Mull M
Abteilung für Neuroradiologie, Universitätsklinikum RWTH Aachen.
Radiologe. 1997 Nov;37(11):871-7. doi: 10.1007/s001170050296.
Classification of brain infarcts based on the location, size and shape of parenchymal damage alone can be difficult and misleading. This is particularly true in subcortical infarctions and infarcts in so-called watershed areas between neighboring territories of the main hemispheric arteries. Pathogenetic mechanisms, signs and symptoms, lesion patterns in CT and MRI are discussed as well as angiomorphological conditions. Hemodynamically induced low-flow infarcts are rare and show typical, but not pathognomic lesion patterns on CT and MRI. Characteristic subcortical chainlike and confluent lesions are located in the supra- and paraventricular white matter, representing the core of a hemodynamically induced infarction. Definite diagnosis of low-flow infarcts requires information on the underlying complex vascular compromise of the extra- and intracranial arterial circulation. A noncompetent circle of Willis is the main predisposing condition in hemispheric low-flow infarcts even in severe occlusive disease of the internal carotid arteries.
仅基于脑实质损害的位置、大小和形状对脑梗死进行分类可能既困难又具有误导性。在皮质下梗死以及主要半球动脉相邻区域之间所谓的分水岭区梗死中尤其如此。本文将讨论发病机制、体征和症状、CT和MRI中的病变模式以及血管形态学情况。血流动力学诱导的低灌注梗死很少见，在CT和MRI上显示典型但不具有特异性的病变模式。特征性的皮质下链状和融合性病变位于脑室上和脑室旁白质，代表血流动力学诱导梗死的核心。低灌注梗死的明确诊断需要了解颅外和颅内动脉循环潜在的复杂血管损害情况。即使在内颈动脉严重闭塞性疾病中， Willis环功能不全仍是半球低灌注梗死的主要易感因素。
