175例侧脑室体旁脑梗死的发病部位与临床对照研究

目的：探讨侧脑室体旁脑梗死的发病部位与临床关系的特点及发病机理,以便给予相应治疗对策。方法：收集175例侧脑室体旁脑梗死的患者,均经头颅CT或MRI证实为侧脑室体旁的梗死,其中小梗死120例,大梗死55例,结合文献就两者的临床症状及影像学表现进行分析,通过这些分析推测出在侧脑室体旁放射冠处锥体束排列与躯体存在定位关系。同时,对其发病机理进行探讨,以采取不同的相应治疗对策。结果：小梗死与大梗死的临床表现略有差别,发病机制有所不同。小梗死以腔隙性脑梗死为多,发病机制同腔隙性脑梗死类似;大梗死以分水岭脑梗死为多,发病机制同分水岭脑梗死类似。但就目前研究上来说,以上两种脑梗死的病因及发病机理仍存在不小的争议,本文就研究所见一并加以探讨。结论：侧脑室体旁放射冠区由前向后依次排列着支配头面部、上肢及下肢的锥体束纤维。可推测皮质脑干束与皮质脊髓束经侧脑室体旁放射冠区纤维由前向后重叠排列,支配感觉的传导束纤维则排列于放射冠的中部至后部,锥体束的后外侧。Broca区语言中枢和Wernicke区语言中枢的皮质下白质传导束在侧脑室体旁放射冠区由前向后排列,Broca区的纤维可能主要走行于放射冠的前部,Wernicke区的纤维可能主要走行于放射冠的后部,而侧脑室体旁放射冠的中部可能存在两种纤维的重叠。同时,针对发病的不同的病理生理机制,采取不同的相应治疗对策。

The Control Analysis of the Pathogenic Sites and Clinical Manifestation in 175 Cases of Infarctions beside the Body of the Lateral Ventricle

Objective： To explore the position and clinical relations and characteristics of the pathogenesis of cerebral infarction beside the body of the lateral ventricle, so as to give corresponding treatment measures. Methods： 175 cases with infarction beside the body of the lateral ventricle by CT or MRI were collected. Among them, 120 cases had small infarctions, and 55 cases had big infarctions. We discussed the clinical and imagery characteristics of two groups, and by combining the documents and the clinical signs and imaging findings we speculated out the positioning relationship in the lateral ventricle radiation. Meanwhile, we investigated the pathogenesis and discussed different treatment measures. Results： The clinical manifestations showed difference between the small infarctions and the big infarctions, and their pathogenesis was different, too. The pathogenesis of the small infarctions was similar to the lacunar infarction; and that of the big infarction was similar to the watershed infarction. But as for the present research, there were still a lot of controversy between the etiology and pathogenesis of the two types of cerebral infarction. This paper tried to study and discuss much more on what we found. Conclusion： It was considered preliminarily that somatotopy of the pyramidal tract in the corona radiate was basically arranged from its anterior part to its posterior part in the order of innervating the face, the upper limb and the lower limb. The white matter of the subcortex in the Broca area language centre and Wernicke area language centre was arranged from its anterior part to its posterior part. The central of the body of the lateral ventricle may have two kinds of fibers. At the same time, it was required to take different treatment measures according to the different pathophysiological mechanisms.