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目的探讨弥散加权成像(DWI)上急性多发脑梗死的病因和发病机制。方法将DWI上呈现急性脑梗死的147例患者分为腔隙性脑梗死和非腔隙性脑梗死两组,按照TOAST标准(trial of org10172in acute stroketreatment)进行病因分类,腔隙性脑梗死还包括除小动脉病以外其他可能的原因。结果62例急性腔隙性脑梗死患者中有21例为多发,占33.87%;其中8例(38.09%)可找到小动脉病以外的其他原因,包括心源性栓塞3例、动脉源性栓塞3例、血液疾病1例、高凝状态1例。85例急性非腔隙性脑梗死患者中有9例为多发,占10.59%,其中心源性栓塞3例。结论DWI对急性多发脑梗死病因的识别有重要意义。急性多发腔隙性脑梗死提示一个非小动脉病的卒中机制,如栓子、血液疾病或高凝状态;不同血管供血的多发脑梗死提示心源性栓子,而非动脉-动脉的栓塞。
Objective To investigate the etiology and pathogenesis of acute multiple cerebral infarction on diffusion-weighted imaging (DWI). Methods A total of 147 patients with acute cerebral infarction on DWI were divided into two groups: lacunar infarction and non-lacunar infarction. According to the TOAST standard (trial of org10172in acute stroketreatment), lacunar infarction included Other possible causes besides arteriolar disease. Results Of the 62 patients with acute lacunar infarction, 21 were multiple, accounting for 33.87%. Among them, 8 (38.09%) had other causes besides small artery disease, including 3 cases of cardioembolism, arterial embolism 3 cases, 1 case of blood disease, hypercoagulable state in 1 case. Nine of 85 patients with acute non-lacunar infarction were multiple, accounting for 10.59% of whom 3 were cardiac-derived embolism. Conclusion DWI is of great importance in the identification of the etiology of acute multiple cerebral infarction. Acute multiple lacunar infarcts suggest a stroke-related non-arterial stroke mechanism such as emboli, blood disease, or hypercoagulable states; multiple cerebral infarctions with different blood vessels suggest cardiogenic emboli instead of arterial-arterial embolization.