1、2022-8-1卒中的分类卒中卒中缺血性卒中缺血性卒中原发性出血原发性出血脑出血脑出血蛛网膜下腔出血蛛网膜下腔出血穿支动脉病穿支动脉病(腔隙性)(腔隙性)心源性栓塞心源性栓塞心房纤颤心房纤颤瓣膜病瓣膜病心室血栓心室血栓其他其他隐匿性卒中隐匿性卒中其他不常见原因其他不常见原因血栓前状态血栓前状态夹层夹层动脉炎动脉炎偏头痛偏头痛/血管痉挛血管痉挛药物滥用药物滥用其他其他动脉粥样硬化动脉粥样硬化性脑血管病性脑血管病低灌注低灌注动脉源性动脉源性栓塞栓塞15%85%20%25%20%30%5%Momjian-Mayor I,et al.The pathophysiology of watershed i
2、nfarction in internal carotid artery disease:review of cerebral perfusion studies.Stroke.2019 Mar;36(3):567-77.图A示 1:大脑前动脉供血区;2:大脑中动脉供血区;3:大脑后动脉供血区。图B示脑内分水岭区(箭头)。A B脑分水岭区的部位及脑分水岭梗死的类型Invest Radiol 2019;39:462469ICA stenosis is assumed to cause 20%of all strokes栓塞血液动力学ICWCWSPA开口低灌注CWS 女患,72岁,HT和DM病史多
3、年;急性起病,临床表现为运动性轻偏瘫。内分水岭梗塞内分水岭梗塞 男,53岁,急性发病,记忆力下降和轻度言语困难,右侧肢体轻瘫。内分水岭梗死050301低血压双侧多灶脑分水岭梗死低血压双侧多灶脑分水岭梗死A B CRCARCA、LCALCA、VAVA造影基本正常,未见动脉局部狭窄造影基本正常,未见动脉局部狭窄或闭塞,血流充盈良好。或闭塞,血流充盈良好。Extracranial arterial collateral circulationIntracranial arterial collateral circulationThe rosary-like pattern as typical f
4、or the presence of hemodynamic compromise.Stroke.2019;28:354357.Small individual lesions arranged in a linear pattern would therefore result fromsuch uneven perfusion.Stroke.2000;31:1090-1096.Stroke.2000;31:1090-1096.Stroke.2000;31:1090-1096.SPECTPETStroke 2000;31:631-636.Stroke 2000;31:631-636.Stroke 2000;31:631-636.Stroke 2000;31:631-636.A,侧脑室水平;B,基底神经节水平;C,丘脑水平。J Neurosurg 77:927940J Neurosurg 77:927940J Neurosurg 77:927940 第一次卒中第二次卒中外科手术后