Yamauchi H, Fukuyama H, Ogawa M, Ouchi Y, Kimura J
Department of Neurology, Faculty of Medicine, Kyoto University, Japan.
Stroke. 1994 Sep;25(9):1788-93. doi: 10.1161/01.str.25.9.1788.
It is unclear why only some patients with lacunar infarction and radiological evidence of diffuse white matter abnormalities have dementia. The purpose of this study is to investigate the value of callosal atrophy as an indicator of cognitive impairment.
We used magnetic resonance imaging to evaluate 11 right-handed male patients with lacunar infarction and extensive white matter hypodensities on computed tomography (8 with dementia and 3 without dementia). The midsagittal corpus callosum area on T1-weighted images was compared with the IQ determined by the Wechsler Adult Intelligence Scale. The relation between these parameters and cerebral oxygen metabolism measured with positron emission tomography was also evaluated in the 8 patients with dementia.
All patients showed diffuse high-intensity areas in the bilateral hemispheric white matter on T2-weighted images. Compared with 19 age- and sex-matched right-handed normal control subjects, the patients had a significantly smaller callosal area. The severity of callosal atrophy, which varied from mild to severe, was significantly related to the total IQ. In the 8 demented patients, the total callosal area was significantly correlated with the mean level of oxygen metabolism in the cerebral white matter.
In patients with lacunar infarction and diffuse white matter abnormalities, the presence of callosal atrophy may indicate cognitive impairment. Callosal atrophy may reflect the severity and extent of white matter damage associated with a decrease in oxygen metabolism, which may determine the severity of intellectual decline.
目前尚不清楚为何仅有部分伴有腔隙性梗死且有弥漫性白质异常影像学证据的患者会出现痴呆。本研究的目的是探讨胼胝体萎缩作为认知障碍指标的价值。
我们使用磁共振成像对11例右利手男性腔隙性梗死患者进行评估，这些患者在计算机断层扫描上显示有广泛的白质低密度影（8例患有痴呆，3例未患痴呆）。将T1加权图像上的正中矢状胼胝体面积与韦氏成人智力量表测定的智商进行比较。还对8例痴呆患者的这些参数与正电子发射断层扫描测量的脑氧代谢之间的关系进行了评估。
所有患者在T2加权图像上双侧半球白质均显示弥漫性高强度区域。与19名年龄和性别匹配的右利手正常对照受试者相比，这些患者的胼胝体面积明显更小。胼胝体萎缩的严重程度从轻度到重度不等，与总智商显著相关。在8例痴呆患者中，胼胝体总面积与脑白质氧代谢平均水平显著相关。
在伴有腔隙性梗死和弥漫性白质异常的患者中，胼胝体萎缩的存在可能表明存在认知障碍。胼胝体萎缩可能反映了与氧代谢降低相关的白质损伤的严重程度和范围，这可能决定智力衰退的严重程度。
