急性扣带回梗死:21例回顾性病例系列研究  

Acute cingulate cortex infarction:a retrospective case series of 21 cases

作　　者：董思语 孙美 田宇飞 程虹[1] Dong Siyu;Sun Mei;Tian Yufei;Cheng Hong(Department of Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经内科,南京210029 [2]南京医科大学第一附属医院神经外科,南京210029

出　　处：《国际脑血管病杂志》2022年第7期481-488,共8页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性扣带回(cingulate cortex,CC)梗死患者的临床表现、危险因素及转归。方法回顾性纳入2019年12月至2022年4月南京医科大学第一附属医院神经内科收治的急性CC梗死患者,根据梗死部位分为前扣带回(anterior cingulate cortex,ACC)梗死组和后扣带回(posterior cingulate cortex,PCC)梗死组。分析患者的临床表现、卒中危险因素、影像学检查以及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分结果。发病后1个月时采用改良Rankin量表进行短期转归评价。结果共纳入21例急性CC梗死患者,男性12例(57.14%),年龄(67.14±12.36)岁(范围45~89岁)。ACC梗死16例(76.19%),其中单侧CC梗死13例(81.25%),临床表现主要为情感淡漠、注意力下降以及执行功能障碍等;PCC梗死组5例(23.81%),均为单侧起病,主要表现为记忆力下降和视空间障碍。21例患者中,18例(85.71%)患者伴有≥2种血管危险因素,13例(61.90%)伴有≥3种血管危险因素,其中以高血压最为常见(90.48%);19例(90.48%)病因为大动脉粥样硬化,2例(9.52%)为心源性栓塞。经治疗后两组患者症状均有明显改善,治疗前后NIHSS评分有统计学差异(Z=4.07,P<0.01)。随访时16例(76.19%)转归良好,5例(23.81%)转归不良,且无一例死亡。结论ACC和PCC梗死主要表现为不同形式的认知损害。CC梗死若诊疗及时,总体转归良好。Objective To investigate the clinical manifestations,risk factors and outcomes of patients with acute cingulate cortex(CC)infarction.Methods Patients with acute CC infarction admitted to the Department of Neurology,the First Affiliated Hospital of Nanjing Medical University from December 2019 to April 2022 were enrolled retrospectively.According to the location of infarction,they were divided into anterior cingulate cortex(ACC)infarction group and posterior cingulate cortex(PCC)infarction group.The clinical manifestations,stroke risk factors,imaging examination and National Institutes of Health Stroke Scale(NIHSS)score of the patients were analyzed.At one month after onset,the modified Rankin Scale was used to evaluate the short-term outcome.Results A total of 21 patients with acute CC infarction were enrolled,including 12 males(57.14%),aged 67.14±12.36 years(range,45-89 years).There were 16 patients(76.19%)with ACC infarction,including 13(81.25%)unilateral CC infarction.The clinical manifestations were mainly apathy,decreased concentration,and executive dysfunction.There were 5 patients(23.81%)with PCC infarction,all with unilateral onset,mainly manifested as memory loss and visual space disorder.Among the 21 patients,18(85.71%)had≥2 vascular risk factors,and 13 patients(61.90%)had≥3 vascular risk factors,of which hypertension was most common(90.48%);19(90.48%)were caused by atherosclerosis,and 2(9.52%)were caused by cardiogenic embolism.After treatment,the symptoms of both groups were improved significantly,and there was statistical difference in the NIHSS score before and after treatment(Z=4.07,P<0.01).During the follow-up,16 patients(76.19%)had a good outcome,5(23.81%)had a poor outcome and no death occurred.Conclusions ACC and PCC infarction mainly showed different forms of cognitive impairment.If the diagnosis and treatment are timely,the overall outcome of CC infarction is good.

关 键 词：脑梗死 扣带回 认知障碍 弥散磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]