Multiple subcortical acute ischemic lesions reflect small vessel disease rather than cardiogenic embolism
Multiple subcortical acute ischemic lesions reflect small vessel disease rather than cardiogenic embolism
复制标题
DOI：
10.1007/s00415-012-6451-4
复制
发表时间：
2012-09-01
影响因子：
6
通讯作者：
Hennerici，M. G.
中科院分区：
文献类型：
--
作者：
Wolf，M. E.;Sauer，T.;Hennerici，M. G.
不同半球或血管区域的多发性急性缺血性病变主要被认为是源于近端的栓塞源。然而，尽管进行了仔细的诊断工作，但病因分类往往仍未确定。我们认为，在小血管疾病(SVD)中有时可以观察到多个急性缺血性损害。从前瞻性收集的7000多名中风患者的数据库中，识别出173名急性双半球脑梗塞患者。我们在弥散加权磁共振成像(DWI)上分析了那些有多个小面积(<15 mm)皮质下急性缺血性病变的受试者，这些受试者同时伴有严重的小血管病变(Fazekas II-III级)，而没有近端的栓塞源。20例患者(平均年龄66±1112岁，男性12例)，平均2.95±111.24个急性病灶(每个患者2~7个病灶)，其中Fazekas II°5例，Fazekas III°15例。病变多位于腔隙性脑梗塞的典型部位。入院时NIHSS评分0~8分，平均(2.95±22.0)分。不同血管区域的多发性急性缺血性病变可能并不总是起源于近端的心血管血栓。同时的皮质下小缺血灶可能反映远端缺血，因为小血管病变反映了同时的血液流变学功能障碍。
Multiple acute ischemic lesions in different hemispheres or vascular territories are mainly considered to be of proximal embolic origin. However, despite careful diagnostic work-up, the etiological classification often stays undetermined. We propose that multiple acute ischemic lesions can sometimes be a phenomenon observed in small vessel disease (SVD). From a prospectively collected database of more than 7,000 stroke patients, 173 patients with acute bihemispheric infarction were identified. We analyzed those subjects with multiple small (< 15 mm Ø) subcortical acute ischemic lesions on diffusion-weighted MRI (DWI) and concomitant severe small vessel disease (Fazekas grades II–III) without a proximal embolic source as evaluated by cardiological investigations. Twenty patients (mean age 66 ± 12 years, 12 men) with a mean number of 2.95 ± 1.24 acute lesions on DWI (range of 2–7 lesions per patient) were identified (n= 5 Fazekas II°,n= 15 Fazekas III°). Most of the lesions were located in typical areas of lacunar infarction. The mean NIHSS score on admission was 2.95 ± 2.0 (range 0–8). Multiple acute ischemic lesions in different vascular territories might not always be of proximal cardiovascular embolic origin. Simultaneous small subcortical ischemic lesions may reflect remote ischemia due to small vessel disease reflecting simultaneous hemorheological dysfunction.