Department of Neurology, Shengjing Hospital, Affiliated Hospital of China Medical University, 36 Sanhao Street, Shenyang 110004, China.
Neurol Sci. 2013 Jul;34(7):1109-16. doi: 10.1007/s10072-012-1187-6. Epub 2012 Sep 14.
Single small subcortical infarction (SSSI), also called lacunar infarction, has been regarded as a different entity with distinct pathogenesis, either lipohyalinosis and fibrinoid degeneration or atherosclerosis. The aim of our study is to identify the heterogeneity of SSSI by comparing the characteristics and imaging features according to lesion location. We retrospectively studied 203 patients with acute SSSIs (diameter ≤20 mm) demonstrated by diffusion-weighted imaging in the perforator territory of the middle cerebral artery, basilar artery, or vertebral artery. We divided the 203 patients according to the lesion location in relation to the parent artery into a distal infarction (dSSSI) group and a proximal infarction (pSSSI) group. We evaluated and compared the imaging features and clinical characteristics between the groups. The evaluated characteristics included indicators of lipohyalinosis [leukoaraiosis and silent brain infarction (SBI)], indicators of atherosclerosis [parent artery disease (PAD) and atherosclerosis of other cerebral arteries (AOCA)], lesion size, and some vascular risk factors. Between the two groups, the pSSSI group had larger lesion size, higher prevalence of PAD and AOCA, and greater frequency of diabetes mellitus, while the dSSSI group had smaller lesion size, higher prevalence of leukoaraiosis and SBI, and lower serum folic acid. Diversity of the SSSIs in imaging features and clinical characteristics according to lesion location suggests the heterogeneity of SSSIs; distal infarction is closely associated with lipohyalinosis, while proximal infarction seems to be related with atherosclerosis.
单发小皮质下梗死（SSSI），也称为腔隙性梗死，被认为是一种具有不同发病机制的实体，要么是脂肪玻璃样变和纤维蛋白样变性，要么是动脉粥样硬化。我们研究的目的是通过比较根据病变位置的特征和影像学特征来确定 SSSI 的异质性。我们回顾性研究了 203 例经弥散加权成像显示的急性 SSSI（直径≤20mm）患者，这些患者的病变位于大脑中动脉、基底动脉或椎动脉的穿支区域。我们根据病变与母动脉的位置关系将 203 例患者分为远端梗死（dSSSI）组和近端梗死（pSSSI）组。我们评估并比较了两组之间的影像学特征和临床特征。评估的特征包括脂肪玻璃样变的指标[脑白质病变和无症状性脑梗死（SBI）]、动脉粥样硬化的指标[母动脉病变（PAD）和其他脑动脉粥样硬化（AOCA）]、病变大小和一些血管危险因素。在两组之间，pSSSI 组的病变更大，PAD 和 AOCA 的患病率更高，糖尿病的发病率也更高，而 dSSSI 组的病变更小，脑白质病变和 SBI 的患病率更高，血清叶酸水平更低。根据病变位置，SSSI 在影像学特征和临床特征方面的多样性表明 SSSI 存在异质性；远端梗死与脂肪玻璃样变密切相关，而近端梗死似乎与动脉粥样硬化有关。
