脑分水岭梗塞的临床特点及其对认知功能的影响
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摘要
目的
探讨脑分水岭梗塞的临床特点及对其认知功能的影响。
方法
收集住院患者经MRI诊断为脑分水岭梗塞35例患者的临床资料,将脑分水岭梗塞分为皮质前型、皮质后型、皮质下型和混合型,对各型梗塞的临床特点进行分析；应用CTA检查手段对其中11例患者血管情况进行评估；同时选取同时期住院无脑梗塞的患者15例作为对照组,对两组进行MMSE和MoCA评分,应用SPSS15.0统计学软件,对两组进行统计分析。
结果
在各类型的脑分水岭梗塞中,皮质下型最常见,占脑分水岭梗塞的48.57%；11例血管CTA检查结果显示9例(81.82%)为皮质下型梗塞,11例均有不同程度的颅内外血管狭窄,颅内血管狭窄以大脑中动脉最常见；分水岭梗塞对认知功能有不同程度的影响,MoCA较MMSE能更敏感的反应认知功能的变化,行MMSE评分,梗塞组与非梗塞组之间无统计学意义(P>0.05),行MoCA评分,梗塞组与非梗塞组之间有统计学意义(P<0.005),在MoCA量表中,两组之间比较,其中视空间及执行功能、注意力、延迟记忆三项对比均有统计学意义(P<0.005),而语言、命名、抽象和定向力四项两组之间无统计学意义(P>0.05)。
结论
分水岭梗塞有其特有临床特点；对认知功能有影响；MoCA能更敏感的反应认知功能的变化。
Objective
To investigate the clinical manifestation of Cerebral Watershed infarction (CWI) and the impact on cognitive function.
Methods
35 patients with CWI diagnosed by magnetic resonance imaging(MRI) were collected and were divided into anteral watershed infarction (AWSI), posterior watershed infraction (PWSI), internal watershed infarction(IWSI) and mixed watershed infarction(MWI). Our job is to analysis the clinical feature of each pattern, and to evaluate blood vessel condition of 11 patients using CTA. Meanwhile, choose control group without cerebral infarction, Using MMSE and MoCA to compare the two groups under the help of SPSS 15.0.
Result
Posterior watershed infarction is the most common pattern in our research; account for 48.57%; 11 patients taked CTA all show hemadostenosis in both intracranial and extracranial artery. And it indeed have some impact on cognitive function.MoCA is more sensitive than MMSE in detecting mild changes of cognitive function,the two groups have significant difference(P<0.005). In MoCA, vision vacuity and execution function, attention and delayed memory have statistically significant(P<0.005), except speech, naming, abstract and orientation force.
Conclusion
CWI has its own feature, and have some impact on cognitive function. MoCA is more sensitive than MMSE in detecting mild cognitive impairment.
探讨脑分水岭梗塞的临床特点及对其认知功能的影响。
方法
收集住院患者经MRI诊断为脑分水岭梗塞35例患者的临床资料,将脑分水岭梗塞分为皮质前型、皮质后型、皮质下型和混合型,对各型梗塞的临床特点进行分析；应用CTA检查手段对其中11例患者血管情况进行评估；同时选取同时期住院无脑梗塞的患者15例作为对照组,对两组进行MMSE和MoCA评分,应用SPSS15.0统计学软件,对两组进行统计分析。
结果
在各类型的脑分水岭梗塞中,皮质下型最常见,占脑分水岭梗塞的48.57%；11例血管CTA检查结果显示9例(81.82%)为皮质下型梗塞,11例均有不同程度的颅内外血管狭窄,颅内血管狭窄以大脑中动脉最常见；分水岭梗塞对认知功能有不同程度的影响,MoCA较MMSE能更敏感的反应认知功能的变化,行MMSE评分,梗塞组与非梗塞组之间无统计学意义(P>0.05),行MoCA评分,梗塞组与非梗塞组之间有统计学意义(P<0.005),在MoCA量表中,两组之间比较,其中视空间及执行功能、注意力、延迟记忆三项对比均有统计学意义(P<0.005),而语言、命名、抽象和定向力四项两组之间无统计学意义(P>0.05)。
结论
分水岭梗塞有其特有临床特点；对认知功能有影响；MoCA能更敏感的反应认知功能的变化。
Objective
To investigate the clinical manifestation of Cerebral Watershed infarction (CWI) and the impact on cognitive function.
