Small Cortical Infarcts Transformed to Lobar Cerebral Microbleeds: A Case Series
Small Cortical Infarcts Transformed to Lobar Cerebral Microbleeds: A Case Series
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2018.12.050
复制
发表时间：
2019-04-01
影响因子：
2.5
通讯作者：
Tomimoto, Hidekazu
中科院分区：
文献类型：
--
作者：
Ito, Ai Ogawa;Shindo, Akihiro;Tomimoto, Hidekazu
由于成像设备的发展，脑微出血（MBs）已被经常观察到，并分为深部和大叶性脑微出血。大叶MBs与脑淀粉样血管病密切相关。在此，我们报告了3例小皮质缺血性脑卒中后发生的大叶性脑卒中。1例因颈动脉严重狭窄行颈动脉支架置入术，1例诊断为动脉对动脉栓塞，1例为来源不明的栓塞性卒中。弥散加权磁共振成像（MRI）检测新的小皮质梗死。初始MRI显示，脑卒中发病时，T2加权梯度回忆回声或敏感性加权成像（SWI）未见缺血性病变周围出血。12-20个月后的SWI随访显示，先前检测到的缺血性病变中存在大叶mbbs，在液体衰减反转恢复成像中，mbbs周围仍存在高强度病变。这些病例表明，脑MBs是通过小皮质梗死的转化而发展起来的。所有病例均表现为大叶性MBs，这些MBs存在于先前检测到的慢性缺血性病变中。局部缺血性病变周围存在的大叶mb可预测栓塞性梗死。
Cerebral microbleeds (MBs) have been often observed due to the development of imaging devices, and are classified to deep and lobar MBs. Lobar MBs are strongly associated with cerebral amyloid angiopathy. Here, we report 3 cases of lobar MBs that developed after small cortical ischemic stroke. One case underwent carotid artery stenting for severe carotid stenosis, one was diagnosed with artery-to-artery embolism, and the other was embolic stroke of undetermined source. New small cortical infarctions were detected with diffusion-weighted magnetic resonance imaging (MRI). Initial MRI revealed no hemorrhage around the ischemic lesion on T2*-weighted gradient-recalled echo or susceptibility-weighted imaging (SWI) at the onset of stroke. Follow-up SWI after 12-20 months revealed lobar MBs in the previously detected ischemic lesions, and high-intensity lesions remained around the MBs on fluid-attenuated inversion recovery imaging. These cases revealed that cerebral MBs developed through the transformation of small cortical infarctions. All cases showed lobar MBs, and these MBs existed in the previously detected ischemic lesions at a chronic stage. Lobar MBs present around ischemic lesions may predict embolic infarcts.