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BRAIN and NERVE Volume 69, Issue 11 （November 2017）

BRAIN and NERVE 69巻11号（2017年11月発行）

Japanese English

原著

90歳以上の超高齢者における急性期脳梗塞—頭部MRI拡散強調画像を用いた検討 Clinical Features of Very Elderly Patients Aged 90 Years or Above with Acute Ischemic Stroke: A Study by Using Diffusion Weighted Brain Magnetic Resonance Imaging 坂井利行 ¹ , 近藤昌秀 ¹ , 川名陽介 ¹ , 中川俊男 ² , 冨本秀和 ³ Toshiyuki Sakai ¹ , Masahide Kondo ¹ , Yosuke Kawana ¹ , Toshio Nakagawa ² , Hidekazu Tomimoto ³ ¹済生会松阪総合病院神経内科 ²済生会松阪総合病院放射線科 ³三重大学大学院医学系研究科神経病態内科学 ¹Department of Neurology, Saiseikai Matsusaka General Hospital ²Department of Radiology, Saiseikai Matsusaka General Hospital ³Department of Neurology, Graduate School of Medicine, Mie University キーワード： 90歳以上の超高齢者 , 急性期脳梗塞 , 病型 , 拡散強調画像 , 心原性脳塞栓症 , very elderly patients aged 90 years or above , acute ischemic stroke , stroke subtypes , diffusion weighted imaging , cardiogenic brain embolism Keyword: 90歳以上の超高齢者 , 急性期脳梗塞 , 病型 , 拡散強調画像 , 心原性脳塞栓症 , very elderly patients aged 90 years or above , acute ischemic stroke , stroke subtypes , diffusion weighted imaging , cardiogenic brain embolism pp.1337-1345

発行日 2017年11月1日 Published Date 2017/11/1

DOI https://doi.org/10.11477/mf.1416200913

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Abstract 文献概要
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参考文献 Reference

90歳以上の急性期脳梗塞患者76例において病型と頭部MRI拡散強調画像（DWI）を検討した。病型はアテローム血栓性脳梗塞，アテローム血栓性脳塞栓（ATBE），ラクナ梗塞（LI），心原性脳塞栓症（CBE）とその他（UTBI）の5型に分類した。CBEが50.0％を占め，心房細動は46.1％にみられた。多発梗塞が52.6％で，大脳半球広範梗塞は23.7％であった。脳梗塞巣別（合併例を含む）では大脳半球灌流領域梗塞が85.5％，大脳半球境界領域梗塞が13.2％および椎骨脳底動脈支配領域梗塞が17.1％であった。DWIにおける脳梗塞巣分布と病型の関連では，大脳皮質表在性梗塞はATBE，CBEとUTBIの3型に，孤発性の大脳半球深部領域梗塞は5型のすべてにみられた。大脳半球広範梗塞にほかの部位の梗塞が合併するパターンはCBEにのみ，孤発性の橋梗塞はLIにのみみられた。

Abstract

We investigated the diffusion weighted magnetic resonance imaging (DWI) features of 76 very elderly patients aged 90 years or above with acute ischemic stroke. Stroke subtypes were classified into five types according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and the Japanese Stroke Databank. The incidence rates of atherothrombotic brain infarction (ATBI), atherothrombotic brain embolism (ATBE), lacunar infarction (LI), cardiogenic brain embolism (CBE) and undetermined type of brain infarction (UTBI) were 2.6%, 17.1%, 10.5%, 50.0% and 19.8%, respectively. We estimated that the incidence of acute ischemic stroke in women was 3.5-fold higher than that in men. This is likely because survival rate of females is higher than that of males in populations aged 90 years or above. The prevalence of atrial fibrillation (AF) was 46.1% in patients with brain infarctions, and 92.1% in patients with CBE. The frequency of multiple infarctions is 52.6% and that of single infarction is 47.4%. In DWI of lesions, the frequencies of territorial infarction in the cerebral hemisphere, borderzone infarction, and vertebrobasilar infarction were 85.5%, 13.2% and 17.1%, respectively. The frequencies of massive territorial infarction and cerebellar infarction were 23.7% and 13.2%, respectively. With regard to the relationship between DWI lesion topography and stroke subtypes, superficial infarctions in the cerebral hemisphere were seen in patients with ATBE, CBE and UTBI. Single infarctions deep in the cerebral hemisphere were seen in all patients with any of the five stroke subtypes. Massive territorial infarctions with infarctions in other sites of the cerebral hemisphere or vertebrobasilar region were seen only in patients with CBE, and single pontine infarction was seen only in patients with LI.

(Received November 19, 2015; Accepted July 3, 2017; Published November 1, 2017)