Lesion Topography and Its Correlation With Etiology in Medullary Infarction: Analysis From a Multi-Center Stroke Study in China
Lesion Topography and Its Correlation With Etiology in Medullary Infarction: Analysis From a Multi-Center Stroke Study in China
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DOI：
10.3389/fneur.2018.00813
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发表时间：
2018-09-27
影响因子：
3.4
通讯作者：
Peng, Bin
中科院分区：
文献类型：
--
作者：
Hong, Yue-hui;Zhou, Li-xin;Peng, Bin
目的：延髓梗死（MI）的病变地形图是异质性的，其与卒中病因的相关性仍然是难以捉摸的。我们的目的是澄清心肌梗死的病变模式，并评估其与卒中病因学的相关性。材料和方法：在SMART研究（一项关于中国卒中二级预防的多中心试验）中，2008年4月至2010年12月期间，对1129例具有DWI的受试者进行回顾性评价，其中43例DWI证实的心肌梗死（3.8%）。病变被分类为延髓外侧和内侧梗死（LMI和MMI，分别为33和10例受试者），位于头尾侧的3个节段，与卒中病因相关。结果：大动脉粥样硬化29例，小血管闭塞11例，心源性栓塞1例，动脉夹层2例。大动脉疾病是LMI中最常见的原因（24/33，72.7%），而小血管闭塞在MMI中并不少见（5/10，50.0%）。虽然大动脉粥样硬化和小血管闭塞之间的梗死模式差异不显著，但两种不同的病变模式被认为是相关的：（1）嘴侧MMI伴连续脑桥内侧梗死更可能归因于小血管闭塞而不是大动脉粥样硬化。Kameda等人（2）与小血管闭塞相比，大动脉疾病更常引起腹侧至背侧延伸的MMI。入院时的中位NIHSS为4。在中位17个月的随访期间，2名患者死亡，2名患者出现复发性缺血事件，41名受试者中有39名（95.1%）功能独立（mRS 0-2）。结论：这项多中心研究表明，MI具有不同的病变模式，具体取决于不同的中风病因和机制。未来更大样本量的研究应建立MI的病变模式，并验证其与卒中病因和机制的相关性，这可能会改善卒中管理。
Objectives: The lesion topography of medullary infarction (MI) is heterogeneous and its correlation with stroke etiology remains elusive. We aim to clarify the lesion pattern of MI and to assess its correlation with stroke etiology.Material and Methods: Of 1129 subjects with available DWI in SMART study (a multi-center trial concerning secondary stroke prevention in China) between April 2008 and December 2010, 43 patients with DWI confirmed MI (3.8%) were retrospectively evaluated. Lesions were categorized as lateral and medial medullary infarction (LMI and MMI, 33 and 10 subjects respectively) at 3 levels rostro-caudally and correlated with the stroke etiology. Clinical profiles and long-term prognosis were analyzed.Results: Large artery atherosclerosis, small vessel occlusion, cardiogenic embolism and artery dissection accounted for 29, 11, 1, and 2 infarcts, respectively. Large artery disease was the most common cause in LMI (24 of 33, 72.7%) whereas small vessel occlusion was not uncommon in MMI (5 of 10, 50.0%). Though the difference of infarct pattern between large artery atherosclerosis and small vessel occlusion was insignificant, two distinct lesion patterns were considered to be relevant: (1) Rostral MMI with continuous medial pontine infarctions were more likely attributed to small vessel occlusion than large artery atherosclerosis. Kameda et al. (2) MMI with ventral to dorsal extension were more often caused by large artery disease than small vessel occlusion. Median NIHSS at admission was 4. During a median follow-up of 17 months, 2 patients died and 2 experienced recurrent ischemic events, 39 of 41 subjects (95.1%) were functional independent (mRS 0-2).Conclusions: This multi-center study demonstrates that MI has distinct lesion pattern depending on various stroke etiologies and mechanisms. Future investigations with larger sample size should establish the lesion pattern of MI and validate its correlation with the stroke etiology and mechanisms, which might improve stroke management.