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기존 미세뇌출혈부위에 발생한 급성열공경색

Acute Lacunar Infarction Adjacent to the Pre-existing Cerebral Microbleeds

Article information

J Korean Neurol Assoc. 2015;33(3):245-246
Publication date (electronic) : August 1, 2015
doi : http://dx.doi.org/10.17340/jkna.2015.3.25
Jee Eun Lee, MD, Woojun Kim, MD, PhD, Yoon Sang Oh, MD, A-Hyun Cho, MD, PhD
Department of Neurology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
이지은, 김우준, 오윤상, 조아현
가톨릭대학교 의과대학 여의도성모병원 신경과
Address for correspondence: A-Hyun Cho, MD, PhD  Department of Neurology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea  Tel: +82-2-3779-2433 Fax: +82-2-782-8654 E-mail: ahyun@catholic.ac.kr
received : December 30, 2014 , rev-recd : March 16, 2015 , accepted : March 16, 2015 .

급성열공뇌경색(acute lacunar infarct)과 미세뇌출혈(cerebral microbleeds)은 뇌소혈관질환이라는 유사한 병리기전을 공유한다[1]. 그러나 전자의 경우 혈관이 막히는 경우이고 후자의 경우 혈관벽을 통한 혈액의 누출이 발생한 경우이다[2]. 따라서 두 개의 서로 다른 병리현상 및 영상소견이 함께 관찰되기는 어렵다. 최근 영상기술의 발전으로 기울기에코영상(gradient echo image)을 통하여 미세뇌출혈을 관찰하고, 확산강조영상(diffusion-weighted image)을 통하여 급성열공경색을 쉽게 관찰할 수 있게 됨에 따라 다양한 영상소견의 발견이 가능하다. 이에 저자들은 급성증상열공경색 환자에서 뇌경색 부위에 미세뇌출혈이 공존하고 있는 증례를 관찰하여 그 영상소견을 공유하고자 한다. 본 신경영상은 뇌소혈관질환의 서로 다른 표현형인 열공경색과 미세뇌출혈이 공존하는 경우를 보여주는 드문 뇌영상이다. 이러한 소견을 보이는 모든 환자 증례에서 유의한 백질변성이 함께 관찰되는 것은 뇌소혈관질환이 진행된 상태임을 추측하게 한다(Fig.).

Figure.

Case 1. A 67-male with hypertension shows left internal capsular infarction on diffusion-weighted image (DWI) with a microbleed on gradient-echo image (GRE) adjacent to the ischemic lesion. Fluid-attenuated inversion recovery image (FLAIR) reveals white matter hyperintensity as an another manifestation of cerebral small vessel diseases. Case 2. A 68-female with hypertension and diabetes shows a cerebral microbleed on GRE within acute pontine infarction on DWI. White matter hyperintensity is observed on FLAIR. Case 3. A 74-female with hypertension and hyperlipidemia shows left basal ganglia infarction on DWI with a microbleed on GRE. Significant white matter hyperintensity is also present on FLAIR. Case 4. A 78-male with hypertension and colon cancer presents a microbleed on GRE around the acute pontine infarction on DWI also with white matter hyperintensity on FLAIR. Case 5. A 50-female with hypertension and cervical cancer shows acute pontine infarction on DWI with a microbleed on GRE. White matter hyperintensity is observed on FLAIR.

Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No.2012R1A1B5000477).

References

1. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013;12:822–838.
2. Shoamanesh A, Kwok CS, Benavente O. Cerebral microbleeds: histopathological correlation of neuroimaging. Cerebrovasc Dis 2011;32:528–534.

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Copyright © 2015 Korean Neurological Association

Figure.

Figure.

Case 1. A 67-male with hypertension shows left internal capsular infarction on diffusion-weighted image (DWI) with a microbleed on gradient-echo image (GRE) adjacent to the ischemic lesion. Fluid-attenuated inversion recovery image (FLAIR) reveals white matter hyperintensity as an another manifestation of cerebral small vessel diseases. Case 2. A 68-female with hypertension and diabetes shows a cerebral microbleed on GRE within acute pontine infarction on DWI. White matter hyperintensity is observed on FLAIR. Case 3. A 74-female with hypertension and hyperlipidemia shows left basal ganglia infarction on DWI with a microbleed on GRE. Significant white matter hyperintensity is also present on FLAIR. Case 4. A 78-male with hypertension and colon cancer presents a microbleed on GRE around the acute pontine infarction on DWI also with white matter hyperintensity on FLAIR. Case 5. A 50-female with hypertension and cervical cancer shows acute pontine infarction on DWI with a microbleed on GRE. White matter hyperintensity is observed on FLAIR.