Isozaki Makoto, Kataoka Hiroharu, Fukushima Kazuhito, Ishibashi-Ueda Hatsue, Yamada Naoaki, Iida Hidehiro, Iihara Koji
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
Department of Radiology, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
Surg Neurol Int. 2017 Jan 19;8:6. doi: 10.4103/2152-7806.198733. eCollection 2017.
We investigated the relationship between silent ischemic lesions, defined as hyperintense lesions on T2-weighted magnetic resonance imaging scans of brain white matter and cerebral hemodynamics (baseline cerebral blood flow and cerebral vasoreactivity).
Between January 2007 and December 2012, 61 patients with asymptomatic internal carotid artery stenosis were evaluated for asymptomatic silent ischemic lesions, acute infarction, and cerebral hemodynamics. Patients were divided into 2 groups based on silent ischemic lesion distribution; the Symmetry group ( = 34) included patients who showed symmetrical distribution of lesions (or had no lesions), and the Asymmetry group ( = 27) included patients with a greater number of lesions in the ipsilateral than that in the contralateral hemisphere. The Asymmetry group was further divided into Internal ( = 15) and External ( = 12) types.
Two External-type patients (17%) showed spotty asymptomatic acute infarction in the ipsilateral hemisphere. There were no significant differences in patient characteristics, histopathological findings, vascular risk factors, or cerebral blood flow values between the groups. The mean cerebral vasoreactivity value in the ipsilateral hemisphere for the Internal type was 13.0 ± 15.2% (range: -11.4% to 41.6%), which was significantly lower than values of the contralateral hemisphere (36.7 ± 20.8%; range: 3.9% to 75.7%; <.01) and ipsilateral hemispheres of the other groups ( <.01).
The finding that increased ipsilateral asymmetrical silent ischemic lesions correlated with cerebral vasoreactivity reduction may help predict the risk of cerebral infarction in patients with asymptomatic internal carotid artery stenosis.
我们研究了无症状性缺血性病变（定义为脑白质T2加权磁共振成像扫描上的高信号病变）与脑血流动力学（基线脑血流量和脑血管反应性）之间的关系。
在2007年1月至2012年12月期间，对61例无症状性颈内动脉狭窄患者进行了无症状性缺血性病变、急性梗死和脑血流动力学评估。根据无症状性缺血性病变的分布将患者分为两组；对称组（n = 34）包括病变呈对称分布（或无病变）的患者，不对称组（n = 27）包括同侧病变数量多于对侧半球的患者。不对称组进一步分为内侧型（n = 15）和外侧型（n = 12）。
两名外侧型患者（17%）在同侧半球出现散在的无症状性急性梗死。两组在患者特征、组织病理学发现、血管危险因素或脑血流值方面无显著差异。内侧型同侧半球的平均脑血管反应性值为13.0±15.2%（范围：-11.4%至41.6%），显著低于对侧半球（36.7±20.8%；范围：3.9%至75.7%；P <.01）和其他组的同侧半球（P <.01）。
同侧不对称性无症状性缺血性病变增加与脑血管反应性降低相关这一发现，可能有助于预测无症状性颈内动脉狭窄患者发生脑梗死的风险。
