Evrard S, Woimant F, Le Coz P, Polivka M, Cousin C, Haguenau M
Service de Neurologie, Centre Hospitalier Robert Ballanger, Aulnay-Sous-Bois, France.
Neurol Res. 1992;14(2 Suppl):97-9. doi: 10.1080/01616412.1992.11740022.
Twenty-four patients presenting an acute stroke with watershed cerebral infarct on CT scan or MRI were included in this retrospective study. Age was 63 +/- 14 years (mean +/- SD), and sex ratio was 2 men for 1 woman. Main clinical features were: in anterior location, lower limb weakness and frontal syndrome with transcortical motor aphasia in left lesions or spatial dyscalculia in right ones; in posterior location, brachiofacial weakness with constant quadranopsia and hypoesthesia, and Gerstmann syndrome in left lesion. There was no distinctive feature for subcortical and multiple infarcts. In bilateral infarcts, there were one pseudobulbar syndrome, and 2 pseudo brainstem syndromes with neuropsychological signs. Aetiologies were severe carotid artery disease in 14 cases, severe cardiopathy in 6, isolated cerebral angiitis in 1, essential thrombocythemia in 1, protein C deficiency with sickle cell disease in 1, and cholesterol emboli in 1 anatomical case. CBF performed in carotid artery occlusions or tight stenoses showed evidence of haemodynamic changes. Microembolic process can be proposed in the case with cholesterol emboli. Preventive treatment is discussed.
本回顾性研究纳入了24例经CT扫描或MRI显示为分水岭脑梗死的急性卒中患者。年龄为63±14岁（均值±标准差），男女比例为2:1。主要临床特征为：在前循环部位，下肢无力，左侧病变时出现额叶综合征伴经皮质运动性失语，右侧病变时出现空间失算症；在后循环部位，臂面部无力，伴有持续性象限盲和感觉减退，左侧病变时出现格斯特曼综合征。皮质下梗死和多发性梗死无明显特征。在双侧梗死中，有1例假性延髓综合征，2例伴有神经心理学症状的假性脑干综合征。病因包括14例严重颈动脉疾病、6例严重心脏病、1例孤立性脑血管炎、1例原发性血小板增多症、1例蛋白C缺乏合并镰状细胞病以及1例解剖学上的胆固醇栓塞病例。对颈动脉闭塞或严重狭窄患者进行的脑血流量检查显示有血流动力学改变的证据。胆固醇栓塞病例可推测存在微栓塞过程。文中讨论了预防性治疗。