Methods
35 patients with CWI diagnosed by magnetic resonance imaging(MRI) were collected and were divided into anteral watershed infarction (AWSI), posterior watershed infraction (PWSI), internal watershed infarction(IWSI) and mixed watershed infarction(MWI). Our job is to analysis the clinical feature of each pattern, and to evaluate blood vessel condition of 11 patients using CTA. Meanwhile, choose control group without cerebral infarction, Using MMSE and MoCA to compare the two groups under the help of SPSS 15.0.
Result
Posterior watershed infarction is the most common pattern in our research; account for 48.57%; 11 patients taked CTA all show hemadostenosis in both intracranial and extracranial artery. And it indeed have some impact on cognitive function.MoCA is more sensitive than MMSE in detecting mild changes of cognitive function,the two groups have significant difference(P<0.005). In MoCA, vision vacuity and execution function, attention and delayed memory have statistically significant(P<0.005), except speech, naming, abstract and orientation force.
Conclusion
CWI has its own feature, and have some impact on cognitive function. MoCA is more sensitive than MMSE in detecting mild cognitive impairment.
引文
1 Isabelle MM, Baron JC.The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease:review of cerebral perfusion studies.stroke.2005;36(3):567-577.
2 Peterson RC,Smith GE,Waring SC, et al. Mild cognitive impairment. Clinical characterization and outcome. ArchNeurol.1999;56:303-308.
3 Eneinas M,juan R,Marcos A,et al.rCBF assessed with SPECT as a marker of progression of MCI and AD. Eur J Nucl Med Mol Imaging.2003;30:149-151.
4 Schinidt WP,Roesle A,krefzschmar K,et al.Functional and congnitive consequences of silent stroke of discovered used brain MRI in an elderly population J Am. Geriatric. 2004;52:1212-1213.
5 Aart S,Annelies WE,Weverling-Rijinsburser, et al.late-onset Dementia:structural brain Damage and total cerebral blood flow.Radiology.2005;236:990-995.
6 Oda-christina S,Thanomphone S, Rudolf k,et al. Cerebral Hypoperfusion Generates Cortial Watershed Microinfarcts in Alzheimer Disease.American Stroke Association.2002;33:1986-1992.
7 Nasreddinc ZS,Phillips NA, Bedirian V,et al.The Montreal Congnitive Assessment, MoCA:a brief screening tool for Mild Cognitive Impairment. J Am Geriatr Soc.2005;534:695-699.
8 Lee PH,Bang OY,OH SH,et al.Subcortial white matter infarcts:comparison of superficial perforating artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging. Stroke.2003;3411:2630-2635.
9 Moriwaki H, Matsumoto M. Hemodynamic Aspect of cerebral watershed infraction Assessment of perfusion Reserve Using Iodine-123-Iodoamphetamine SPECT. The Journal of Nuclear medicine.1997; 38:1556-1562.
10杨小霞,李国前,洪渚全,等.脑分水岭梗死的临床研究.中国实用医药杂志.2007；2：3-5.
11 李兆爱,王桂,分水岭梗塞的98例临床分析.临床研究.2007；45：39.
12冯加纯,王守春,分水岭梗塞的发病机制及Willis环血流代偿对其的影响.中国脑血管病学杂志.2008；53：102-106.
13 Heier LA,Bauer CJ, Schwartz L,et al.Large Virchow-Robin Spaces:MR-clinical correlation.Am J neuroradiology.1989;20:346-350.
14 Yong SW, Bang OY, Lee P,et al. Interal and cortial border-zone infarction:clinical and diffusion-weighted imaging features.Stroke.2006;37:841-846.
15 Lee D K, Kim J S, Kwon S U, et al. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease:early diffusion-weighted imaging study. Stroke.2005;3612:2583-2588.
16 Kim SJ, Lee CW, Kim HJ, et al. Acute-stage evolution of watershed infraction assessed on diffusion-weighted MR imaging. Cerebrovasc Dis.2006;21:357-362.
17 Bogousslavsly J,Regli F. Unilateral watershed infarcts. Neurology.1986;36:373-377.
1 Isabelle MM, Baron JC,.The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease:review of cerebral perfusion studies. Stroke.2005;363:567-577.
