中华医学会系列杂志
Chinese Journal of Brain Diseases and RehabilitationISSN 2095-123X CN 11-9309/R 联系我们网站地图帮助中心
期刊导读
期刊存档

您的位置:首页>> 文章摘要

短暂性非局灶神经症状潜在轻微缺血性卒中及其后续血管事件的高风险

王光胜1 陈孝东1 杨同慧1 常春红1 王元伟1 王英1 周业庭2 童道明1

223600 江苏省,徐州医科大学附属沭阳人民医院神经内科1,临床研究部2

童道明,Email:tongdaoming@163.com

江苏省临床重点专科建设项目(20160013)

摘 要:目的 研究短暂性非局灶神经症状是否潜在轻微缺血性卒中(MIS)的高风险。方法 选择2012年1月至2013年1月在沭阳县人民医院因短暂性非局灶神经症状就诊于神经科门诊的初诊患者(年龄≥25岁)285例为研究对象。MIS的诊断标准为美国国家卫生研究院卒中量表(NIHSS)评分<3分。结果 在285例短暂性非局灶神经症状患者中,156例(54.7%)伴MIS被MRI确诊。MIS最常见的血管受累区域是前循环(58.3%)。头晕伴头痛是更可能合并MIS风险的短暂性非局灶神经症状(32.1% vs.14.7%,P<0.001)。多因素分析表明,中年(RR 1.082,95% CI 1.157~1.189)和较高的ABCD2评分(RR 7.915,95% CI 4.648~13.480)与短暂性非局灶神经症状伴MIS显著相关。尽管MIS有良好的生存率,但MIS组患者未经调整的后续血管事件(SVE)的发生率比没有MIS的患者显著增高(32.7% vs.19.4%,P=0.011),未调整的SVE风险比高达6.38(95% CI 2.271~13.260)。结论 半数以上的短暂性非局灶神经症状潜在MIS的高风险,其特点是好发于中年,有高ABCD2评分和高风险的SVE。前循环是短暂性非局灶神经症状伴MIS的重要区域之一。

关键词:卒中; 磁共振成像; 后续性血管事件; 暂时性非局灶神经症状

评论   收藏 全文阅读: FullText | PDF

文献标引:王光胜1 陈孝东1 杨同慧1 常春红1 王元伟1 王英1 周业庭2 童道明1.短暂性非局灶神经症状潜在轻微缺血性卒中及其后续血管事件的高风险[J/CD].中华脑科疾病与康复杂志(电子版),2016,6(3):136.

