Department of Neurosurgery, Myong-ji St. Mary's Hospital, Seoul, South Korea.
Acta Neurochir (Wien). 2011 Jun;153(6):1253-61. doi: 10.1007/s00701-010-0926-9. Epub 2011 Jan 7.
We report six new cases of ischaemic stroke after cerebral haemorrhage in patients with moyamoya disease (MMD) and analyse their clinical and radiological characteristics, together with cases reported in the literature, to deduce the mechanism of cerebral infarct.
Six (2%) of 246 patients with MMD who were admitted to our hospitals between 1993 and 2009 suffered cerebral infarct after intracranial haemorrhage. Ten patients identified in the literature with the PubMed search engine were also included in this study. All the ischaemic lesions in these 16 patients were analysed according to their location, size, and number and were compared according to the spatial relationship between the haemorrhage and infarct, as follows: (1) anterior vs posterior involvement, (2) cortical vs subcortical involvement, (3) watershed vs non-watershed infarct, (4) small vs large infarct, (5) single vs multiple infarct, and (6) adjacent vs distant involvement.
Acute synchronous multiple brain infarcts occurred in six (38%) patients and recurrent infarcts in three patients (19%). Cerebral infarcts had mainly cortical (72%), anterior (66%), and distant involvement (75%) and were large (69%) and non-watershed (66%). Adjacent infarct had significantly anterior involvement (P < 0.05), and distant infarcts tended to have cortical involvement. Non-watershed infarcts had significantly cortical involvement (P < 0.05). Watershed infarcts tended to be large. Vasospasm was confirmed either pathologically or angiographically in two patients with large cerebral infarcts.
We suggest that thromboembolism or vasospasm plays a crucial role in the pathogenesis of cerebral infarction after acute intracranial haemorrhage in patients with MMD.
我们报告了 6 例因烟雾病（MMD）脑出血后发生的缺血性脑卒中病例，并分析了其临床和影像学特征，同时结合文献中的病例，推断出脑梗死的发病机制。
1993 年至 2009 年间，我院收治的 246 例 MMD 患者中有 6 例（2%）发生脑出血后继发脑梗死。我们还使用 PubMed 搜索引擎在文献中检索到 10 例符合条件的患者。对这 16 例患者的所有缺血性病变，根据其位置、大小和数量进行分析，并根据出血和梗死之间的空间关系进行比较，具体如下：（1）前循环与后循环受累，（2）皮质与皮质下受累，（3）分水岭与非分水岭梗死，（4）小梗死与大梗死，（5）单发与多发梗死，（6）相邻与远处受累。
6 例（38%）患者出现急性同步多发脑梗死，3 例（19%）患者出现复发性梗死。脑梗死主要位于皮质（72%）、前循环（66%）和远处（75%），梗死灶较大（69%）且非分水岭（66%）。相邻梗死明显与前循环受累有关（P<0.05），而远处梗死更倾向于皮质受累。非分水岭梗死明显与皮质受累有关（P<0.05）。分水岭梗死更倾向于大梗死灶。2 例大梗死灶患者的病理或血管造影证实存在血管痉挛。
我们认为，血栓栓塞或血管痉挛在 MMD 患者急性颅内出血后继发性脑梗死的发病机制中起关键作用。
