Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
J Clin Neurol. 2006 Sep;2(3):171-8. doi: 10.3988/jcn.2006.2.3.171. Epub 2006 Sep 20.
There is no clear description about the patterns of each mechanism of striatocapsular infarctions. The aims of our study were to elucidate differences in the distributions of lesions of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease.
We prospectively enrolled patients with acute infarcts located in the lenticulostriate artery territory that were not lacunar infarcts. Brain coronal diffusion-weighted imaging (DWI) was obtained and magnetic resonance angiography (MRA) was carried out to evaluate the distribution of infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into three categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE), and (3) dominant in the proximal territory. We performed tests for embolic sources (transthoracic echocardiography, transesophageal echocardiography, Holter monitoring, and contrast-enhanced MRA including the aortic arch) in most patients. Stroke mechanisms were classified into stroke from proximal embolism, MCA disease, and stroke of undetermined etiology.
A total of 47 patients (28 men and 19 women; mean age, 62 years) were recruited. A proximal embolic source was significantly more prevalent in patients with a DE lesion than in those with a DD lesion. The most common proximal embolic source was of cardiac origin. In contrast, symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion.
These results suggest that the dominant area of striatocapsular infarction on coronal DWI is an important clue for stroke etiology. Coronal DWI could therefore be helpful to determining the mechanisms in patients with striatocapsular infarctions that are currently described as having an "undetermined etiology" according to the Trial of Org 10172 in Acute Stroke Treatment classification.
对于纹状体-脑囊梗死各机制的模式，尚无明确的描述。本研究旨在阐明累及纹状体-脑囊区域的急性大脑中动脉（MCA）梗死病变分布的差异，并比较栓塞性纹状体-脑囊梗死与起源于 MCA 病变的梗死。
我们前瞻性纳入了非腔隙性梗死的急性位于纹状体纹状动脉区域的梗死患者。对所有患者均行脑冠状位弥散加权成像（DWI）和磁共振血管造影（MRA）以评估梗死病变和 MCA 狭窄的分布。梗死分布类型分为 3 种：（1）远侧优势型（DD），（2）远侧和近侧分布均等型（DE），（3）近侧优势型。我们对大多数患者进行了栓塞源检查（经胸超声心动图、经食管超声心动图、动态心电图监测和对比增强 MRA 包括主动脉弓）。将卒中机制分为近端栓塞性卒中、MCA 病变性卒中和病因不明性卒中。
共纳入 47 例患者（28 例男性和 19 例女性；平均年龄 62 岁）。DE 病变患者中，近端栓塞源更常见。最常见的近端栓塞源来自心脏。相比之下，DD 病变患者中，症状性 MCA 狭窄更为常见。
这些结果表明，冠状位 DWI 上纹状体-脑囊梗死的优势区是卒中病因的重要线索。因此，冠状位 DWI 可能有助于确定目前根据急性卒中治疗试验的 Org 10172 分类描述为“病因不明”的纹状体-脑囊梗死患者的机制。
