弥散加权成像上急性多发脑梗死的病因学探讨  

Aetiological study of acute multiple brain infarction on diffusion-weighted imaging

作　　者：邵素君[1] 王效敏[1] 刘文宏[1] 

机构地区：[1]北京世纪坛医院神经内科,100038

出　　处：《北京医学》2008年第4期230-233,共4页Beijing Medical Journal

摘　　要：目的探讨弥散加权成像(DWI)上急性多发脑梗死的病因和发病机制。方法将DWI上呈现急性脑梗死的147例患者分为腔隙性脑梗死和非腔隙性脑梗死两组,按照TOAST标准(trial of org10172in acute stroketreatment)进行病因分类,腔隙性脑梗死还包括除小动脉病以外其他可能的原因。结果62例急性腔隙性脑梗死患者中有21例为多发,占33.87%;其中8例(38.09%)可找到小动脉病以外的其他原因,包括心源性栓塞3例、动脉源性栓塞3例、血液疾病1例、高凝状态1例。85例急性非腔隙性脑梗死患者中有9例为多发,占10.59%,其中心源性栓塞3例。结论DWI对急性多发脑梗死病因的识别有重要意义。急性多发腔隙性脑梗死提示一个非小动脉病的卒中机制,如栓子、血液疾病或高凝状态;不同血管供血的多发脑梗死提示心源性栓子,而非动脉-动脉的栓塞。Objective To explore the aetiology and stroke mechanism of acute multiple brain infarction on diffusion-weighted imaging （DWI）. Methods 147 consecutive patients defined by DWI were evaluated, who were divided into 2 categories：①acute lacunar stroke, ②acute non-lacunar stroke. The causes of stroke were classified according to the TOAST criteria, though ＂lacunar stroke＂ included possible causes other than small artery disease （SAD）. Results Aute multiple lacunar stroke was detected in 21 of 62 patients （33.87%） with lacunar stroke. Other stroke mechanisms different from SAD were found in 8 cases （38.09%）, which included cardiac embolism in three cases, aortic embolism in three cases, hematologic disease in one case and hypercoagulable state in one case. Acute multiple non-lacunar stroke was detected in 9 of 85 （10.59%） patients with non-lacunar stroke. The embalism with catdiac origin was detected in three cases. Conclusions Detection of multiple acute brain infarcts （MABI） by diffusion-weighted magnetic resonance imaging （DWI） may be of great significance in providing an information about stroke mechanism： ①acute multiple lacunar stroke suggests the causes other than small artery disease （SAD）, such as embolism, blood disease or coagulopathy, ②acute multiple non-lacunar stroke in the territory supplied by different aortic branches indicates the presence of cardiac embolism rather than artery to artery embolism.

关 键 词：弥散加权成像(DWI) 腔隙性脑梗死 多发脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]