Eppinger Sebastian, Gattringer Thomas, Nachbaur Lena, Fandler Simon, Pirpamer Lukas, Ropele Stefan, Wardlaw Joanna, Enzinger Christian, Fazekas Franz
Department of Neurology, Medical University of Graz, Austria.
Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, A-8036 Graz, Austria.
Ther Adv Neurol Disord. 2019 Apr 22;12:1756286419835716. doi: 10.1177/1756286419835716. eCollection 2019.
Recent small subcortical infarcts (RSSIs) mostly result from the occlusion of a single, small, brain artery due to intrinsic cerebral small-vessel disease (CSVD). Some RSSIs may be attributable to other causes such as cardiac embolism or large-artery disease, and their association with coexisting CSVD and vascular risk factors may vary with morphological magnetic resonance imaging (MRI) features.
We retrospectively identified all inpatients with a single symptomatic MRI-confirmed RSSI between 2008 and 2013. RSSIs were rated for size, shape, location (i.e. anterior: basal ganglia and centrum semiovale posterior cerebral circulation: thalamus and pons) and MRI signs of concomitant CSVD. In a further step, clinical data, including detailed diagnostic workup and vascular risk factors, were analyzed with regard to RSSI features.
Among 335 RSSI patients (mean age 71.1 ± 12.1 years), 131 (39%) RSSIs were >15 mm in axial diameter and 66 (20%) were tubular shaped. Atrial fibrillation (AF) was present in 44 (13.1%) and an ipsilateral vessel stenosis > 50% in 30 (9%) patients. Arterial hypertension and CSVD MRI markers were more frequent in patients with anterior-circulation RSSIs, whereas diabetes was more prevalent in posterior-circulation RSSIs. Larger RSSIs occurred more frequently in the basal ganglia and pons, and the latter were associated with signs of large-artery atherosclerosis. Patients with concomitant AF had no specific MRI profile.
Our findings suggest the contribution of different pathophysiological mechanisms to the occurrence of RSSIs in the anterior and posterior cerebral circulation. While there appears to be some general association of larger infarcts in the pons with large-artery disease, we found no pattern suggestive of AF in RSSIs.
近期皮质下小梗死灶（RSSIs）大多是由于脑内小血管疾病（CSVD）导致单一、细小的脑动脉闭塞所致。一些RSSIs可能归因于其他原因，如心脏栓塞或大动脉疾病，并且它们与共存的CSVD和血管危险因素的关联可能因形态学磁共振成像（MRI）特征而异。
我们回顾性确定了2008年至2013年间所有经MRI证实有单一症状性RSSI的住院患者。对RSSIs的大小、形状、位置（即前部：基底节和半卵圆中心；后部脑循环：丘脑和脑桥）以及伴随CSVD的MRI征象进行评分。进一步分析临床数据，包括详细的诊断检查和血管危险因素与RSSI特征的关系。
在335例RSSI患者（平均年龄71.1±12.1岁）中，131例（39%）RSSIs的轴径>15 mm，66例（20%）呈管状。44例（13.1%）存在心房颤动（AF），30例（9%）患者同侧血管狭窄>50%。前部循环RSSI患者中动脉高血压和CSVD的MRI标志物更为常见，而后部循环RSSI患者中糖尿病更为普遍。较大的RSSIs更常见于基底节和脑桥，后者与大动脉粥样硬化征象相关。伴有AF的患者没有特定的MRI表现。
我们的研究结果表明不同的病理生理机制对大脑前、后循环中RSSIs的发生有影响。虽然脑桥中较大梗死灶似乎与大动脉疾病有一定的普遍关联，但我们在RSSIs中未发现提示AF的模式。
