Progress of Infarct Pattern, Etiology or Mechanism in Ischemic Cerebrovascular Disease

doi:10.3969/j.issn.1673-5765.2019.09.019

Abstract

Abstract:

The infarct patterns of ischemic cerebrovascular diseases are diverse. Based on the number of infarct, the infarct pattern can be classified as no infarct, single infarct or multiple infarcts. Single infarct can be classified according to the size and location of the infarcts, and multiple infarcts can be classified according to the involved territory of culprit artery. Different patterns of single and multiple infarcts are related to the etiology and mechanism.

Key words: Ischemic cerebrovascular disease; Infarct pattern; Etiology; Mechanism

摘要：

缺血性脑血管病的梗死模式具有多样性，根据梗死数目可分为无梗死、单发梗死和多发梗死。单发梗死主要根据病灶的位置和大小进行分类，多发梗死则根据血管的供血范围进行分类。单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。

关键词: 缺血性脑血管病; 梗死模式; 病因; 发病机制

WANG Guang-Yao, JING Jing, MENG Xia, LIU Li-Ping, ZHAO Xing-Quan, WANG Yong-Jun, WANG Yi-Long. Progress of Infarct Pattern, Etiology or Mechanism in Ischemic Cerebrovascular Disease[J]. Chinese Journal of Stroke, 2019, 14(09): 950-954.

王光耀, 荆京, 孟霞, 刘丽萍, 赵性泉, 王拥军, 王伊龙. 缺血性脑血管病梗死模式的分类及病因、发病机制研究进展[J]. 中国卒中杂志, 2019, 14(09): 950-954.

References

[1] EDLOW B L，HURWITZ S，EDLOW J A.

Diagnosis of DWI-negative acute ischemic stroke：a

meta-analysis[J]. Neurology，2017，89（3）：256-262.

[2] AMARENCO P，LAVALLÉE P C，LABREUCHE J，

et al. One-Year risk of stroke after transient ischemic

attack or minor stroke[J]. N Engl J Med，2016，374

（16）：1533-1542.

[3] WEN H M，LAM W W，RAINER T，et al. Multiple

acute cerebral infarcts on diffusion-weighted

imaging and risk of recurrent stroke[J]. Neurology，

2004，63（7）：1317-1319.

[4] WESSELS T，WESSELS C，ELLSIEPEN A，et

al. Contribution of diffusion-weighted imaging in

determination of stroke etiology[J]. AJNR Am J

Neuroradiol，2006，27（1）：35-39.

[5] KANG D W，CHALELA J A，EZZEDDINE M A，

et al. Association of ischemic lesion patterns on early

diffusion-weighted imaging with TOAST stroke

subtypes[J]. Arch Neurol，2003，60（12）：1730-

1734.

[6] ROQUER J，RODRÍGUEZ-CAMPELLO A，

CUADRADO-GODIA E，et al. Acute brain MRIDWI

patterns and stroke recurrence after mildmoderate

stroke[J]. J Neurol，2010，257（6）：947-

953.

[7] BONATI L H，LYRER P A，WETZEL S G，et al.

Diffusion weighted imaging，apparent diffusion

coefficient maps and stroke etiology[J]. J Neurol，

2005，252（11）：1387-1393.

[8] UENO Y，KIMURA K，IGUCHI Y，et al. Mobile

aortic plaques are a cause of multiple brain infarcts

seen on diffusion-weighted imaging[J]. Stroke，2007，

38（9）：2470-2476.

[9] BANG O Y，LEE P H，HEO K G，et al. Specific DWI

lesion patterns predict prognosis after acute ischaemic

stroke within the MCA territory[J]. J Neurol

Neurosurg Psychiatry，2005，76（9）：1222-1228.

[10] RINGELSTEIN E B，BINIEK R，WEILLER C，et

al. Type and extent of hemispheric brain infarctions

and clinical outcome in early and delayed middle

cerebral artery recanalization[J]. Neurology，1992，

42（2）：289-298.

