腦小血管病概念與治療課件

腦小血管病

——概念與治療杜萬(wàn)良北京天壇醫(yī)院神經(jīng)內(nèi)科腦小血管注射硫酸鋇的標(biāo)本。白質(zhì)中央血管密度低。Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.腦小血管注射硫酸鋇的標(biāo)本。供給胼胝體的小分支。Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.腦小血管病的分類急性：卒中慢性：癡呆腔隙綜合征腔隙綜合征(1)純運(yùn)動(dòng)性輕偏癱(PMH)最常見(jiàn)。病灶可發(fā)生在內(nèi)囊、腦橋、大腦腳、基底節(jié)、大腦皮質(zhì)、放射冠等處。(2)純感覺(jué)性卒中(PSS)病灶位于丘腦腹后核，通常為大腦后動(dòng)脈的丘腦穿通支梗死所致。少數(shù)病例可由脊髓丘腦束、丘腦皮質(zhì)束的病灶所致，也可因病灶侵及整個(gè)丘腦的外側(cè)及內(nèi)囊后肢的放射冠而引起。(3)感覺(jué)運(yùn)動(dòng)性卒中(SMS)病灶位于丘腦腹后外側(cè)核和內(nèi)囊后肢，通常由大腦后動(dòng)脈的丘腦穿通支或脈絡(luò)膜后動(dòng)脈閉塞所致。(4)共濟(jì)失調(diào)輕偏癱(HAH)病灶發(fā)生在腦橋基底部或內(nèi)囊，放射冠、小腦等處也可發(fā)生。(5)構(gòu)音不良-手笨拙綜合征(DHS)病灶位于腦橋基底部的上1/3和2/3交界處或內(nèi)囊最上部分的膝部。腦小血管病的分類微出血血管周圍間隙擴(kuò)大白質(zhì)疏松腔隙MR表現(xiàn)Wardlaw,J.M.,etal.,Neuroimagingstandardsforresearchintosmallvesseldiseaseanditscontributiontoageingandneurodegeneration.TheLancetNeurology,2021.12(8):p.822-838.急性腔梗的

1年演變Wardlaw,J.M.,C.Smith,andM.Dichgans,Mechanismsofsporadiccerebralsmallvesseldisease:insightsfromneuroimaging.LancetNeurol,2021.12(5):p.483-97.腔隙常在白質(zhì)高信號(hào)邊緣Duering,M.,etal.,Incidentlacunespreferentiallylocalizetotheedgeofwhitematterhyperintensities:insightsintothepathophysiologyofcerebralsmallvesseldisease.Brain,2021.136(Pt9):p.2717-26.一名75歲男性，短暫性神經(jīng)病癥發(fā)作后1周出現(xiàn)病癥性左側(cè)額葉出血Charidimou,A.,J.C.Baron,andD.J.Werring,Transientfocalneurologicalepisodes,cerebralamyloidangiopathy,andintracerebralhemorrhagerisk:lookingbeyondTIAs.IntJStroke,2021.8(2):p.105-8.SVDscore(range0–4)男性(OR1.58,95%CI1.10–2.29),高血壓(OR1.50,95%CI1.02–2.20),吸煙

(OR2.81,95%CI1.59–3.63),腔隙性卒中

(OR2.45,95%CI1.70–3.54)與SVDScore相關(guān).腦萎縮與SVDScore無(wú)關(guān)Staals,J.,etal.,Strokesubtype,vascularriskfactors,andtotalMRIbrainsmall-vesseldiseaseburden.Neurology,2021.83(14):p.1228-34.腦小血管病的分類動(dòng)脈硬化性血管炎遺傳性腫瘤性感染性藥物相關(guān)性一名CADASIL〔伴皮質(zhì)下梗死和腦白質(zhì)病的常染色體顯性遺傳性腦動(dòng)脈病〕患者56歲和66歲的影像Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.一名66歲的女性CADASIL患者Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.COL4A1突變47歲無(wú)病癥COL4A1突變患者〔A,C,E,G,I,J〕。57歲CADASIL患者。一名HERNS

