大脑中动脉中央旁带状梗死：边缘带缺血还是皮质动脉闭塞？

Iwanaga Takeshi, Arakawa Shuji, Siritho Sasitorn, Fitt Greg, Dewey Helen M, Chambers Brian R, Donnan Geoffrey A

National Stroke Research Institute, Austin Health, Vic., Australia.

Cerebrovasc Dis. 2009;27(3):215-22. doi: 10.1159/000196818. Epub 2009 Jan 29.

BACKGROUND AND PURPOSE

We have noted the presence of small strip-like infarcts involving the cortex within the interdivisional territory of the middle cerebral artery (MCA) and sometimes extending to the periventricular region. The incidence in a stroke unit population, mechanisms, clinical expression and prognosis of patients with these cortical infarcts are unknown. To clarify these issues we retrospectively and prospectively identified these patients in our own stroke unit population.

METHODS

Patients were identified retrospectively and prospectively from the Austin Hospital Stroke Unit from March 2001 to May 2007. All were selected on the basis of the recent onset of an acute neurological deficit with imaging showing strip infarction within the MCA territory. Clinical features were recorded and the mechanism of infarction was classified based on the TOAST criteria from standard investigations.

RESULTS

From 4,274 acute stroke admissions, there were 24 patients (0.6%), 12 males and 12 females (mean age 75 years; range 44-92 years) with CT or MRI showing characteristic linear infarction in the middle cerebral territory. In most cases, infarction was adjacent to the central sulcus. Common clinical features included mild-to-moderate hemiparesis with cortical signs. The most common TOAST criterion mechanism categories were artery-to-artery or cardiac embolism. It is postulated that this resulted in either isolated small cortical artery branch occlusion or borderzone infarction between superior and inferior divisions of the MCA due to more proximal large-artery vessel occlusion. Prognosis was good.

CONCLUSIONS

We describe the phenotypic expression, postulated mechanisms and prognosis of strip-like infarcts between the superior and inferior MCA divisions. The likely artery-artery or cardio-embolic mechanisms should prompt clinicians to search for an embolic source. While the prognosis of the syndrome is generally good, its recognition may allow specific therapies to be developed to improve clinical outcomes further.

背景与目的

我们注意到在大脑中动脉（MCA）分支间区域存在累及皮质的小条状梗死灶，有时还会延伸至脑室周围区域。这些皮质梗死患者在卒中单元人群中的发病率、机制、临床表现及预后尚不清楚。为阐明这些问题，我们对自己卒中单元的人群进行了回顾性和前瞻性研究以确定这些患者。

方法

回顾性和前瞻性纳入2001年3月至2007年5月在奥斯汀医院卒中单元的患者。所有患者均基于近期急性神经功能缺损发作且影像学显示MCA区域有条状梗死而入选。记录临床特征，并根据标准检查的TOAST标准对梗死机制进行分类。

结果

在4274例急性卒中入院患者中，有24例（0.6%），男性12例，女性12例（平均年龄75岁；范围44 - 92岁），其CT或MRI显示大脑中区域有特征性的线状梗死。在大多数情况下，梗死灶邻近中央沟。常见临床特征包括伴有皮质体征的轻至中度偏瘫。最常见的TOAST标准机制类别是动脉到动脉栓塞或心源性栓塞。据推测，这是由于更近端的大动脉血管闭塞导致孤立的小皮质动脉分支闭塞或MCA上下分支之间的边缘带梗死。预后良好。