Clinical stroke syndromes: clinical-anatomical correlations.

T Gavrilescu, C S Kase
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Abstract

The vascular territories of the major cerebral arteries supplying the cerebral cortex, subcortical structures, cerebellum, and brainstem in humans are relatively uniform. Because of their anatomical distribution, and the specialized neurologic functions located within these territories, infraction due to arterial occlusion gives rise to distinct clinical syndromes. Thus, the physical findings on neurologic examination permit a reliable topographic diagnosis. With extensive infraction involving all or major portions of a particular vascular territory, the resultant clinical syndromes tend to be severe, reflecting the large area of involvement. More typically, however, infarcts do not involve a vascular territory in its entirety but are limited to the distribution of secondary branches by various mechanisms of arterial occlusion. Depending on their location, these smaller infarcts produce syndromes that may vary in severity and manifestations. Our understanding of the clinical approach of clinicoanatomical correlations in these forms of cerebral infarction has been facilitated by the widespread use of brain CT and MRI scans, that have virtually replaced the classical approach of clinicopathological correlations in autopsy material. In this review we have divided the manifestations of occlusive cerebrovascular disease according to the vascular territories affected. The distinct clinical syndromes which thus arise and their common mechanisms are described. Correlation is made with the typical CT and MRI images.

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临床脑卒中综合征:临床解剖相关性。
供应人类大脑皮层、皮层下结构、小脑和脑干的大脑大动脉的血管区域相对均匀。由于它们的解剖分布,以及位于这些区域内的特殊神经功能,动脉闭塞引起的梗死会引起不同的临床综合征。因此,神经学检查的物理结果允许可靠的地形诊断。当广泛的梗死涉及特定血管区域的全部或主要部分时,由此产生的临床综合征往往是严重的,反映了大面积的受累。然而,更典型的是,梗死并不涉及整个血管领域,而是由于动脉闭塞的各种机制而局限于次级分支的分布。根据其位置的不同,这些较小的梗死产生的症状可能在严重程度和表现上有所不同。脑CT和MRI扫描的广泛应用促进了我们对这些脑梗死形式的临床解剖相关性的临床方法的理解,这些方法实际上已经取代了尸检材料中临床病理相关性的经典方法。在这篇综述中,我们将闭塞性脑血管病的表现根据受影响的血管区域进行了划分。不同的临床综合征,从而出现和他们的共同机制描述。与典型的CT和MRI图像进行相关性分析。
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