Bogousslavsky J, Regli F, Maeder P, Meuli R, Nader J
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Neurology. 1993 Aug;43(8):1528-33. doi: 10.1212/wnl.43.8.1528.
In a prospective study of 70 patients with infarcts in the posterior circulation admitted consecutively to a population-based primary-care center, we assessed infarct location and etiology using magnetic resonance imaging, three-dimensional time-of-flight magnetic resonance angiography, and noninvasive cardiac tests. The brainstem (mainly the paramedian pons) was the most commonly infarcted site (41/70, 59%), followed by the cerebellum (33/70, 47%). Combined supra- and infratentorial multiple vertebrobasilar infarcts occurred in 11 patients (16%). Overall, 27 patients (39%) had > or = 50% stenosis or occlusion of the basilar artery. There were other large-artery lesions in 19 patients (27%), including vertebral (V2-V4) stenosis or occlusion (in seven) and dolichoectatic vertebral/basilar arteries (in 12). Fifteen of the 70 patients had a potential cardiac source of embolism, which coexisted with large-artery disease in more than one-third of the cases. Cerebellar infarct without concomitant brainstem or occipital infarct was associated with cardioembolism (67%), while isolated paramedian pontine or midbrain infarct was associated with basilar artery stenosis (71%), suggesting in situ occlusion of the mouth of the perforators off the stenosed basilar artery. After exclusion of other potential causes of stroke, presumed small-artery disease associated with chronic hypertension remained the likely etiology in only 11 patients (16%), but these infarcts were not associated with any of the classical lacunar syndromes. Our findings emphasize the high frequency of severe intracranial large-artery disease in posterior circulation infarcts.
在一项对一家以社区为基础的初级保健中心连续收治的70例后循环梗死患者的前瞻性研究中，我们使用磁共振成像、三维时间飞跃磁共振血管造影和无创心脏检查评估梗死部位和病因。脑干（主要是脑桥旁正中部位）是最常发生梗死的部位（41/70，59%），其次是小脑（33/70，47%）。幕上和幕下联合的多发性椎基底动脉梗死发生在11例患者中（16%）。总体而言，27例患者（39%）基底动脉狭窄或闭塞≥50%。19例患者（27%）存在其他大动脉病变，包括椎动脉（V2 - V4）狭窄或闭塞（7例）和椎动脉/基底动脉迂曲扩张（12例）。70例患者中有15例存在潜在的心源性栓塞源，其中超过三分之一的病例与大动脉疾病并存。孤立的小脑梗死而无脑干或枕叶梗死与心源性栓塞相关（67%），而孤立的脑桥旁正中或中脑梗死与基底动脉狭窄相关（71%），提示狭窄基底动脉穿支开口处原位闭塞。在排除其他潜在的卒中病因后，仅11例患者（16%）可能的病因是与慢性高血压相关的小动脉疾病，但这些梗死与任何经典的腔隙综合征均无关。我们的研究结果强调了后循环梗死中严重颅内大动脉疾病的高发生率。
