Amarenco P, Lévy C, Cohen A, Touboul P J, Roullet E, Bousser M G
Department of Neurology, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Stroke. 1994 Jan;25(1):105-12. doi: 10.1161/01.str.25.1.105.
Territorial cerebellar infarcts have mainly a thromboembolic mechanism. Cerebellar infarcts less than 2 cm in diameter have recently been reported as nonterritorial infarcts, but it is not clear whether they are low-flow or embolic infarcts. The aim of the present study was to compare the characteristics and causes of territorial and nonterritorial infarcts in a prospective series of 115 patients.
We collected data from 115 consecutive patients with cerebellar infarcts (79 territorial and 36 nonterritorial [ie, less than 2 cm]), using magnetic resonance imaging (88 patients) and computed tomography.
Patients with territorial infarcts and those with nonterritorial infarcts had similar vascular risk factors and clinical presentations and an equal frequency of cardiac source of embolism (32% versus 42%; P = NS) and of large artery occlusive disease (23% versus 19%; P = NS). Occlusive lesions of large arteries at angiography occurred at the level of one cerebellar artery (5% versus 0%; P = NS) and proximal to the ostia of the cerebellar arteries (18% versus 19%; P = NS). Infarcts distal to occlusive lesions were subdivided into unilateral vertebral artery occlusive disease (presumed artery-to-artery embolic mechanism; 18% versus 5%; P = NS) and low-flow state distal to bilateral vertebral or basilar artery occlusion (presumed hemodynamic mechanism; 0% versus 14%; P = .004). Patients with nonterritorial infarcts had more frequent hypercoagulable state (17% versus 1.25%; odds ratio, 15.6 [95% confidence interval, 1.8 to 135]). For the remaining patients, the mechanism of the infarct was unknown (34% versus 22%; P = NS).
Cerebellar infarcts less than 2 cm in diameter (ie, nonterritorial) have the same high rate of embolic mechanism as territorial infarcts (47% versus 49%; P = NS), have more frequent hypercoagulable state, and sometimes have a hemodynamic mechanism.
小脑区域梗死主要由血栓栓塞机制引起。近期有报道称直径小于2 cm的小脑梗死为非区域梗死，但尚不清楚它们是低灌注梗死还是栓塞性梗死。本研究的目的是在前瞻性纳入的115例患者中比较区域梗死和非区域梗死的特征及病因。
我们收集了115例连续性小脑梗死患者（79例区域梗死和36例非区域梗死[即直径小于2 cm]）的数据，采用磁共振成像（88例患者）和计算机断层扫描。
区域梗死患者和非区域梗死患者具有相似的血管危险因素和临床表现，心脏栓塞源（32%对42%；P = 无显著性差异）和大动脉闭塞性疾病（23%对19%；P = 无显著性差异）的发生频率相同。血管造影时大动脉闭塞性病变发生在一条小脑动脉水平（5%对0%；P = 无显著性差异）以及小脑动脉开口近端（18%对19%；P = 无显著性差异）。闭塞性病变远端的梗死分为单侧椎动脉闭塞性疾病（推测为动脉到动脉的栓塞机制；18%对5%；P = 无显著性差异）和双侧椎动脉或基底动脉闭塞远端的低灌注状态（推测为血流动力学机制；0%对14%；P = 0.004）。非区域梗死患者高凝状态更为常见（17%对1.25%；比值比，15.6[95%置信区间，1.8至135]）。对于其余患者，梗死机制不明（34%对22%；P = 无显著性差异）。
直径小于2 cm的小脑梗死（即非区域梗死）与区域梗死具有相同的高栓塞机制发生率（47%对49%；P = 无显著性差异），高凝状态更为常见，且有时存在血流动力学机制。
