Department of Neurology, Kyoto Second Red Cross Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602, Japan.
J Neurol Sci. 2011 May 15;304(1-2):78-82. doi: 10.1016/j.jns.2011.02.006. Epub 2011 Mar 13.
Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies.
We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate arteries and anterior pontine arteries. Radiologically defined BAD of the lenticulostriate arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior pontine arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared.
Ninety five patients in the lenticulostriate arteries group (36.1%) and 78 patients in anterior pontine arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate arteries group (OR: 4.21, p=0.0001) and in anterior pontine arteries group (OR: 5.32, p=0.0018).
Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
小的深部脑梗死通常由两种不同的血管病变引起：1. 大动脉穿透动脉口的粥样硬化闭塞，称为分支粥样硬化性疾病（BAD）；2. 脂透明变性性退行性改变，称为脂透明变性（LD）。我们在此分析和描述这两种不同病变的特征。
我们研究了 394 例穿透动脉区域梗死患者，其梗死部位为纹状体动脉和前脑桥动脉区域。放射学定义的纹状体动脉 BAD 定义为直径大于 10mm 的梗死灶，在轴位切片上可见 3 个或更多轴位切片，前脑桥动脉 BAD 定义为单侧梗死灶延伸至脑桥基底表面。在这两个区域组中，BAD 和 LD 之间的差异进行了比较。
纹状体动脉组 95 例（36.1%）和前脑桥动脉组 78 例（59.5%）患者被归类为 BAD。初始 NIHSS、进行性运动功能缺损的发生率和不良功能结局显著更高，同时伴有沉默性腔隙性梗死的发生率则较低。在逻辑回归分析中，与 LD 相比，BAD 与进行性运动功能缺损独立相关，在纹状体动脉组（OR：4.21，p=0.0001）和前脑桥动脉组（OR：5.32，p=0.0018）中均如此。
放射学定义的 BAD 和 LD 具有不同的特征。BAD 与进行性运动功能缺损显著相关，被认为是穿透性动脉梗死中进行性运动功能缺损的主要血管机制。
