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作 者:张栩[1] 李海峰[1] 张勇[1] 潘旭东[1] 刘宗超[1]
机构地区:[1]青岛大学医学院附属医院神经内科,266003
出 处:《中国脑血管病杂志》2007年第7期310-313,324,共5页Chinese Journal of Cerebrovascular Diseases
摘 要:目的探讨内侧分水岭梗死(IWI)的临床和影像学特点及与颈动脉系统病变的关系。方法选择DWI病灶符合内侧分水岭梗死的患者27例,将其分为融合型IWI(CIWI)及部分型IWI(PIWI)。行头部颈动脉MRA和(或)DSA进行血管评价,确定主要责任血管病变;于入院第1天及第7天测量NIHSS评分,确定病情;卒中后3个月采用修订的Rankin评分评价预后。结果27例IWI患者中14例为融合型,13例为部分型;22例(82%)有颈动脉系统严重狭窄或闭塞,其中CIWI12例,PIWI10例,差异无统计学意义(P>0.05)。CIWI患者ICA病变的发生比例高于PIWI患者(11/14,4/13),多表现为非腔隙综合征(10/14,4/13);PIWI患者MCA病变的发生比例高于CIWI患者(6/13,1/14),多表现为腔隙综合征(9/13,4/14),差异有统计学意义(P<0.05)。CIWI患者较PIWI患者7d内多见病程进展,且3个月预后差(5/14,0/13;P<0.05)。结论IWI与颈动脉系统病变存在比较确切的关系,CIWI和PIWI发病机制中受累的血管作用存在一定差异。Objective To investigate clinical and imaging characteristics of internal watershed infarction (IWI) and their relationship with carotid system lesions. Methods Twenty-seven patients whose lesions on diffusion-weighted imaging ( DWI ) in accordance with IWI were selected. The patients were divided into confluent IWI group (CIWI; n = 14) and partial IWI (PIWI; n = 13 ) group. Carotid artery magnetic resonance angiography (MRA) and/or digital subtraction angiography (DSA) were performed to evaluate vascular status, and the lesions in the responsible vessels were identified; NIHSS scores were measured at day 1 and day 7 of admission, and the course of diseases was determined; the prognosis was evaluated by the modified Rankin Scale at 3 months after stroke. Results Of the 27 patterns with IWI, 22 ($2%) had severe carotid stenosis or occlusion, among them 12 had CIWI and 10 had PIWI, and there was no statistical difference ( P 〉 O. 05 ). The incidence of ICA lesions in patients with CIWI was higher than that in patients with PIWI ( 11/14 vs. 4/13 ), most of them presented as nonlacunar syndrome ( 10/14 vs. 4/13) ; the incidence of ICA lesions in patients with PIWI was higher than that in patients with CIWI (6/13 vs. 1/14) , most of them presented as lacunar syndrome (9/13 vs. 4/14), and there was statistical difference ( P 〈 O. 05 ). The progression of the course of diseases was often observed within 7 days and the prognosis was poor at 3 months in patients with CIWI as compared with patients with PIWI (5/14 vs. 0/13; P 〈0. 05 ). Conclusion IWI has a relatively exact relationship with carotid system lesions. The effect of affected vessel may have some differences in the pathogenesis of CIWI and PIWI.
关 键 词:颈动脉疾病 分水岭梗死 血流动力学 栓塞 影像学
分 类 号:R743.3[医药卫生—神经病学与精神病学]
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