課件：腦小血管病概念與治療

1、腦小血管病——概念與治療,杜萬良北京天壇醫(yī)院神經(jīng)內科2014.11.15,腦小血管,注射硫酸鋇的標本。白質中央血管密度低。,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,腦小血管,注射硫酸鋇的標本。供應胼胝體的小分支。,Salamon, N., Neuroimaging of cer

2、ebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,腦小血管病的分類,腔隙綜合征,腔隙綜合征,腦小血管病的分類,MR表現(xiàn),Wardlaw, J.M., et al., Neuroimaging standards for research into small vessel disease and its contribution to ageing and

3、 neurodegeneration. The Lancet Neurology, 2013. 12(8): p. 822-838.,急性腔梗的1年演變,Wardlaw, J.M., C. Smith, and M. Dichgans, Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol, 201

4、3. 12(5): p. 483-97.,腔隙常在 白質高信號邊緣,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, 201

5、3. 136(Pt 9): p. 2717-26.,一名75歲男性，短暫性神經(jīng)癥狀發(fā)作后1周出現(xiàn)癥狀性左側額葉出血,Charidimou, A., J.C. Baron, and D.J. Werring, Transient focal neurological episodes, cerebral amyloid angiopathy, and intracerebral hemorrhage risk: looking beyon

6、d TIAs. Int J Stroke, 2013. 8(2): p. 105-8.,SVD score (range 0–4),男性(OR 1.58, 95% CI 1.10–2.29), 高血壓(OR 1.50, 95% CI 1.02–2.20), 吸煙 (OR 2.81, 95% CI 1.59–3.63), 腔隙性卒中 (OR 2.45, 95% CI 1.70–3.54) 與SVDScore相關. 腦萎縮與SVDSco

7、re無關,Staals, J., et al., Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology, 2014. 83(14): p. 1228-34.,腦小血管病的分類,一名CADASIL（伴皮質下梗死和腦白質病的常染色體顯性遺傳性腦動脈?。┗颊?6歲和66歲的影像,Salamon, N.,

8、 Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,一名66歲的女性CADASIL患者,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,COL4A1突變,47歲無癥狀COL

9、4A1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-卒中的遺傳性內皮細胞病)患者早期曾被誤診為多發(fā)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,早期有占位效應和強化。,Salamon, N., Ne

10、uroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.,19,一名Susac綜合征（腦病，視網(wǎng)膜小動脈閉塞，聽力喪失）患者的胼胝體中部病灶,Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-2

11、4.,7T,75歲，男性。動脈，靜脈,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歲，男，一過性黑矇，栓塞，基底動脈高信號。b.49歲，男，反復TIA，動脈粥樣硬化，頸內動脈末端高信號。

12、c.66歲，女，血管周圍間隙。d.19歲，男，非擴大的血管周圍間隙。,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歲，男性，7T。B.同一人，3T。C. 42歲，男性，微出血。D.

13、57歲，女性，房顫，突發(fā)失語、左側輕癱，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，大腦中動脈栓塞,Moran, C., T.G. Phan, and V.K. Srikanth,

14、 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 clin

15、ical and imaging characteristics. Eur Neurol, 2010. 63(6): p. 343-9.,線性病灶,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.,

16、腔隙性卒中,A.紋狀體內囊卒中B.丘腦卒中：丘腦結節(jié)動脈膝狀體動脈脈絡膜后動脈旁正中動脈C.脈絡膜前動脈D.髓質穿支,J Neurol (2014) 261:405–411,小血管病,A-C. 75歲，男性，共濟失調輕偏癱，4分。未溶栓。核磁顯示內囊后肢病灶。出院時遺留左下肢輕癱，1分。D-E. 55歲，男性，感覺運動性輕偏癱，5分。溶栓。復查CT顯示內囊后肢病灶。出院時遺留右下肢輕癱，1分。,Pantoni, L.

17、, F. Fierini, and A. Poggesi, Thrombolysis in acute stroke patients with cerebral small vessel disease. Cerebrovasc Dis, 2014. 37(1): p. 5-13.,3個月結局,J Neurol (2014) 261:405–411,SPS3,SPS3 設計要點,終點事件,樣本量,8個國家81家醫(yī)療中心 3020例