Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry
Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry
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DOI：
10.1001/archneur.56.7.824
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发表时间：
1999-07-01
影响因子：
--
通讯作者：
Caplan, LR
中科院分区：
文献类型：
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作者：
Yamamoto, Y;Georgiadis, AL;Caplan, LR
背景：大脑后动脉（PCA）区域内的闭塞是常见的。虽然相关的临床症状和体征是已知的，中风的机制和解剖分布的PCA领土病变所造成的各种中风的机制是不太好的定义。发表的报告只选择了特殊亚组的patients.Patients和方法：我们研究了新英格兰医学中心后循环登记处的79例患者的卒中机制、梗死分布和临床结果，这些患者的脑成像扫描显示梗死涉及PCA的1个或多个皮质区域。48例患者（61%）的梗死仅限于PCA区域（纯PCA），而31例（39%）也有其他区域（PCA+）的梗死。47例患者（59%）的病灶位于PCA的皮质区域，32例患者（41%）位于皮质和深部。皮质和深部病灶在PCA+病灶中更常见。卒中机制为心源性栓塞（32例[41%]）、近端动脉疾病（25例[32%]）、隐源性栓塞（8例[10%]）、内源性PCA疾病（7例[9%]）、血管收缩（4例[5%]）和凝血病（3例[4%]）。心源性栓塞和内源性PCA病变的患者多为单纯PCA区梗死，而近端动脉病变的患者多为PCA+梗死。66例（84%）患者存在视力异常。运动无力，认知和行为异常，共济失调被发现在20例（25%），只有12（15%）有感觉signs.Conclusions：绝大多数的纯PCA和PCA+领土梗死是由心脏或动脉内栓塞。内源性PCA疾病、血管收缩和凝血障碍是梗死的较不常见的原因。
Background: Infarcts in the territory of the posterior cerebral arteries (PCAs) are common. Although associated clinical symptoms and signs are known, the mechanisms of stroke and the anatomical distribution of PCA territory lesions caused by the various stroke mechanisms are less well defined. Published reports have selected only special subgroups of patients.Patients and Methods: We studied stroke mechanisms, infarct distribution, and clinical findings among 79 patients in the New England Medical Center Posterior Circulation Registry in whom brain imaging scans showed infarcts that involved 1 or more cortical territories of the PCA.Results: Forty-eight patients (61%) had infarcts limited to the PCA territory (pure PCA), while 31 (39%) also had infarcts in other territories (PCA+). Infarcts were in the cortical territory of the PCA in 47 patients (59%) and were cortical and deep in 32 (41%). Infarcts that were cortical and deep were more common in PCA+ lesions. Stroke mechanisms were embolism of cardiac origin (32 [41%]), proximal arterial disease (25 [32%]), cryptogenic embolism (8 [10%]), intrinsic PCA disease (7 [9%]), vasoconstriction (4 [5%]), and coagulopathy (3 [4%]). Patients with cardiogenic embolism and intrinsic PCA disease often had pure PCA territory infarcts, while patients with proximal arterial disease more often had PCA+ infarcts, Visual abnormalities were present in 66 patients (84%). Motor weakness, cognitive and behavioral abnormalities, and ataxia were found in 20 patients (25%); only 12 (15%) had sensory signs.Conclusions: The great majority of pure PCA and PCA+ territory infarcts are caused by cardiac or intra-arterial embolism. Intrinsic PCA disease, vasoconstriction, and coagulopathy are less common causes of infarction.