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【摘要】 目的 探讨大脑中动脉狭窄或闭塞患者的MRI影像上脑梗死模式与临床表现类型特点。方法 58例经DSA确诊的大脑中动脉狭窄或闭塞患者,依据头部MRI成像所示梗死灶的特点及临床表现进行分类。结果 58例大脑中动脉狭窄或闭塞患者根据影像学分类,深部小梗死最常见,占55.17%,交界区梗死占24.14%,皮层区域内梗死占22.41%,有7例在MRI影像上正常。临床类型分型,部分前循环脑梗死占48.28%,腔隙性脑梗死占22.41%,完全前循环脑梗死占5.17%。结论 大脑中动脉狭窄或闭塞患者MRI影像上脑梗死模式以深部小梗死为主;大脑中动脉狭窄或闭塞患者临床表现类型以部分前循环脑梗死为主,亦可仅表现为头晕、头痛或无症状。�
【关键词】 大脑中动脉;狭窄或闭塞;MRI影像;脑梗死模式;临床表现;DSA
颅内动脉粥样硬化性脑血管狭窄,尤其是大脑中动脉(middle cerebral artery,MCA)的狭窄,是国人缺血性脑卒中的常见原因,笔者采用DSA来确定大脑中动脉狭窄或闭塞,并分析MCA狭窄或闭塞患者的临床症状以及MRI改变特点。�
1 资料与方法�
1.1 临床资料 58例均为经DSA检查后诊断为大脑中动脉狭窄或闭塞的患者,男39例,女19例,年龄37～81岁,平均61.6岁。�
1.2 入组标准 均经DSA诊断为大脑中动脉狭窄或闭塞,MCA狭窄程度>50%(中度以上狭窄),所有患者均于发病1周内行颅脑MRI检查,且证实梗死灶位于病变大脑中动脉供血区。经超声心动排除有心源性栓塞可能的患者,心源性栓塞可能包括最近发生过心肌梗死(15 mm的“巨大腔隙”或纹状体内囊梗死以及腔隙样梗死均称之为深部小梗死;③交界区梗死:包括前、后和内交界区梗死。�
1.4 临床分型 参照不依赖影像学结果的牛津郡社区卒中研究分型(OCSP):①完全前循环梗死(TACI);②部分前循环梗死(PACI) ;③腔隙性脑梗死(LACI);④后循环梗死(POCI)。�
2 结果�
2.1 DSA结果 58例患者中,50例为中度以上狭窄,8例为闭塞。�
2.2 头部MRI影像上脑梗死类型显示为:58例大脑中动脉狭窄或闭塞患者中,有7例(12.07%)影像学上表现为正常;有32例(55.17%)表现为深部小梗死,其中腔隙样梗死24例,内囊纹状体梗死8例;交界区梗死14例(24.14%),其中有6例合并皮层区域内梗死;皮层区域内梗死有13例(22.41%),MCA供血区完全梗死2例,MCA皮层支供血区梗死1例,MCA皮层支供血区小梗死3例,半卵圆中心梗死7例(其中有2例合并皮层小梗死)。分型以深部小梗死脑梗死最为常见,其次为分水岭梗死。�
2.3 OCSP分型 58例大脑中动脉狭窄或闭塞患者OCSP分型以部分前循环脑梗死(PACI)最为常见,有28例,占48.28%,其次为腔隙性脑梗死(LACI),有14例,占24.14%,完全前循环脑梗死有2例,占3.45%。另外,还有一部分患者仅表现为头晕、头痛或TIA,甚至没有临床症状。无症状者有4例,占6.90%;表现为头晕者有3例,占5.17%;表现为头痛者有2例,占3.45%;表现为TIA者有5例,占8.62%。�
2.4 头颅MRI影像上脑梗死类型与MCA狭窄程度关系 通过非条件Logistic回归分析表明,皮层区域内梗死(OR=0.376,P 总之,大脑中动脉狭窄或闭塞患者中OCSP分型以部分前循环脑梗死(PACI)最为常见,另有少部分可以表现为头痛、头晕、TIA或无症状,影像学分型以深部小梗死最常见,其次为交界区梗死,其发病机制为动脉�动脉栓塞与血液动力学异常。一些临床表现为头痛、头晕、TIA或无症状,影像学表现正常或仅有腔隙型脑梗死的患者可能存在大脑中动脉狭窄或闭塞,因此血管检查应该作为缺血性脑血管病的常规检查。�
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