脳梗塞１０

【臨床症状】認知機能障害、右手不全麻痺

【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
    • 左頭頂葉に広範な梗塞巣あり
    • 支配血管はMCA（中大脳動脈）とPCA（後大脳動脈）で梗塞部位は両血管の境界領域が中心
    • MRAでは左ICAのC4～C1にかけて狭窄疑い、またBA（脳底動脈）、右PCA（後大脳動脈）でも狭窄を疑う
    • 上記より右ICAはアテローム性（血行力学性）、PCAはアテローム塞栓性による梗塞と考えられる（ICAに関しては狭窄による血流低下がMCA終末部の虚血に繋がっているか）
    • 他、陳旧性の脳梗塞が左後頭葉にあり、DWIで等（高）信号、ADCで高信号より、慢性期に近い病変と推察できる