脳梗塞１

【臨床症状】まっすぐ進めない

【問題】どこに脳梗塞がある？　また、支配血管、発症時期、病型（分類）について記載せよ

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    ▶答えはこちら
    • 右半卵円レベル、橋、左小脳に新鮮な脳梗塞
    • 右半卵円レベルはMCA領域、橋はAICA（前下小脳動脈）領域の穿通枝、左小脳はPICA（後下小脳動脈）領域
    • いずれの所見もDWIで高信号、ADCで低信号を認めるため、超急性期～急性期の所見
    • 右半卵円レベル、橋はラクナ梗塞、小脳は皮質がスペアされていないことからアテローム（塞栓性）、もしくは心原性が疑われる
    • 他、右頭頂葉に陳旧性の梗塞巣あり（ADCの信号上昇から少なくとも1か月より前の梗塞と考えらえる）
    • ACAはA2遠位部で狭窄疑い、左MCAのM1/2、左MCAのM2に狭窄疑い、椎骨動脈V4の閉塞疑い