Horowitz D R, Tuhrim S
Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Neurology. 1997 Dec;49(6):1538-41. doi: 10.1212/wnl.49.6.1538.
Large subcortical infarctions may be due to cerebral embolism and cause cortical signs more frequently than small subcortical infarctions, which usually result from small-vessel disease and are not associated with cortical findings. We evaluated 51 consecutive patients with a subcortical infarct on CT that was 1.5 cm or larger for a potential carotid or cardiac source of embolism and determined how frequently aphasia, hemineglect, or gaze paresis occurred. A carotid or cardiac embolic source was identified in 63% of the total population with a carotid source occurring in 23% and a cardiac source occurring in 49%. More than one-half of the patients with hypertension or diabetes mellitus had an embolic source, whereas all patients without these risk factors had a possible carotid or cardiac source of embolism. Aphasia or hemineglect occurred in 39% of patients and gaze paresis occurred in 41%. Large subcortical strokes frequently result in a different clinical syndrome and from a different mechanism than small subcortical strokes.
大面积皮质下梗死可能由脑栓塞引起，与小面积皮质下梗死相比，其导致皮质体征的频率更高。小面积皮质下梗死通常由小血管疾病引起，且不伴有皮质病变。我们对51例CT显示皮质下梗死灶直径达1.5厘米或更大的连续患者进行评估，以寻找潜在的颈动脉或心脏栓子来源，并确定失语、偏侧忽视或凝视麻痹的发生频率。在全部患者中，63%发现有颈动脉或心脏栓子来源，其中23%为颈动脉来源，49%为心脏来源。超过一半的高血压或糖尿病患者有栓子来源，而所有无这些危险因素的患者都可能有颈动脉或心脏栓子来源。39%的患者出现失语或偏侧忽视，41%的患者出现凝视麻痹。大面积皮质下卒中与小面积皮质下卒中相比，常常导致不同的临床综合征，其发病机制也不同。
