脑梗死出血转化32例临床与影像分析

目的 探讨脑梗死出血转化（hemorrhagic transformation,HT）的临床与影像改变的特点.方法 回顾性分析32例继发出血转化的脑梗死患者临床、影像资料.结果 ①卒中症状加重或出现新症状者15例（46.9％）,继发HT后美国国立卫生研究院卒中量表（NIHSS）评分较起病时增加（P=0.017）;HT发生距起病中位数为2天;②梗死部位：大脑半球29例（90.6％）,病灶直径＞3.0 cm 27例（84.4％）;③出血部位：脑叶19例（59.4％）,基底节区13例（40.6％）;④CT/MRI发现片状出血23例（71.9％）,脑组织肿胀17例（53.1％）.结论 脑梗死出血转化最常见于大脑中动脉供血区脑梗死,其中约半数患者出现卒中症状加重或新症状,以片状出血最多见,CT/MRI是诊断HT的重要手段.

Study on clinical and radiological changes in 32 patients with hemorrhagic transformation after cerebral infarction

Objective To investigate the clinical and radiological features of hemorrhagic transformation （HT） after cerebral infarction （CI）.Method We retrospectively studied the medical records,the brain CT/MRI changes in 32 cases of cerebral infarction with HT.Results ① 15 cases （46.9％） suffered from progressive stroke symptoms or new central neurological symptoms,National Institutes of Health Stroke Scale （NIHSS） after HT was significantly higher than that at onset （P =0.017）.The median from onset to HT was 2 days.② The lesions of infarction located in the cerebral hemisphere in 29 cases （90.6％）,and the diameters of the lesions in 27 cases （84.4％） were greater than 3.0 cm.③ As the location of HT,the cerebral lobes were involved in 19 cases （59.4％）,while basal ganglia involved in 13 cases （40.6％）.④ CT/MRI demonstrated plaque-shape hemorrhage in 23 cases （71.9％）,while focal brain edema were found in 17 cases （53.1％）.Conclusion HT after CI happened primarily in the area of the middle cerebral artery,half of the patients suffered from progressive stroke symptoms or new symptoms,CT/MRI played an important role in the diagnosis of HT.