高凝状态相关性非单一动脉供血区多发急性脑梗死的临床特点和微栓子监测

发布时间：2018-06-26 13:42

本文选题：脑梗死 + 栓塞　；参考：《中国神经精神疾病杂志》2016年08期

【摘要】：目的研究高凝状态相关性非单一动脉供血区多发急性脑梗死的临床和影像学特点、微栓子监测,探讨其可能的发病机制。方法收集就诊于我院神经内科的高凝状态相关性非单一动脉供血区多发急性脑梗死患者的临床资料、实验室检查、头MRI、TCD微栓子监测,总结分析其特点。结果共收集22例患者。均以局灶性神经功能缺损急性起病,包括偏瘫、失语、偏身感觉障碍、构音障碍、偏盲、皮质盲。高凝状态相关性基础疾病如下:系统性恶性肿瘤10例,高同型半胱氨酸血症(中重度,HCY50μmol/L)5例,肾病综合征2例,抗磷脂综合征2例,溃疡性结肠炎1例,真性红细胞增多症1例,阵发性睡眠性血红蛋白尿症1例。18例在卒中发病后高凝状态相关性基础疾病才被首次确诊。DWI示多发急性梗死灶,不符合单一动脉供血区,累及双侧前循环或前后循环,病灶累及大脑半球脑叶皮层/皮层下22例,深部12例,小脑10例,脑干2例。22例行微栓子监测者10例阳性。结论对于非单一动脉供血区多发急性脑梗死,要注意筛查高凝状态相关性基础疾病,高凝状态和微栓塞可能都参与其发病机制。
[Abstract]:Objective to study the clinical and imaging features of multiple acute cerebral infarction (ACI) in hypercoagulant state associated with non-single artery supply area, and to investigate the possible pathogenesis of hypercoagulation-related acute cerebral infarction (ACI) by monitoring microemboli. Methods the clinical data, laboratory examination and TCD microemboli monitoring of multiple acute cerebral infarction patients with hypercoagulant state associated with non-single artery blood supply were collected and analyzed in our department of neurology. Results A total of 22 patients were collected. All patients had acute onset of focal neurological deficit, including hemiplegia, aphasia, hemiplegia, dysarthria, hemianopsia and cortical blindness. The basic diseases associated with hypercoagulability were as follows: 10 cases of systemic malignant tumor, 5 cases of hyperhomocysteinemia (moderate and severe HCY 50 渭 mol / L), 2 cases of nephrotic syndrome, 2 cases of antiphospholipid syndrome, 1 case of ulcerative colitis, 1 case of true polycythemia. One case with paroxysmal nocturnal hemoglobinuria. 18 cases with hypercoagulation-related basic diseases after stroke were first diagnosed. DWI showed multiple acute infarct foci, which did not accord with single artery supply area and involved bilateral anterior circulation or anterior and posterior circulation. There were 22 cases of cerebral hemispheric cortex / subcortical involvement, 12 cases of deep cerebral cortex, 10 cases of cerebellum and 2 cases of brain stem. 10 cases were positive for microemboli monitoring. Conclusion for multiple acute cerebral infarction in non-single arterial blood supply area, attention should be paid to screening basic diseases associated with hypercoagulability. Hypercoagulability and microembolism may be involved in the pathogenesis of cerebral infarction.
【作者单位】：北京大学第一医院神经内科;
【分类号】：R743.3

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