Fu S S, Li H R, Shi B Y, Zhang H T, Zhang S L
Department of Neurology, the People's Hospital of Zhengzhou City, Zhengzhou 450003, China.
Zhonghua Yi Xue Za Zhi. 2020 Jan 21;100(3):202-206. doi: 10.3760/cma.j.issn.0376-2491.2020.03.009.
To investigate the characteristics and possible mechanisms of differtent stroke patterns of single subcortical small infarction (SSSI) in the middle cerebral artery (MCA) territory. The clinical and imaging data of patients with acute SSSI in MCA territory admitted to the Neurology Department of People's Hospital of Zhengzhou City from January 2016 to December 2017 were retrospectively analyzed. According to the presence of MCA stenosis and whether the lesion sites on axial DWI-MRI involved the lowest basal ganglia, SSSl were divided into different patterns. The clinical and imaging characteristics of patients with different stroke patterns were compared. Of the 91 patients, 24 (26.37%) were SSSI with parental artery disease (SSSIPAD), 28 (30.77%) were proximal SSSI without PAD (pSSSI-PAD) and 39 (42.86%) were distal SSSI without PAD (dSSSI-PAD). There were significant differences in age, hypertension, diabetes mellitus, smoking, NIHSS score, low density lipoprotein cholesterin (LDL-C) level, infarct layers ≥3, lesion diameter, white matter hyperintensity, lacunar infarction, enlarged perivascular space, cerebral microbleed, concomitant intracranial and extracranial atherosclerotic stenosis among the three groups (all 0.05). Compared with SSSIPAD(-), patients with SSSIPAD(+) had significantly higher prevalence of smoking, proximal SSSI, ICAS, ECAS, NIHSS score, LDL-C level and larger lesion diameter (all 0.05). The clinical characteristics and imaging features were different among different SSSI stroke patterns. SSSIPAD is an important infarct type. pSSSI-PAD may showed intermediate features of SSSIPAD and dSSSI-PAD, and evidence of atherosclerosis should be carefully searched for such patients.
探讨大脑中动脉(MCA)供血区域单发性皮质下小梗死(SSSI)不同卒中模式的特点及可能机制。回顾性分析2016年1月至2017年12月郑州市人民医院神经内科收治的急性MCA供血区域SSSI患者的临床及影像资料。根据MCA狭窄情况以及轴位DWI-MRI上病变部位是否累及最低基底节,将SSSI分为不同模式。比较不同卒中模式患者的临床及影像特征。91例患者中,24例(26.37%)为伴供血动脉病变的SSSI(SSSIPAD),28例(30.77%)为无PAD的近端SSSI(pSSSI-PAD),39例(42.86%)为无PAD的远端SSSI(dSSSI-PAD)。三组在年龄、高血压、糖尿病、吸烟、美国国立卫生研究院卒中量表(NIHSS)评分、低密度脂蛋白胆固醇(LDL-C)水平、梗死层数≥3、病变直径、白质高信号、腔隙性梗死、血管周围间隙增宽、脑微出血、合并颅内及颅外动脉粥样硬化狭窄方面差异均有统计学意义(均P<0.05)。与SSSIPAD(-)患者相比,SSSIPAD(+)患者吸烟、近端SSSI、颅内动脉粥样硬化(ICAS)、颅外动脉粥样硬化(ECAS)、NIHSS评分、LDL-C水平及病变直径患病率均显著更高(均P<0.05)。不同SSSI卒中模式的临床特征及影像表现不同。SSSIPAD是一种重要的梗死类型。pSSSI-PAD可能表现出SSSIPAD和dSSSI-PAD的中间特征,对此类患者应仔细寻找动脉粥样硬化的证据。