1、杜萬良北京天壇醫(yī)院神經(jīng)內(nèi)科2014.11.15腦小血管注射硫酸鋇的標本。白質(zhì)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(yīng)胼胝體的小分支。Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.腦小血管病的分類急性：卒中慢性：癡呆腔隙綜合征 腔隙綜合征 (1)純運動性

2、輕偏癱(PMH)最常見。病灶可發(fā)生在內(nèi)囊、腦橋、大腦腳、基底節(jié)、大腦皮質(zhì)、放射冠等處。(2)純感覺性卒中(PSS)病灶位于丘腦腹后核，通常為大腦后動脈的丘腦穿通支梗死所致。少數(shù)病例可由脊髓丘腦束、丘腦皮質(zhì)束的病灶所致，也可因病灶侵及整個丘腦的外側(cè)及內(nèi)囊后肢的放射冠而引起。(3)感覺運動性卒中(SMS)病灶位于丘腦腹后外側(cè)核和內(nèi)囊后肢，通常由大腦后動脈的丘腦穿通支或脈絡(luò)膜后動脈閉塞所致。(4)共濟失調(diào)輕偏癱(HAH)病灶發(fā)生在腦橋基底部或內(nèi)囊，放射冠、小腦等處也可發(fā)生。(5)構(gòu)音不良-手笨拙綜合征(DHS)病灶位于腦橋基底部的上1/3 和2/3 交界處或內(nèi)囊最上部分的膝部。 腦小血管病的分類微出

3、血血管周圍間隙擴大白質(zhì)疏松腔隙MR表現(xiàn)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.急性腔梗的急性腔梗的1年演變年演變Wardlaw, J.M., C. Smith, and M. Dichgans, Mechanisms of sporadic cerebral small

4、 vessel disease: insights from neuroimaging. Lancet Neurol, 2013. 12(5): p. 483-97.腔隙常在腔隙常在 白質(zhì)高信號邊白質(zhì)高信號邊緣緣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, 2013. 136(P

5、t 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(cè)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 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

6、), 高血壓(OR 1.50, 95% CI 1.022.20), 吸煙 (OR 2.81, 95% CI 1.593.63), 腔隙性卒中 (OR 2.45, 95% CI 1.703.54) 與SVDScore相關(guān). 腦萎縮與SVDScore無關(guān)Staals, J., et al., Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology, 2014. 83(14): p. 1228-34.腦小血管病的分類動脈硬化性血管炎遺傳性腫瘤性感染性藥物相關(guān)性一

7、名CADASIL（伴皮質(zhì)下梗死和腦白質(zhì)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., 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突變突變47歲無癥狀COL4A1突變患者（A,C,E,G,I,J）。57

8、歲CADASIL患者。一名HERNS (伴有視網(wǎng)膜病-腎病-卒中的遺傳性內(nèi)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. 519-24.一名一名HERNS患者的影像早期有占位效應(yīng)和強化。Salamon, N., Neuroimaging of cerebral small vessel disease. Brain Pathol, 2014. 24(5): p. 519-24.一名Susac綜合征（腦病，視網(wǎng)膜小動脈閉塞，聽力

9、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. 519-24.7T75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. 125-30.7Ta.58歲，男，一過性黑矇，栓塞，基底動脈高信號。b.49歲，男，反復(fù)

10、TIA，動脈粥樣硬化，頸內(nèi)動脈末端高信號。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. 125-30.7TA.89歲，男性，7T。B.同一人，3T。C. 42歲，男性，微出血。D. 57歲，女性，房顫，突發(fā)失語、左側(cè)輕癱，心源性栓塞。van Veluw, S.J., et al., High resolution

11、 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, 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

12、., et al., Lesion patterns of small deep infarcts have different clinical 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.治療治療腔隙性卒中A.紋狀體

13、內(nèi)囊卒中B.丘腦卒中：丘腦結(jié)節(jié)動脈膝狀體動脈脈絡(luò)膜后動脈旁正中動脈C.脈絡(luò)膜前動脈D.髓質(zhì)穿支J Neurol (2014) 261:405411小血管病A-C. 75歲，男性，共濟失調(diào)輕偏癱，4分。未溶栓。核磁顯示內(nèi)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(fù)查CT顯示內(nèi)囊后肢病灶。出院時遺留右下肢輕癱，1分。Pantoni, L., 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(jié)局J Neurol (2014) 261:405411SPS3隨機析因設(shè)計抗血小板治療阿司匹林安慰劑阿司匹林氯吡格雷降低血壓治療常規(guī)（收縮壓130149mmHg)強化（收縮壓130mmHg)SPS3 設(shè)計