CAJ | 학술논문

目的探讨老年人大动脉粥样硬化与小动脉病变所致皮质下小梗死（small subcortical infarction，SSI）的临床与影像学表现。方法收治的57例老年人急性SSI患者根据TOAST标准被分为大动脉粥样硬化性卒中（large artery atherosclerosis，LAA）（n=26）和小动脉闭塞性卒中（small artery occlusion，SAO）（n=31）。比较其临床经过及MRI、弥散加权成像（diffusion-weight imaging，DWI）、磁共振血管造影（magnetic resonance angiography，MRA）。采用Barthel指数（Barthel Index，BI）评价缺血性卒中患者发病21d和90d时的转归。结果LAA所致SSI患者头MRI、DWI显示为多发小梗死灶（P＜0.01），而且以侧脑室旁为主（P＜0.01）。SAO组SSI患者预后较好。结论大动脉粥样硬化不仅可导致该动脉供血区大面积梗死，也可能导致SSI，多为多发性梗死，且预后不良。故应对SSI患者积极行MRA检查，针对病因采取积极治疗措施，以防出现大面积梗死。
목적탐토노년인대동맥죽양경화여소동맥병변소치피질하소경사（small subcortical infarction，SSI）적림상여영상학표현。방법수치적57례노년인급성SSI환자근거TOAST표준피분위대동맥죽양경화성졸중（large artery atherosclerosis，LAA）（n=26）화소동맥폐새성졸중（small artery occlusion，SAO）（n=31）。비교기림상경과급MRI、미산가권성상（diffusion-weight imaging，DWI）、자공진혈관조영（magnetic resonance angiography，MRA）。채용Barthel지수（Barthel Index，BI）평개결혈성졸중환자발병21d화90d시적전귀。결과LAA소치SSI환자두MRI、DWI현시위다발소경사조（P＜0.01），이차이측뇌실방위주（P＜0.01）。SAO조SSI환자예후교호。결론대동맥죽양경화불부가도치해동맥공혈구대면적경사，야가능도치SSI，다위다발성경사，차예후불량。고응대SSI환자적겁행MRA검사，침대병인채취적겁치료조시，이방출현대면적경사。
Objective To investigate the difference of clinical features between two kinds of acute small subcortical caused by infarcts large artery atherosclerosis and small vessel disease.Methods The hospitalized patients with acute SSI were divided into large atherosclerotic stroke group(n=26) and small-artery occlusive stroke group(n=31) according to TOAST criteria.The neuroimaging features between the two groups were compared.The outcome of patients was evaluated with Barthel Index(BI) at day 21 and 90 after stroke.Results Patients in the LAA group had multiple lesions(P<0.01) in MRI and DWI.The infarcts were focused on the region adjacent to lateral ventricle(P<0.05).Conclusion Large artery atherosclerosis can lead to large area cerebral infarction,but also SSI.MRA is important to patients with SSI in order to prevent the large area cerebral infarction in the future.