大脑中动脉狭窄或闭塞患者影像学与临床分析

目的探讨大脑中动脉严重狭窄或闭塞患者临床与影像学特征。方法回顾性分析35例大脑中动脉中重度狭窄或闭塞患者的临床资料，并对其临床表现、MRA影像学特征进行分析。结果临床表现：35例患者均表现为偏瘫，其中面部和上下肢同时受累16例（45．7％），上下肢同时受累11例（31．4％），面部及上肢受累3例（8．6％），单纯面部受累2例（5，7％），面部及下肢受累2例（5．7％），单纯上肢受累1例（2．9％）。MRA影像学特征及脑梗死类型：29例（82．9％）患者表现为病变侧MCA中度以上狭窄，6例（17．1％）表现为MCA闭塞。30例（85．7％）表现为缺血性梗死灶，其中深部小梗死最为常见（53．3％），其次为交界区梗死（26．7％），皮层区域内脑梗死相对较少（20．0％）。结论偏瘫是大脑中动脉狭窄或闭塞患者常见的临床症状，主要表现为面部和上下肢同时受累；深部小梗死是影像学脑梗死常见的类型。

Clinical and imaging features and infarct pattern analysis in patients with middle cerebral artery stenosis and occlusion

Objective To evaluate the clinical and imaging features and infarct pattern in patients with middle cerebral artery(MCA) stenosis and occlusion,to clarify its infarct pathogenesis. Methods 35 MCA moderate and severe stenosis or occlusion patients diagnosed by TCD were studied;the clinical and imaging features and infarct pattern were retrospectively analyzed. Results ( 1 ) Clinical features :The clinical manifestations of 35 patients was hemiplegia symptoms,in which 16 cases(45.7％ ) involved to the face,upper and lower limb,11 cases(31.4％ ) involved to the upper and lower limb,3 cases(8.6％ ) involved to the facial and upper limb,2 cases(5.7％ ) involved only to the facial,2 cases(5.7％ ) involved to the facial and upper limb,1 cases(2.9％ ) involved only to the upper limb. (2) MRA imaging characteristics and infarct pattern: 29 cases ( 82.9％ ) of patients with stenosis or occlusion showed moderate severe stenosis,6 cases( 17.1％ ) showed MCA occlusion. 30 cases( 85.7％ ) showed ischemic infarction,in which perforating artery infarction was the most common infarct pattern of middle cerebral artery stenosis or occlusive patients( 53.3％ ) ,followed by water-shed infarct ( 26. 7) ％, pial infarct was ielatively small (20. 0％ ). Conclusion The hemiplegia was the most common clinical symptoms in patients with MCA stenosis and occlusion, and mainly involves to the face,upper and lower limb;The perforating artery infarction was the most common infarct pattern,and its infarct mechanism was an artery-to-artery embolism or hemodynamic abnormalities.