Levy R, Duyckaerts C, Hauw J J
INSERM U 360, Association Claude Bernard, Hôpital de la Salpêtrière, Paris, France.
Stroke. 1995 Apr;26(4):609-13. doi: 10.1161/01.str.26.4.609.
At neuropathological examination, the territory of the anterior choroidal artery is frequently found to be involved in massive infarcts of the internal carotid artery territory. The aim of our study was to analyze the clinical spectrum, the course, and the mechanism of these massive infarcts compared with the rare infarcts involving only the anterior choroidal artery territory.
Retrospective clinical examination and pathological study were performed in 35 patients with cerebral infarcts affecting at least the territory of the anterior choroidal artery.
In no patient had the involvement of the anterior choroidal territory infarcts been recognized clinically, nor had the triad of clinical signs (hemiplegia, hemianesthesia, and hemianopsia) classically seen in infarcts restricted to this territory been found alone. Impairment of consciousness, cognitive disorders, or oculomotor palsies had been found in addition to one or more signs of the triad. This was probably related to the involvement of other territories (94%), especially the middle cerebral artery territory (68%) and the posterior cerebral artery territory (20%). The concomitant involvement of several territories was due most frequently to an occlusion of the internal carotid artery, which was found at autopsy in 74% of the patients. These occlusions were often associated with cardioembolism (54%). In contrast, artery-to-artery embolism (17%) and small-artery disease (6%) were seldom found. Only two cases of infarcts restricted to the anterior choroidal artery territory were observed.
The involvement of the territory of the anterior choroidal artery in massive infarcts was due mainly to a cardioembolic occlusion of the internal carotid artery.
在神经病理学检查中，经常发现脉络膜前动脉供血区域参与颈内动脉供血区域的大面积梗死。我们研究的目的是分析这些大面积梗死与仅累及脉络膜前动脉供血区域的罕见梗死相比的临床谱、病程及机制。
对35例至少累及脉络膜前动脉供血区域的脑梗死患者进行回顾性临床检查及病理研究。
在所有患者中，临床上均未识别出脉络膜前动脉供血区域梗死，也未单独发现局限于该区域梗死时典型出现的三联征临床体征（偏瘫、偏身感觉障碍和偏盲）。除三联征的一个或多个体征外，还发现有意识障碍、认知障碍或动眼神经麻痹。这可能与其他区域（94%）受累有关，尤其是大脑中动脉供血区域（68%）和大脑后动脉供血区域（20%）。多个区域同时受累最常见的原因是颈内动脉闭塞，尸检发现74%的患者存在这种情况。这些闭塞常与心源性栓塞（54%）相关。相比之下，动脉到动脉栓塞（17%）和小动脉疾病（6%）很少见。仅观察到2例局限于脉络膜前动脉供血区域的梗死。
脉络膜前动脉供血区域在大面积梗死中的受累主要是由于颈内动脉的心源性栓塞性闭塞。
