摘要
目的探讨急性丘脑梗死病灶动脉血供与病因分型、临床表现及预后的关系。方法 116例急性丘脑梗死患者行头颅MRI检查,对病灶供血、TOAST分型、神经系统体征、神经功能恢复(mRS评分)等指标进行分析。结果 116例中单纯丘脑梗死占79.3%,联合丘脑梗死占20.7%。根据TOAST分型,大动脉硬化型占12.1%,心源型占15.5%,小动脉闭塞型占60.3%,其他占12.1%。单纯丘脑梗死中,下外侧动脉供血区占75.0%,结节丘脑动脉供血区占10.9%,脉络膜后动脉供血区占11.9%,旁中央动脉供血区占2.2%;临床表现依次为:感觉缺失、偏瘫、丘脑痛和共济失调;意识水平改变、认知功能障碍、人格改变;视野缺损、感觉障碍;意识下降、眼球运动异常和精神行为异常。下外侧动脉、结节丘脑动脉和脉络膜后动脉供血区起病后90dmRS评分较入院时明显降低(P<0.01),旁中央动脉供血区mRS评分增加。结论丘脑梗死的主要病因为小动脉闭塞,其中以下外侧动脉供血区最为常见,其临床主要症状为感觉缺失、偏瘫。旁中央动脉供血区丘脑梗死预后差。
Objective To explore the relationships between the vascular supply of thalamic infarcts,etiology,clinical manifestation and prognosis.Methods We observed 116 acute thalamic infarctions and analyzed vascular supply,TOAST classification,nerve system signs and neurological function recovery.Results 116 acute thalamic infarctions patients were divided into 2 groups according to DWI patterns：isolated thalamic infarcts group（79.3%）and combined thalamic infarcts group（20.7%）.The patients were also divided 4 groups according to etiology based on TOAST classification：Large Artery Atherosclerosis（LAA 12.1%）,Cardiac Embolism（CE 15.5%）,Small Vessel Occlusion（SVO 60.3%）,other cause or no etiology identified（NA 12.1%）.In all cases of isolated thalamic infarction,they are inferolateral artery territory（75%）,tuberothalamic artery territory（10.9%）,posterior choroidal artery territory（11.9%）,paramedian artery territory（2.2%）;the clinical features are as follows：hemisensory loss,hemiplegia,thalamus pain and ataxia;level of consciousness change,cognitive dysfunction,personality change;sensory disorders,visual field defect;consciousness disorders,ocular motility disorders,mental and behavior disorder.MRS scores of 90 d after onset was distinctly decrease than admission in inferolateral artery,tuberothalamic artery and posterior choroidal artery territory groups（P0.01）,paramedian artery territory group had the worst mRS score.Conclusion Thalamic infarction is mainly due to small artery occlusion.Inferolateral territory was more prevalent in isolated thalamic infarct and its main clinical symptoms are loss of sensation and hemiplegia.The prognosis in paramedian artery territory is bad.
出处
《中国实用神经疾病杂志》
2018年第1期26-29,共4页
Chinese Journal of Practical Nervous Diseases
基金
甘肃省自然科学基金(编号:1506RJZA259)
关键词
丘脑
梗死
临床表现
病因
磁共振成像
预后
Thalamic
Infarction
Clinical manifestation
Etiology
MRI
Prognosis
