课件：脑小血管病概念与治疗.ppt

脑小血管病 概念与治疗,杜万良 北京天坛医院神经内科 2014.11.15,脑小血管,注射硫酸钡的标本。白质中央血管密度低。,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,脑小血管,注射硫酸钡的标本。供应胼胝体的小分支。,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,脑小血管病的分类,腔隙综合征,腔隙综合征,脑小血管病的分类,MR表现,Wardlaw, J.M., et al., Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. The Lancet Neurology, 2013. 12(8): p. 822-838.,急性腔梗的 1年演变,Wardlaw, J.M., C. Smith, and M. Dichgans, Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol, 2013. 12(5): p. 483-97.,腔隙常在 白质高信号边缘,Duering, M., et al., Incident lacunes preferentially localize to the edge of white matter hyperintensities: insights into the pathophysiology of cerebral small vessel disease. Brain, 2013. 136(Pt 9): p. 2717-26.,一名75岁男性，短暂性神经症状发作后1周出现症状性左侧额叶出血,Charidimou, A., J.C. Baron, and D.J. Werring, Transient focal neurological episodes, cerebral amyloid angiopathy, and intracerebral hemorrhage risk: looking beyond TIAs. Int J Stroke, 2013. 8(2): p. 105-8.,SVD score (range 04),男性(OR 1.58, 95% CI 1.102.29), 高血压(OR 1.50, 95% CI 1.022.20), 吸烟 (OR 2.81, 95% CI 1.593.63), 腔隙性卒中 (OR 2.45, 95% CI 1.703.54) 与SVD Score相关. 脑萎缩与SVD Score无关,Staals, J., et al., Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology, 2014. 83(14): p. 1228-34.,脑小血管病的分类,一名CADASIL（伴皮质下梗死和脑白质病的常染色体显性遗传性脑动脉病）患者56岁和66岁的影像,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,一名66岁的女性CADASIL患者,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,COL4A1突变,47岁无症状COL4A1突变患者（A,C,E,G,I,J）。 57岁CADASIL患者。,一名HERNS (伴有视网膜病-肾病-卒中的遗传性内皮细胞病)患者早期曾被误诊为多发性硬化,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,一名HERNS患者的影像,早期有占位效应和强化。,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,19,一名Susac综合征（脑病，视网膜小动脉闭塞，听力丧失）患者的胼胝体中部病灶,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,7T,75岁，男性。动脉，静脉,van Veluw, S.J., et al., High resolution imaging of cerebral small vessel disease with 7 T MRI. Acta Neurochir Suppl, 2014. 119: p. 125-30.,7T,a.58岁，男，一过性黑矇，栓塞，基底动脉高信号。 b.49岁，男，反复TIA，动脉粥样硬化，颈内动脉末端高信号。 c.66岁，女，血管周围间隙。 d.19岁，男，非扩大的血管周围间隙。,van Veluw, S.J., et al., High resolution imaging of cerebral small vessel disease with 7 T MRI. Acta Neurochir Suppl, 2014. 119: p. 125-30.,7T,A.89岁，男性，7T。 B.同一人，3T。 C. 42岁，男性，微出血。 D. 57岁，女性，房颤，突发失语、左侧轻瘫，心源性栓塞。,van Veluw, S.J., et al., High resolution imaging of cerebral small vessel disease with 7 T MRI. Acta Neurochir Suppl, 2014. 119: p. 125-30.,深部梗死，大脑中动脉栓塞,Moran, C., T.G. Phan, and V.K. Srikanth, Cerebral small vessel disease: a review of clinical, radiological, and histopathological phenotypes. Int J Stroke, 2012. 7(1): p. 36-46.,孤立病灶,Kim, J.T., et al., Lesion patterns of small deep infarcts have different clinical and imaging characteristics. Eur Neurol, 2010. 63(6): p. 343-9.,线性病灶,Kim, J.T., et al., Lesion patterns of small deep infarcts have different clinical and imaging characteristics. Eur Neurol, 2010. 63(6): p. 343-9.,腔隙性卒中,A.纹状体内囊卒中 B.丘脑卒中： 丘脑结节动脉 膝状体动脉 脉络膜后动脉 旁正中动脉 C.脉络膜前动脉 D.髓质穿支,J Neurol (2014) 261:405411,小血管病,A-C. 75岁，男性，共济失调轻偏瘫，4分。未溶栓。核磁显示内囊后肢病灶。出院时遗留左下肢轻瘫，1分。 D-E. 55岁，男性，感觉运动性轻偏瘫，5分。溶栓。 复查CT显示内囊后肢病灶。 出院时遗留右下肢轻瘫，1分。,Pantoni, L., F. Fierini, and A. Poggesi, Thrombolysis in acute stroke