Bogousslavsky J, Bernasconi A, Kumral E
Department of Neurology, Centre Hospitalier, Universitaire Vaudois, Lausanne, Switzerland.
Arch Neurol. 1996 Jan;53(1):50-7. doi: 10.1001/archneur.1996.00550010068017.
To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation.
Data analysis from a prospective acute stroke registry in a community-based primary care center.
Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent.
Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing diagnosis before brain imaging.
评估累及前循环的急性多发性梗死的发生率以及临床、部位和病因模式。
对社区基层医疗中心前瞻性急性卒中登记处的数据进行分析。
在4年期间的751例首次发生前循环缺血性卒中的患者中，40例（5%）发生了累及前循环的急性多发性梗死。在计算机断层扫描和钆增强磁共振成像上，梗死有四种部位模式：（1）浅表梗死（11例[28%]）；（2）浅表和深部梗死（12例[30%]）；（3）深部梗死（3例[8%]）；（4）累及前循环和后循环的梗死（14例[35%]）。四分之一的病例双侧大脑半球均受累。高达20%的患者有特定的临床表现。这包括伴有左侧偏盲、偏身感觉丧失或偏瘫（右利手患者）的完全性失语、伴有偏盲的经皮质混合性失语以及急性单纯认知障碍（“痴呆”）。13例患者（33%）发现有大动脉疾病；11例患者（28%）发现有心源性栓塞；3例患者（8%）两者均有。双侧梗死与心源性栓塞（4例患者）和双侧大动脉疾病（3例患者）有关。卒中后1个月，四分之一的患者独立生活，三分之一有一定残疾，40%死亡或完全依赖他人。
累及前循环的急性多发性梗死可能比目前认为的更常为双侧性，且常与后循环梗死相关。它们主要累及软脑膜半球区域，通常由心源性栓塞或双侧颈动脉粥样硬化引起。高达五分之一的患者可能伴有特定的神经 - 神经心理学功能障碍模式，从而在脑成像之前就能做出诊断。
