大脑中动脉深穿支孤立性脑梗死的临床分析

摘要

Objective To investigate the pathogenesis and clinical features of the isolated cerebral infarctions in the supply region of deep perforators of middle cerebral artery. Methods The cases of the isolate acute infarct in the supply region of of deep perforators of middle cerebral artery were employed.All patients had isolate acute infarct in the supply region(basal ganglia or periventricular region)of deep perforators of MCA revealed on diffusion weighted imaging(DWI)and magnetic resonance imaging(MRI).All of the patients were divided into two groups.Analyzed the size and shape of the lesions,some stroke risk factors,revalence of SVD indicators(leukoaraiosis and enlarged perivascular spaces),NIHSS grade when hospitalized and progressive cerebral infarction rates of these patients. Results The rate of arhrosclerosis,NIHSS grade when hospitalized and progressive cerebral infarction rates in patients with the ipsilateral MCA stenosis>50% were significantly higher than the patients with the ipsilateral MCA stenosis ≤50%,and most of the shape of the lesions on the coronary DWI were linear lesions,While most patients with the ipsilateral MCA stenosis ≤50% were performed round or oval lesions,and had higher score in revalence of SVD indicators. Conclusion According to the MCA stenosis,shape of the lesions,rate of arhrosclerosis,revalence of SVD indicators,patients with isolate acute infarct in the supply region of of deep perforators of middle cerebral artery have different pathogenesis and clinical features,and patients with the ipsilateral MCA stenosis>50% will have relatively more risk of progress with more severity.%目的：探讨大脑中动脉深穿支孤立性脑梗死发病机制及临床特点。方法2012年1月至12月大脑中动脉深穿支分布区域急性脑梗死患者98例。根据大脑中动脉（MCA）是否存在病变分为2组，分别进行梗死灶大小、形态、卒中危险因素、脑小血管病变指标（脑白质疏松和扩大的血管周围间隙）、入院即刻美国国立卫生院神经功能缺损评分（NIHSS评分）及进展性脑梗死的发生率的比较。结果两组患者伴有MCA狭窄组梗死灶体积、动脉粥样硬化比例、入院即刻NIHSS评分均高于MCA非狭窄组，病灶在DWI冠状位上多呈线性病灶，且易出现进展，进展程度较重。而MCA非狭窄组患者，梗死病灶在DWI冠状位上多表现为圆形或椭圆形，动脉粥样硬化比例偏低，LA评分及EPVS评分偏高。结论根据MCA病变程度，动脉粥样硬化情况，脑小血管病变指标及梗死形态的不同提示大脑中动脉深穿支孤立性脑梗死发病机制的不同，且伴有MCA狭窄的患者易发生进展，病变程度较重。