Baird A E, Donnan G A, Saling M
Department of Neurology, Austin Hospital, Heidelberg, Victoria.
Clin Exp Neurol. 1991;28:50-5.
The mechanism of internal carotid watershed cerebral infarction is not well understood, but the phenomenon has been described in association with carotid occlusive disease, and more recently with distal middle cerebral artery occlusion beyond the origin of the lenticulostriate branches. The clinical correlates of these changes have not yet been described. We present 5 patients in whom acute internal watershed infarction had occurred, and correlate the clinical, neuropsychological and 99mTc-HMPAO SPECT (Single Photon Emission Computed Tomography using 99mtechnetium-hexamethylpropylene amine oxime) cerebral perfusion findings. Four patients had distal middle cerebral artery occlusion demonstrated on angiography, and one showed profound hemispheric depression in cerebral perfusion with only a small area of infarction. We have concentrated on the mechanism of distal middle cerebral artery occlusion to describe the "arc" of the watershed zone created. We propose that internal watershed infarcts can further be subdivided into anterior and posterior subtypes, outline the vascular territories involved, and propose an overall classification of cerebral watershed infarction.
颈内动脉分水岭脑梗死的机制尚未完全明确，但这一现象已被描述为与颈动脉闭塞性疾病相关，最近还与豆纹动脉起源以远的大脑中动脉远端闭塞有关。这些变化的临床相关性尚未见报道。我们报告了5例发生急性内分水岭梗死的患者，并将其临床、神经心理学表现与99m锝-六甲基丙烯胺肟单光子发射计算机断层扫描（99mTc-HMPAO SPECT）脑灌注结果进行了关联分析。4例患者血管造影显示大脑中动脉远端闭塞，1例表现为脑灌注严重半球性降低，梗死面积较小。我们重点研究了大脑中动脉远端闭塞的机制，以描述所形成的分水岭区的“弧形”。我们提出，内分水岭梗死可进一步细分为前、后亚型，概述所涉及的血管区域，并提出脑分水岭梗死的总体分类。
