缺血性脑卒中后血管性痴呆的临床特点及MRI早期诊断价值  

Clinical features of vascular dementia after ischemic stroke and early diagnostic value of MRI

作　　者：顾国强 熊敏荣[1] 孙云峰[1] GU Guoqiang;XIONG Minrong;SUN Yunfeng(Department of Radiology,the Third People's Hospital of Huzhou City in ZhejiangProvince,Huzhou 313000,China)

机构地区：[1]浙江省湖州市第三人民医院放射科

出　　处：《中国现代医生》2019年第25期116-119,共4页China Modern Doctor

基　　金：浙江省湖州市第二批科技计划项目(2018GZ39);浙江省基础公益研究计划项目(LGF19H090003)

摘　　要：目的探讨缺血性脑卒中后血管性痴呆的临床特点及MRI早期诊断价值。方法选取2013年1月~2018年1月在我院住院并诊断为缺血性脑卒中患者共80例,按照卒中后认知功能评定及VaD诊断标准分为非VaD组(对照组)42例和VaD组(观察组)38例。两组患者选取合适的头部专用线圈,行MRI检查;记录患者一般资料及MRI结果,根据梗死病灶部位分为皮层组和皮层下组,根据梗死病灶大小分为大梗死、中梗死、小梗死和腔隙性梗死;观察MRI下脑组织形态学变化,评价是否存在皮质萎缩、脑沟增宽、海马内侧脑脊液池增宽及白质稀疏等改变;行MMSE、HIS及MoCA评分。结果两组患者MRI下梗死部位比较,观察组中额叶及颞叶皮层、额叶及颞叶和顶叶皮层下、半卵圆中心、侧脑室体旁白质、内囊和丘脑等部位的缺血性梗死灶发生率较对照组升高(P<0.05);观察组大梗死、中梗死人数较对照组升高(P<0.05);观察组MMSE与MoCA评分较对照组降低(P<0.05),HIS评分较对照升高(P<0.05);观察组患者中存在皮质萎缩、脑沟增宽、海马内侧脑脊液池增宽及白质稀疏等改变的人数较对照组升高(P<0.05)。结论缺血性脑卒中后VaD患者在MRI影像下可见皮质萎缩、脑沟增宽及不同部位的梗死病灶等临床特点,MRI可作为早期诊断血管性痴呆的有效手段,值得临床推广。Objective To investigate the clinical features of vascular dementia after ischemic stroke and the value of early diagnosis of MRI.Methods A total of 80 patients admitted to our hospital from January 2013 to January 2018 who were diagnosed as ischemic stroke were enrolled.According to the post-stroke cognitive function assessment and VaD diagnostic criteria,42 patients were divided into the non-VaD group(control group)and 38 patients were divided into the VaD group(observation group).Two groups of patients were selected for appropriate head-specific coils to carry out MRI examination;general data and MRI results were recorded.According to the infarct lesions,they were divided into cortical group and subcortical group.According to the size of infarct lesions,the lesions were divided into large infarction,middle infarction,small infarction,and lacunar infarction.Morphological changes of brain tissue under MRI were observed to evaluate whether there were cortical atrophy,sulcal widening,widening of cerebrospinal fluid pool in the hippocampus and sparse white matter;MMSE,HIS and MoCA scores were performed.Results The infarction sites of MRI were compared between the two groups.The ischemia of the frontal and temporal cortex.The incidence of ischemic infarction in the frontal and temporal cortex,frontal,temporal and parietal subcortex,semi-oval center,lateral ventricle white matter,internal capsule and thalamus in the observation group was higher than that in the control group(P<0.05);the number of patients with large infarction and middle infarction in the observation group was higher than that in the control group(P<0.05);the MMSE and MoCA scores in the observation group were lower than those in the control group(P<0.05),and the HIS score was higher than that in the control group(P<0.05);The number of patients with cortical atrophy,sulcal widening,hippocampal cerebrospinal fluid pooling widening and white matter sparse in the observation group was higher than that in the control group(P<0.05).Conclusion In patients w

关 键 词：缺血性脑卒中 血管性痴呆 核磁共振 临床特点 

分 类 号：R743.33[医药卫生—神经病学与精神病学]