2 Bogousslavsly J,Regli F. Unilateral watershed infarcts. Neurology.1986;36:373-377.
3 Decroix JP,Graveleau P,Masson M,et al.Infraction in the territory of the anterior choroidal artery:A clinical and computerized tomographic study of 16 cases.Brain.1986;109:1071-1078.;
4 Rebecca F, Paul M, Maura A,et al. Watershed Strokes After Cardiac Surgery:Diagnosis, Etiology, and Outcome.Stroke.2003;453:345-347.
5 杨小霞,李国前,洪渚全,等.脑分水岭梗死的临床研究.中国实用医药杂志.2007；2：3-5.
6 李兆爱,王桂,分水岭梗塞的98例临床分析.临床研究.2007；45：39.
7 殷萍,冯加纯,王守春.分水岭梗塞的发病机制及Willis环血流代偿对其的影响.中国脑血管病学杂志.2008；53：102-106.
8 Leblanc R, Yamamoto YL, Hakim A,et al. Borderzone ischemia. Ann Neurol.1987; 22: 707-713.
9 Bladin CF,Chambers BR.clinical geatures:pathogensis and computed tomographic charactreistica of intermal watershed infraction.stroke.1993;24:1925-1932.
10 Lee,PH, Bang OY,OH SH,et al.Subcortial white matter infarcts:comparison of superficial perforaing artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging. Stroke.2003;3411:2630-2635.
11 Lim YC,Ding CS L,Kong K H.Akinetic mutism after right internal watershed infraction.Singapore Med. Case Report.2007;485:466-468.
12 Moriwaki H, Matsumoto M. Hemodynamic Aspect of cerebral watershed infraction Assessment of perfusion Reserve Using Iodine-123-Iodoamphetamine SPECT. The Journal of Nuclear medicine.1997; 38:1556-1562.
13 Schinidt WP,Roesle A,krefzschmar K,et al. Functional and congnitive consequences of silent stroke of discovered used brain MRI in an elderly population J Am. Geriatric.2004;52:1212-1213.
14 Oda-christina S, Thanomphone S,Rudolf k,et al.Cerebral Hypoperfusion Generates Cortial Watershed Microinfarcts in Alzheimer Disease.American Stroke Association.2002;33:1986-1992.
15 Ing-Jye Huang, Cheng-Yu Chen, Hsiao-Wen Chung, et al.Time Course of Cerebral Infarction in the Middle Cerebral Arterial Territory:Deep Watershed versus Territorial Subtypes on Diffusion-weighted MR Images.neuroradiology.2001;33:1345-1347.
16 Primes JJ,Korten AC. Transcortical Sensory Aphasia in a Right-Handed Patient Following Watershed Infarcts in the Right Cerebral Hemisphere:A 15-Month Evaluation of Another Case of Crossed Aphasia. Brain and Language.1999;70:262-272.
2 Peterson RC,Smith GE,Waring SC, et al. Mild cognitive impairment. Clinical characterization and outcome. ArchNeurol.1999;56:303-308.
3 Eneinas M,juan R,Marcos A,et al.rCBF assessed with SPECT as a marker of progression of MCI and AD. Eur J Nucl Med Mol Imaging.2003;30:149-151.
4 Schinidt WP,Roesle A,krefzschmar K,et al.Functional and congnitive consequences of silent stroke of discovered used brain MRI in an elderly population J Am. Geriatric. 2004;52:1212-1213.
5 Aart S,Annelies WE,Weverling-Rijinsburser, et al.late-onset Dementia:structural brain Damage and total cerebral blood flow.Radiology.2005;236:990-995.
6 Oda-christina S,Thanomphone S, Rudolf k,et al. Cerebral Hypoperfusion Generates Cortial Watershed Microinfarcts in Alzheimer Disease.American Stroke Association.2002;33:1986-1992.
7 Nasreddinc ZS,Phillips NA, Bedirian V,et al.The Montreal Congnitive Assessment, MoCA:a brief screening tool for Mild Cognitive Impairment. J Am Geriatr Soc.2005;534:695-699.
8 Lee PH,Bang OY,OH SH,et al.Subcortial white matter infarcts:comparison of superficial perforating artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging. Stroke.2003;3411:2630-2635.
9 Moriwaki H, Matsumoto M. Hemodynamic Aspect of cerebral watershed infraction Assessment of perfusion Reserve Using Iodine-123-Iodoamphetamine SPECT. The Journal of Nuclear medicine.1997; 38:1556-1562.
