Sakai Toshiyuki, Kuzuhara Shigeki
Department of Neurology, Saiseikai Matsusaka General Hospital.
Rinsho Shinkeigaku. 2006 Feb;46(2):122-7.
We report diffusion-weighted magnetic resonance imagings (DWI) at the acute stage of two patients with spectacular shrinking deficit (SSD) due to cardioembolic stroke. Patient 1 was a 74-year-old woman with atrial fibrillation (Af) who had been admitted for acute cholecystitis. She abruptly developed consciousness disturbance, global aphasia and right hemiparesis. Her neurological symptoms rapidly improved 30 minutes after onset, and completely disappeared in four hours. Patient 2 was a 84-year-old woman with Af who had been on medication of warfarin potassium for three years. She abruptly developed consciousness disturbance and left hemiplegia. Her neurological symptoms rapidly improved 90 minutes after onset, and almost completely disappeared in ten hours. Their conditions were consistent with SSD in acute cardioembolic stroke. DWI of Patient 1 taken 27 hours after onset showed hyperintense signal areas in the insular and temporal cortices of the left middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the left middle cerebral artery and posterior cerebral artery. DWI of Patient 2 taken 39 hours after onset showed hyperintense signal areas in the insular and frontal cortices of the right middle cerebral artery territory, and in the parietal cortex corresponding to the border zone between the territories of the right middle cerebral artery and posterior cerebral artery. They indicated multifocal ischemic injuries at the acute stage. The T2-weighted MRI of Patient 2 showed a slight hyperintense signal area only in the right parietal cortex, but the fluid-attenuated inversion recovery (FLAIR) in both patients showed no abnormal signals in the corresponding areas. To our knowledge, ischemic lesions in DWI of SSD at the acute stage after rapid recovery have not been reported previously. DWI is useful in SSD for detecting ischemic injuries of cardioembolic origin at the early stage.
我们报告了2例因心源性栓塞性卒中导致显著收缩期缺损（SSD）患者急性期的扩散加权磁共振成像（DWI）情况。患者1是一名74岁患有心房颤动（Af）的女性，因急性胆囊炎入院。她突然出现意识障碍、完全性失语和右侧偏瘫。发病30分钟后其神经症状迅速改善，并在4小时内完全消失。患者2是一名84岁患有Af的女性，已服用华法林钾三年。她突然出现意识障碍和左侧偏瘫。发病90分钟后其神经症状迅速改善，并在10小时内几乎完全消失。她们的情况符合急性心源性栓塞性卒中的SSD表现。患者1发病27小时后的DWI显示，在左侧大脑中动脉供血区的岛叶和颞叶皮质，以及与左侧大脑中动脉和大脑后动脉供血区边界相对应的顶叶皮质有高信号区。患者2发病39小时后的DWI显示，在右侧大脑中动脉供血区的岛叶和额叶皮质，以及与右侧大脑中动脉和大脑后动脉供血区边界相对应的顶叶皮质有高信号区。这些表明急性期存在多灶性缺血性损伤。患者2的T2加权磁共振成像仅在右侧顶叶皮质显示轻微高信号区，但两名患者的液体衰减反转恢复序列（FLAIR）在相应区域均未显示异常信号。据我们所知，此前尚未有关于快速恢复后急性期SSD的DWI缺血性病变的报道。DWI对SSD早期检测心源性栓塞性缺血性损伤很有用。
