CR)白质的弥散张量成像(diffusion tensor imaging,DTI)参数,即平均弥散率(mean diffusivity,MD)和各向异性分数(fractional anisotropy,FA)。应用CT灌注(CT perfusion,CTP)成像对PV和CR区进行脑血流量(cerebral blood flow,CBF)测定。对DTI参数、CBF和认知评分进行相关性分析。结果 1三组间PV区的CBF及MD值比较,差异均有显著性(P0.01),其中MD值与CBF以及注意执行功能间均呈显著相关性(P0.01),但CBF和认知功能间未见相关性。三组间FA值比较,差异均无显著性,FA值亦未显示与CBF以及认知功能的相关性。2三组间CR区的CBF和MD、FA值比较,差异均无显著性,仅CR区MD和注意执行功能有一定相关性(P0.05),CBF与DTI参数以及认知功能间均未见相关性。结论脑室旁白质完整性的破坏是CSVD患者认知损害的重要影像学标志,且与低灌注密切相关。     

偏头痛伴皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病临床分析

目的探讨国人伴皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病合并偏头痛的可能性。方法对1例临床表现为偏头痛、记忆力减退和情感障碍的患者进行临床MRI、皮肤活检电镜检查。结果患者有家族性偏头痛史，记忆力减退、情感障碍IMRI显示多发性腔隙梗死、白质疏松；皮肤血管内皮细胞增厚，血管平滑肌嗜锇颗粒阳性。结论中国人伴皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病也有可能伴有偏头痛。皮肤活检的血管变化与脑动脉病的关系尚不明。     

阿加曲班治疗急性脉络膜前动脉梗死的疗效观察

目的探讨阿加曲班抗凝治疗急性脉络膜前动脉梗死患者的疗效。方法将急性脉络膜前动脉梗死患者40例分为阿加曲班组(20例)和对照组(20例)。2组均给予他汀类稳定斑块,控制危险因素(血压、血糖)等基础治疗。在基础治疗上,阿加曲班组第1、2天给予阿加曲班120mg/d,48h持续静脉泵入,第3~7天给予阿加曲班20mg,2次/d,抗凝治疗结束后加用阿司匹林100mg/d,氯吡格雷75mg/d;对照组入院后给予阿司匹林100mg/d,氯吡格雷75mg/d,持续应用。测定2组治疗前及治疗后第7、14、30天NIHSS评分及有效率。治疗前完善头颅影像学、血常规、肝肾功能及凝血功能等生化指标。治疗期间观察用药相关不良反应。结果治疗后第7、14、30天与治疗前比较NIHSS评分均降低,以治疗后第30天最为显著,差异有统计学意义(P0.05);阿加曲班组有效率高于对照组,差异有统计学意义(P0.05)。结论阿加曲班可明显改善急性脉络膜前动脉供血区梗死者的神经功能缺损,改善远期预后,显效率高,安全性好。     

脑小血管病患者阿司匹林抵抗的发生率及其与长期预后的关系

【摘要】 目的 探讨脑小血管病（cerebral small vessel disease，CSVD）患者阿司匹林抵抗（aspirin resistance， AR）的发生率，以及AR与结局的关系。 方法 前瞻性纳入2015年8月-2017年6月诊断为CSVD的住院患者。根据血栓弹力图仪测量血小板 抑制率将患者分为AR组和非AR组。记录所有患者基线时人口学、实验室检查、影像学检查等资料，并 在2年随访期间进行影像学复查，同时记录患者新发血管事件及死亡情况。使用多因素Logistic回归分 析确定AR与结局的关系。 结果 共纳入94例患者，年龄为49～84岁，平均年龄66.20±7.37岁，男性55例（58.5%），AR的发生 率为23.4%（22/94）。AR与2年内新发腔隙性脑梗死（OR 4.70，95%CI 1.56～24.13，P =0.041）和脑白 质病变加重（OR 4.07，95%CI 1.28～11.57，P =0.038）风险相关，与新发血管事件及死亡风险无关。 结论 CSVD住院患者中AR发生率约1/5，AR与脑白质病变加重和新发腔隙性脑梗死风险相关。     

穿支动脉粥样硬化性疾病的诊治进展

穿支动脉粥样硬化性疾病（branch atheromatous disease,BAD）是引起急性孤立性皮层下梗死的常见且重要的病因,尤以亚洲人群多见。与脑小血管病所致腔隙性梗死比较,BAD相关梗死灶直径、形态学分布具有一定的特征性。BAD相关卒中急性期更易出现症状波动或神经功能恶化,早期预后不良。目前BAD仍缺乏统一的临床影像诊断标准,使得BAD临床研究及精准诊疗面临挑战。近期应用高分辨及高场强磁共振技术可同时显示载体动脉管壁和穿支动脉形态,未来有望突破BAD的发病机制研究的瓶颈。本文对BAD临床影像特征、诊断标准及防治策略等进行综述,以期提高临床医师的重视和认知水平。     

穿支动脉粥样硬化性疾病的诊治进展

穿支动脉粥样硬化性疾病（branch atheromatous disease,BAD）是引起急性孤立性皮层下梗
死的常见且重要的病因,尤以亚洲人群多见。与脑小血管病所致腔隙性梗死比较,BAD相关梗死灶直
径、形态学分布具有一定的特征性。BAD相关卒中急性期更易出现症状波动或神经功能恶化,早期预
后不良。目前BAD仍缺乏统一的临床影像诊断标准,使得BAD临床研究及精准诊疗面临挑战。近期应
用高分辨及高场强磁共振技术可同时显示载体动脉管壁和穿支动脉形态,未来有望突破BAD的发病
机制研究的瓶颈。本文对BAD临床影像特征、诊断标准及防治策略等进行综述,以期提高临床医师
的重视和认知水平。