进展型脑分水岭梗死的临床和影像学特点  

Clinical and MRI features of progressive cerebral watershed infarction

作　　者：聂志余[1] 靳令经[1] 刘远洪[2] 陈玉辉[1] 李云霞[1] 郭艳[1] 管强[1] 

机构地区：[1]同济大学医学院附属同济医院神经内科,上海200065 [2]河南省濮阳市人民医院优质四科

出　　处：《中华老年心脑血管病杂志》2012年第12期1285-1288,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：上海市卫生局科研课题(2009137)

摘　　要：目的探讨进展型脑分水岭梗死(WI)的临床和影像学特点。方法收集31例进展型WI患者的临床及影像学资料回顾性研究。结果入院时美国国立卫生研究院脑卒中量表(5.1±1.7)分,出院时改良的Rankin量表(mRS)≤2分者3例,mRS 3、4、5、6分者分别为8、16、1和3例。发病后1周内有23例出现血压偏低。首次MRI显示,皮质下型伴皮质后型WI 16例、皮质下型WI 6例、皮质后型伴皮质前型WI 5例、皮质后型WI 3例、皮质前型1例。第2次MRI检查与第1次MRI间隔平均3.8 d,20例演变为大面积脑梗死,7例为W1灶扩大,另4例发展为急性多发性脑梗死。结论进展型W1主要发生在≥70岁的老年人,男性多于女性,近期预后不良,多由皮质下型WI发展为大面积脑梗死,颅内外动脉狭窄或闭塞和低血压可能是发生进展型WI的最主要原因。Objective To study the clinical and MRI features of progressive cerebral watershed in farction. Methods Clinical and MRI data about infarction were retrospectively analyzed. Results 31 patients with progressive cerebral watershed The NIHSS score for the patients at admission was The mRS score for 3,8,16,1 and 3 patients at discharge was 2,3,4,5,and 6,respectively. The blood pressure decreased in 23 patients within one week after onset of the disease. The first MRI showed subcortical and posterior cortical watershed infarction in 16 patients,subcortical watershed infarction in 6 patients,posterior and anterior cortical watershed infarction in 5 patients,posterior cortical watershed infarction in 3 patients and anterior cortical watershed infarction in 1 patient. The second MRI（3.8 clays after the first MRI） displayed progression of watershed infarction to massive cerebral infarction in 20 patients, enlargement of the initial watershed infarction area in 7 patients,and progression of watershed infarction to acute multiple cerebral infarctions in 4 patients. Conclusion Progressive cerebral watershed infarction occurs mainly in the elderly 〉70 years with a poor short-term prognosis and more frequently in males than in females. It usually progresses to massive cerebral infarction from subcortical watershed infarction. Intra-and extracranial artery stenosis or occlusion and low blood pressure may be the important factors for progressive cerebral watershed infarction.

关 键 词：脑梗死 磁共振成像 颅内动脉疾病 血管造影术 数字减影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]