(伴有視網(wǎng)膜病-腎病-卒中的遺傳性內(nèi)皮細(xì)胞病)患者早期曾被誤診為多發(fā)性硬化Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.一名HERNS患者的影像早期有占位效應(yīng)和強(qiáng)化。Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.一名Susac綜合征〔腦病，視網(wǎng)膜小動(dòng)脈閉塞，聽(tīng)力喪失〕患者的胼胝體中部病灶Salamon,N.,Neuroimagingofcerebralsmallvesseldisease.BrainPathol,2021.24(5):p.519-24.7T75歲，男性。動(dòng)脈，靜脈vanVeluw,S.J.,etal.,Highresolutionimagingofcerebralsmallvesseldiseasewith7TMRI.ActaNeurochirSuppl,2021.119:p.125-30.7Ta.58歲，男，一過(guò)性黑矇，栓塞，基底動(dòng)脈高信號(hào)。b.49歲，男，反復(fù)TIA，動(dòng)脈粥樣硬化，頸內(nèi)動(dòng)脈末端高信號(hào)。c.66歲，女，血管周圍間隙。d.19歲，男，非擴(kuò)大的血管周圍間隙。vanVeluw,S.J.,etal.,Highresolutionimagingofcerebralsmallvesseldiseasewith7TMRI.ActaNeurochirSuppl,2021.119:p.125-30.7TA.89歲，男性，7T。B.同一人，3T。C.42歲，男性，微出血。D.57歲，女性，房顫，突發(fā)失語(yǔ)、左側(cè)輕癱，心源性栓塞。vanVeluw,S.J.,etal.,Highresolutionimagingofcerebralsmallvesseldiseasewith7TMRI.ActaNeurochirSuppl,2021.119:p.125-30.深部梗死，大腦中動(dòng)脈栓塞Moran,C.,T.G.Phan,andV.K.Srikanth,Cerebralsmallvesseldisease:areviewofclinical,radiological,andhistopathologicalphenotypes.IntJStroke,2021.7(1):p.36-46.孤立病灶Kim,J.T.,etal.,Lesionpatternsofsmalldeepinfarctshavedifferentclinicalandimagingcharacteristics.EurNeurol,2021.63(6):p.343-9.線性病灶Kim,J.T.,etal.,Lesionpatternsofsmalldeepinfarctshavedifferentclinicalandimagingcharacteristics.EurNeurol,2021.63(6):p.343-9.治療腔隙性卒中A.紋狀體內(nèi)囊卒中B.丘腦卒中：丘腦結(jié)節(jié)動(dòng)脈膝狀體動(dòng)脈脈絡(luò)膜后動(dòng)脈旁正中動(dòng)脈C.脈絡(luò)膜前動(dòng)脈D.髓質(zhì)穿支JNeurol(2021)261:405–411小血管病A-C.75歲，男性，共濟(jì)失調(diào)輕偏癱，4分。未溶栓。核磁顯示內(nèi)囊后肢病灶。出院時(shí)遺留左下肢輕癱，1分。D-E.55歲，男性，感覺(jué)運(yùn)動(dòng)性輕偏癱，5分。溶栓。復(fù)查CT顯示內(nèi)囊后肢病灶。出院時(shí)遺留右下肢輕癱，1分。Pantoni,L.,F.Fierini,andA.Poggesi,Thrombolysisinacutestrokepatientswithcerebralsmallvesseldisease.CerebrovascDis,2021.37(1):p.5-13.3個(gè)月結(jié)局JNeurol(2021)261:405–411SPS3隨機(jī)析因設(shè)計(jì)抗血小板治療阿司匹林＋安慰劑阿司匹林＋氯吡格雷降低血壓治療常規(guī)（收縮壓