[11] WONG K S，GAO S，CHAN Y L，et al. Mechanisms

of acute cerebral infarctions in patients with middle

cerebral artery stenosis：a diffusion-weighted

imaging and microemboli monitoring study[J]. Ann

Neurol，2002，52（1）：74-81.

[12] JUNG J M，KANG D W，YU K H，et al. Predictors

of recurrent stroke in patients with symptomatic

intracranial arterial stenosis[J]. Stroke，2012，43

（10）：2785-2787.

[13] BEJOT Y，CATTEAU A，CAILLIER M，et al.

Trends in incidence，risk factors，and survival in

symptomatic lacunar stroke in Dijon，France，from

1989 to 2006：a population-based study[J]. Stroke，

2008，39（7）：1945-1951.

[14] FISHER C M. Lacunar strokes and infarcts：a

review[J]. Neurology，1982，32（8）：871-876.

[15] MOK V，KIM J S. Prevention and management of

cerebral small vessel disease[J]. J Stroke，2015，17

（2）：111-122.

[16] CAPLAN L R. Lacunar infarction and small vessel

disease：pathology and pathophysiology[J]. J Stroke，

2015，17（1）：2-6.

[17] FISHER C M. Capsular infarcts：the underlying

vascular lesions[J]. Arch Neurol，1979，36（2）：65-73.

[18] LEE K B，OH H G，ROH H，et al. Can we

discriminate stroke mechanisms by analyzing the

infarct patterns in the striatocapsular region?[J]. Eur

Neurol，2008，60（2）：79-84.

[19] NICOLAI A，LAZZARINO L G，BIASUTTI E.

Large striatocapsular infarcts：clinical features and

risk factors[J]. J Neurol，1996，243（1）：44-50.

[20] LEE D K，KIM J S，KWON S U，et al. Lesion

patterns and stroke mechanism in atherosclerotic

middle cerebral artery disease：early diffusionweighted

imaging study[J]. Stroke，2005，36（12）：

2583-2588.

[21] KOENNECKE H C，BERNARDING J，BRAUN

J，et al. Scattered brain infarct pattern on diffusionweighted

magnetic resonance imaging in patients

with acute ischemic stroke[J]. Cerebrovasc Dis，2001，

11（3）：157-163.

[22] MUSTANOJA S，PUTAALA J，HAAPANIEMI E，

et al. Multiple brain infarcts in young adults：clues

for etiologic diagnosis and prognostic impact[J]. Eur

J Neurol，2013，20（2）：216-222.

[23] BAIRD A E，LOVBLAD K O，SCHLAUG G，et al.

Multiple acute stroke syndrome：marker of embolic

disease?[J]. Neurology，2000，54（3）：674-678.

[24] ROH J K，KANG D W，LEE S H，et al. Significance

of acute multiple brain infarction on diffusionweighted

imaging[J]. Stroke，2000，31（3）：688-694.

[25] CHO A H，KIM J S，JEON S B，et al. Mechanism of

multiple infarcts in multiple cerebral circulations on

diffusion-weighted imaging[J]. J Neurol，2007，254

（7）：924-930.

[26] DEPUYDT S，SAROV M，VANDENDRIES C，et

al. Significance of acute multiple infarcts in multiple

cerebral circulations on initial diffusion weighted

imaging in stroke patients[J]. J Neurol Sci，2014，337

（1-2）：151-155.

[27] WOLF M E，SAUER T，KERN R，et al. Multiple

subcortical acute ischemic lesions reflect small

vessel disease rather than cardiogenic embolism[J]. J Neurol，2012，259（9）：1951-1957.

[28] KIM S J，RYOO S，HWANG J，et al. Characterization

of the infarct pattern caused by vulnerable

aortic arch atheroma：DWI and multidetector row CT

study[J]. Cerebrovasc Dis，2012，33（6）：549-557.