参考文献:
1 Easton JD,Saver JL,Albers GW,et al.Definition and evaluation of transient ischemic attack:a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2009,40(6):2276-2293.
2 Bos MJ,van Rijn MJ,Witteman JC,et al.Incidence and prognosis of transient neurological attacks[J].JAMA,2007,298(24):2877-2885.
3 Ferrari J,Knoflach M,Kiechl S,et al.Early clinical worsening in patients with TIA or minor stroke:the Austrian Stroke Unit Registry[J].Neurology,2010,74(2):136-141.
4 Ogata T,Yasaka M,Wakugawa Y,et al.Predisposing factors for acute deterioration of minor ischemic stroke[J].J Neurol Sci,2009,287(1/2):147-150.
5 Simoni M,Rothwell PM.Transient isolated brainstem symptoms preceding posterior circulation stroke:a population-based study[J].Lancet Neurol,2013,12(1):65-71.
6 Hoshino T,Nagao T,Mizuno S,et al.Transient neurological attack before vertebrobasilar stroke[J].J Neurol Sci, 2013,325(1/2):39-42.
7 The Ad Hoc Committee on the classification and outline of cerebrovascular diseaseⅡ[J].Stroke,1975,6 Suppl:566-616.
8 Ovbiagele B,Kidwell CS,Saver JL.Epidemiological impact in the United states of a tissue-based definition of transient ischemic attack[J].Stroke,2003,34(4):919-924.
9 Giles MF,Albers GW,Amarenco P,et al.Addition of brain infarction to the ABCD2 Score(ABCD2I):a collaborative analysis of unpublished data on 4574 patients[J].Stroke,2010,41(9):1907-1913.
10 Compter A,Kappelle LJ,Algra A,et al.Nonfocal symptoms are more frequent in patients with vertebral artery than carotid artery stenosis[J].Cerebrovasc Dis,2013,35(4):378-384.
11 Okroglic S,Widmann CN,Urbach H,et al.Clinical symptoms and risk factors in cerebral microangiopathy patients[J].PLoS One,2013,8(2):e53455.
12 Duque-Parra JE.Perspective on the vestibular cortex throughout history[J].Anat Rec B New Anat,2004,280(1):15-19.
13 Bousser MG,Welch KM.Relation between migraine and stroke[J].Lancet Neurol,2005,4(9):533-542.
14 Stang PE,Carson AP,Rose KM,et al.Headache,cerebrovascular symptoms,and stroke:the Atherosclerosis Risk in Communities Study[J].Neurolog,2005,64(9):1573-1577.
15 Cloutier JF,Saliba I.Isolated vertigo and dizziness of vascular origin[J].J Otolaryngol Head Neck Surg,2008,37(3):331-339.
16 Yamasoba T,Kikuchi S,Higo R,et al.Ischemic brain lesions in aged patients with dizziness[J].Arch Otolaryngol Head Neck Surg,1993,119(12):1346-1350.
17 Navi BB,Kamel H,Shah MP,et al.Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department[J].Stroke,2012,43(6):1484-1489.
18 Compter A,van der Worp HB,van Gijn J,et al.Is the long-time prognoosis of transient ischemic attack or minor ischemic stroke affected by the occurrence of nonfocal symptoms?[J].Stroke,2014,45(5):1318-1323.
19 Hankey GJ.Long-term outcome after ischaemic stroke/transient ischaemic attack[J].Cerebrovasc Dis,2003,16 Suppl:14-19.
20 Fonarow GC,Reeves MJ,Zhao X,et al.Aged-related differences in characteristics,performance measures,treatment trends,and outcomes in patients with ischemic stroke[J].Circulation,2010,121(7):879-891.
21 Laurent S,Boutouyrie P,Lacolley P.Structural and genetic bases of arterial stiffness[J].Hypertension,2005,45(6):1050-1055.
22 Baumgartner RW,Sidler C,Mosso M,et al.Ischemic lacunar stroke in patients with and without potential mechanism other than small-artery disease[J].Stroke,2003,34(3):653-659.
23 Sacco S,Marini C,Totaro R,et al.A population-based study of the incidence and prognosis of lacunar stroke[J].Neurology,2006,66(9):1335-1338.
24 Veress AI,Cornhill JF,Herderick EE,et al.Age-related development of atherosclerotic plaque stress:a population-based finite-element analysis[J].Coron Artery Dis,1998,9(1):13-19.
25 Purroy F,Montaner J,Rovira A,et al.Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions[J]. Stroke,2004,35(10):2313-2319.
26 Marquardt L,Kuker W,Chandratheva A,et al.incidence and prognosis of>or=50% symptomatic vertebral or basilar artery stenosis:prospective population-based study[J].Brain,2009,123(4):982-988.
27 Wang YL,Pan YS,Zhao XQ,et al.Recurrent Stroke was Associated with Poor Quality of Life in Patients with Transient Ischemic Attack or Minor Stroke:Finding from the CHANCE Trial[J].CNS Neurosci Ther,2014,20(12):1029-1035.
28 Winbeck K,Bruckmaier K,Etgen T,et al.Transient ischemic attack and stroke can be differentiated by analyzing early diffusion-weighted imaging signal intensity changes[J].Stroke,2004,35(5):1095-1099.

临床研究

脑梗死出血性转化的危险因素分析

高俊杰 许雯蔚 陈湛愔 何国林. .中华脑科疾病与康复杂志(电子版) 2016;6(3):129.

摘要 FullText PDF 评论 收藏

短暂性非局灶神经症状潜在轻微缺血性卒中及其后续血管事件的高风险

王光胜1 陈孝东1 杨同慧1 常春红1 王元伟1 王英1 周业庭2 童道明1. .中华脑科疾病与康复杂志(电子版) 2016;6(3):136.

摘要 FullText PDF 评论 收藏

18F-FDG PET在阿尔茨海默病临床评估中的初步应用

陶霖1 石吉乐1 孙洪赞2 马英1 佡剑非1 郑东明1. .中华脑科疾病与康复杂志(电子版) 2016;6(3):142.

摘要 FullText PDF 评论 收藏

精神分裂症合并2型糖尿病患者的治疗与管理模式的研究分析

姜华1 熊茜2 程飞1 王琴1 孙逸炜1 王蕴蕴1. .中华脑科疾病与康复杂志(电子版) 2016;6(3):147.

摘要 FullText PDF 评论 收藏