无症状性脑梗死的“沉默”可能与慢性缺血预适应和非策略性部位有关，而不是与小梗死灶有关。
The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size.
机构信息
Department of Neurology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Clinics (Sao Paulo). 2013;68(3):365-9. doi: 10.6061/clinics/2013(03)oa13.
OBJECTIVE
Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'.
METHODS
In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times.
RESULTS
The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups.
CONCLUSIONS
Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.
目的
无症状性脑梗死是一种无声的脑血管事件，与症状性腔隙性梗死不同的是其“无声”；这些梗死的起源仍不清楚。本研究分析了无症状性和症状性腔隙性梗死的特征，并试图探讨这种“无声”的机制。
方法
共纳入 156 例仅无症状性脑梗死患者、90 例仅症状性腔隙性梗死患者、160 例同时有无症状性和症状性腔隙性梗死患者和 115 例无任何梗死患者。比较血管危险因素、脑白质疏松症和血管评估结果。比较仅有症状性腔隙性梗死患者和两种类型梗死患者的国立卫生研究院卒中量表评分。评估所有梗死的部位。通过比较 63 例患者不同时间的磁共振图像上的梗死，回顾性研究两种类型梗死的演变。
结果
无症状性脑梗死的主要危险因素是高血压、年龄和高级别脑白质疏松症；症状性腔隙性梗死的主要因素是高血压、心房颤动和相关动脉粥样硬化。仅有症状性腔隙性梗死患者的神经功能缺损比两种类型梗死患者更严重。更多的无症状性脑梗死位于放射冠和基底节；这些部位与症状性腔隙性梗死不同。症状性腔隙性梗死的初始大小大于无症状性脑梗死，而两组的最终大小几乎相等。
结论
慢性缺血预适应和非策略性部位可能是无症状性脑梗死“无声”的主要原因。
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