[29] SAREMI F，EMMANUEL N，WU P F，et al.

Paradoxical embolism：role of imaging in diagnosis

and treatment planning[J]. Radiographics，2014，34

（6）：1571-1592.

[30] DURAN L，KAYHAN S，KATI C，et al. Cerebral

fat embolism syndrome after long bone fracture due

to gunshot injury[J]. Indian J Crit Care Med，2014，

18（3）：167-169.

[31] KONTANI S，NAKAMURA A，TOKUMI H，et al.

A case of cerebral fat embolism after artificial bone

replacement operation for femoral head fracture[J].

Rinsho Shinkeigaku，2014，54（8）：648-652.

[32] KIM J M，JUNG K H，PARK K H，et al. Clinical

manifestation of cancer related stroke：retrospective

case-control study[J]. J Neurooncol，2013，111（3）：

295-301.

[33] IJICHI T，ITOH T，SAKAI R，et al. Multiple

brain gas embolism after ingestion of concentrated

hydrogen peroxide[J]. Neurology，1997，48（1）：277-

279.

[34] MELLADO T P，CONSTANZO P F，MIQUEL P J，

et al. Ischemic brain infarction after an air embolism.

Case report[J]. Rev Med Chil，2005，133（4）：453-

456.

[35] WILLIAMS T L，PARIKH D R，HOPKIN J R，et

al. Teaching Neuro Images：cerebral air embolism

secondary to atrial-esophageal fistula[J/OL].

Neurology，2009，72（12）：e54-e55. https：//doi.

org/10.1212/01.wnl.0000345003.44413.5b.

[36] ONG C T，CHANG R Y. Intravenous thrombolysis

of occlusion in the middle cerebral and retinal

arteries from presumed ventricular myxoma[J/OL].

Stroke Res Treat，2010，2011：735057. https：//doi.

org/10.4061/2011/735057.

[37] BAEK S H，PARK S，LEE N J，et al. Effective

mechanical thrombectomy in a patient with

hyperacute ischemic stroke associated with cardiac

myxoma[J/OL]. J Stroke Cerebrovasc Dis，2014，23

（9）：e417-e419. https：//doi.org/10.1016/j.jstrokecere

brovasdis.2014.05.006.

[38] ZAKHARI N，CASTILLO M，TORRES C. Unusual

Cerebral Emboli[J]. Neuroimaging Clin N Am，2016，

26（1）：147-163.

[39] CAPLAN L R，WONG K S，GAO S，et al. Is

hypoperfusion an important cause of strokes? If so，

how?[J]. Cerebrovasc Dis，2006，21（3）：145-153.

[40] LI J，CHEN X Y，SOO Y，et al. Benign oligemia in

subacute stage is associated with borderzone infarction

in stroke patients caused by intracranial large

artery disease[J]. Eur Neurol，2016，77（1-2）：80-86.

[41] LIBERMAN A L，ZANDIEH A，LOOMIS C，et

al. Symptomatic carotid occlusion is frequently

associated with microembolization[J]. Stroke，2017，

48（2）：394-399.

[42] BERNASCONI A，BOGOUSSLAVSKY J，

BASSETTI C，et al. Multiple acute infarcts in

the posterior circulation[J]. J Neurol Neurosurg

Psychiatry，1996，60（3）：289-296.

[43] STEINKE W，MANGOLD J，SCHWARTZ A，et al.

Mechanisms of infarction in the superficial posterior

cerebral artery territory[J]. J Neurol，1997，244（9）：

571-578.

[44] KIM B J，SOHN H，SUN B J，et al. Imaging

characteristics of ischemic strokes related to patent

foramen ovale[J]. Stroke，2013，44（12）：3350-3356.

[45] ENGELTER S T，WETZEL S G，RADUE E W，et

al. The clinical significance of diffusion-weighted

MR imaging in infratentorial strokes[J]. Neurology，

2004，62（4）：574-580.