Service de Neurologie, Hôpital Delafontaine, Saint-Denis, France.
Clin Neurol Neurosurg. 2024 Oct;245:108520. doi: 10.1016/j.clineuro.2024.108520. Epub 2024 Aug 26.
Stroke related to giant cell arteritis (GCA) is rare and is associated with a poor outcome. One of the putative ischemic mechanisms is narrowing of the arterial lumen due to wall infiltration by inflammation and intimal proliferation, leading to reduced distal blood flow. It was hypothesized that GCA-related stroke could predominate in watershed areas (WA).
Literature review including all cases of GCA-related stroke with brain images.
Among 75 cases of GCA-related stroke, the anterior and posterior territories were involved in 48 % and 62.6 %, respectively. Up to 88.9 % of cases of anterior stroke probably involved WA. WA lesions in the posterior territories were as follows: uni/bilateral middle cerebellar peduncle (MCP) lesions in 25.5 %, and with less confidence, non-wedge-shaped cerebellar lesions in 46.8 %, or combined lesions in 61.7 %. Stenosis or occlusion of the afferent artery was almost always observed. A few lesions were not easily explained by low flow.
Despite the limitations of arterial territory allocation especially in the posterior circulation, ischemic lesions mainly occurred in WA. MCP lesions, which were typically WA, were highly characteristic of GCA. Low flow downstream focal stenosis was the main, but not the unique, ischemic mechanism of GCA stroke.
与巨细胞动脉炎（GCA）相关的中风很少见，且预后较差。其中一种推测的缺血机制是由于炎症和内膜增生导致动脉壁浸润，从而使动脉管腔变窄，导致远端血流减少。有人假设 GCA 相关性中风可能以分水岭区（WA）为主。
对包括所有有脑部影像的 GCA 相关性中风病例进行文献回顾。
在 75 例 GCA 相关性中风中，前循环和后循环受累的比例分别为 48%和 62.6%。多达 88.9%的前循环中风病例可能涉及 WA。在后循环的 WA 病变如下：单侧/双侧小脑中脑脚（MCP）病变占 25.5%，小脑非楔形病变占 46.8%，或联合病变占 61.7%，但置信度较低。几乎总是可以观察到传入动脉狭窄或闭塞。少数病变不能用低血流很好地解释。
尽管特别是在后循环中动脉区域分配存在局限性，但缺血性病变主要发生在 WA。MCP 病变，通常是 WA，是 GCA 的高度特征性病变。下游局灶性狭窄导致的低血流是 GCA 中风的主要但不是唯一的缺血机制。
