Acute Simultaneous Multiple Infarctions in One Cerebral Hemisphere: A Case Report

同側大腦半球之急性多發性梗塞：病例報告

韓亭怡(Ting-I Han) ； 高木榮(Mu-Jung Kao) ； 周德陽(Der-Yang Chou) ； 楊偑瑜(Pey-Yu Yang)

《台灣復健醫學雜誌》 32卷2期 (2004/06) Pp. 91-95

https://doi.org/10.6315/2004.32(2)06

摘要

眾所周知，梗塞性中風多為單一事件。發生於超過一個血管流域的急性多發性梗塞則較少受到關注。大動脈疾病及心臟血栓是此種梗塞最重要的危險因子。擴散磁振造影因能分辨急性與慢性病灶而成為檢查急性多發性腦梗塞的利器。同側半球之急性多發性梗塞最常見的是前上中大腦動脈梗塞加後上中大腦動脈梗塞或前上中大腦動脈梗塞加後分水嶺梗塞。我們報告一大範圍的中大腦動脈及後大腦動脈同時發生腦梗塞，並經由擴散磁振造影確認的病例。患者因有肥厚性心肌病變之病史，且在住院中以經食道超音波在主動脈辦上檢出疑似纖維彈性瘤之腫瘤，故強烈懷疑其梗塞栓子源自心臟。在診斷急性多發性腦梗塞時，擴散磁振造影能儘早指出正確的病灶位置，故有助於判斷病因，並修正治療方法。

關鍵字

急性多發性梗塞 ； 心臟血栓 ； 擴散磁振造影

並列摘要

Acute ischemic stroke is well known to be a single event. However, multiple simultaneous acute strokes involving more than one vascular territory are less studied. Large-artery disease of corresponding vessels and cardioembolism are thought to be the most important risk factors for multiple simultaneous infarctions. Diffusion-weighted imaging (DWI), which successfully discriminats acute from chronic infarct, is particularly useful in patients with multiple infarcts in more than one territory. The most common combinations of simultaneous multiple infarction in one cerebral hemisphere involve the territories of the anterior superficial middle cerebral artery (MCA) plus the posterior superficial MCA, and the territories of the anterior superficial MCA plus the posterior watershed. We describe a 57-year-old man who presented with simultaneous large middle cerebral artery territory infarction and posterior cerebral artery territory infarction confirmed by DWI. A cardioembolic source was highly suspected because of the presence of multiple lesions, the patient's history of hypertrophic cardiomyopathy and a fibroelastoma over aortic valve noted via transesophageal echocardiography. DWI reveals the accurate site of lesion earlier than traditional images, which indicates a better correlation between symptoms and etiology of stroke, and considerable improvement in patient care.

並列關鍵字

multiple simultaneous acute infarction ； cardioembolism ； diffusion ； weighted imaging