10杨小霞,李国前,洪渚全,等.脑分水岭梗死的临床研究.中国实用医药杂志.2007；2：3-5.
11 李兆爱,王桂,分水岭梗塞的98例临床分析.临床研究.2007；45：39.
12冯加纯,王守春,分水岭梗塞的发病机制及Willis环血流代偿对其的影响.中国脑血管病学杂志.2008；53：102-106.
13 Heier LA,Bauer CJ, Schwartz L,et al.Large Virchow-Robin Spaces:MR-clinical correlation.Am J neuroradiology.1989;20:346-350.
14 Yong SW, Bang OY, Lee P,et al. Interal and cortial border-zone infarction:clinical and diffusion-weighted imaging features.Stroke.2006;37:841-846.
15 Lee D K, Kim J S, Kwon S U, et al. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease:early diffusion-weighted imaging study. Stroke.2005;3612:2583-2588.
16 Kim SJ, Lee CW, Kim HJ, et al. Acute-stage evolution of watershed infraction assessed on diffusion-weighted MR imaging. Cerebrovasc Dis.2006;21:357-362.
17 Bogousslavsly J,Regli F. Unilateral watershed infarcts. Neurology.1986;36:373-377.
1 Isabelle MM, Baron JC,.The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease:review of cerebral perfusion studies. Stroke.2005;363:567-577.
2 Bogousslavsly J,Regli F. Unilateral watershed infarcts. Neurology.1986;36:373-377.
3 Decroix JP,Graveleau P,Masson M,et al.Infraction in the territory of the anterior choroidal artery:A clinical and computerized tomographic study of 16 cases.Brain.1986;109:1071-1078.;
4 Rebecca F, Paul M, Maura A,et al. Watershed Strokes After Cardiac Surgery:Diagnosis, Etiology, and Outcome.Stroke.2003;453:345-347.
5 杨小霞,李国前,洪渚全,等.脑分水岭梗死的临床研究.中国实用医药杂志.2007；2：3-5.
6 李兆爱,王桂,分水岭梗塞的98例临床分析.临床研究.2007；45：39.
7 殷萍,冯加纯,王守春.分水岭梗塞的发病机制及Willis环血流代偿对其的影响.中国脑血管病学杂志.2008；53：102-106.
8 Leblanc R, Yamamoto YL, Hakim A,et al. Borderzone ischemia. Ann Neurol.1987; 22: 707-713.
9 Bladin CF,Chambers BR.clinical geatures:pathogensis and computed tomographic charactreistica of intermal watershed infraction.stroke.1993;24:1925-1932.
10 Lee,PH, Bang OY,OH SH,et al.Subcortial white matter infarcts:comparison of superficial perforaing artery and internal border-zone infarcts using diffusion-weighted magnetic resonance imaging. Stroke.2003;3411:2630-2635.
11 Lim YC,Ding CS L,Kong K H.Akinetic mutism after right internal watershed infraction.Singapore Med. Case Report.2007;485:466-468.
12 Moriwaki H, Matsumoto M. Hemodynamic Aspect of cerebral watershed infraction Assessment of perfusion Reserve Using Iodine-123-Iodoamphetamine SPECT. The Journal of Nuclear medicine.1997; 38:1556-1562.
13 Schinidt WP,Roesle A,krefzschmar K,et al. Functional and congnitive consequences of silent stroke of discovered used brain MRI in an elderly population J Am. Geriatric.2004;52:1212-1213.
14 Oda-christina S, Thanomphone S,Rudolf k,et al.Cerebral Hypoperfusion Generates Cortial Watershed Microinfarcts in Alzheimer Disease.American Stroke Association.2002;33:1986-1992.
15 Ing-Jye Huang, Cheng-Yu Chen, Hsiao-Wen Chung, et al.Time Course of Cerebral Infarction in the Middle Cerebral Arterial Territory:Deep Watershed versus Territorial Subtypes on Diffusion-weighted MR Images.neuroradiology.2001;33:1345-1347.
16 Primes JJ,Korten AC. Transcortical Sensory Aphasia in a Right-Handed Patient Following Watershed Infarcts in the Right Cerebral Hemisphere:A 15-Month Evaluation of Another Case of Crossed Aphasia. Brain and Language.1999;70:262-272.