弥散加权成像阴性的急性脑梗死患者临床特点

发布时间：2018-05-18 22:14

本文选题：急性脑梗死 + 弥散加权成像阴性　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨疑似急性脑梗死(Acute cerebral infarction,ACI)而弥散加权成像(diffusion weighted imaging,DWI)阴性患者的临床特点,包括病因、临床表现、影像学表现、预后等。[方法]收集2011年1月至2016年6月于昆明医科大学第四附属医院神经内科就诊的DWI阴性的疑似急性脑梗死患者信息,汇总资料回顾性分析其人口学特征、病因、临床特点等。[结果]共收集由我院神经内科医生初步诊断为急性脑梗死而DWI阴性的患者73例,其中男性患者与女性患者分别为45例、28例,73例患者中位数年龄68岁(四分位数间距60-76)。从发病到完成DWI检查的中位数时间为420 min(四分位数间距255-640)。美国国立卫生研究院卒中量表(National institutes of Health Stroke Scale,NIHSS)评分中位数为3分(四分位数间距1-4)。73例患者中有48例(65.8%)最终诊断为急性脑梗死,25例(34.2%)最终诊断为其他疾病。最终诊断为急性脑梗死的48例患者中,有13例(27.1%)患者经过重新阅片后发现梗死灶,有1例(2.1%)患者症状加重后复查DWI发现梗死灶,9例(18.8%)患者症状未加重复查DWI发现梗死灶,2例(4.2%)患者症状加重后复查DWI仍未发现梗死灶,但有可以解释症状的头颈部计算机断层扫描血管造影(Computed Tomography Angiography,CTA)大血管闭塞/狭窄或颅脑计算机断层扫描灌注成像(Computed Tomography Perfusion,CTP)低灌注区,13例(27.1%)患者症状未加重且复查DWI阴性但头颈部CTA有可以解释症状的大血管闭塞/狭窄或颅脑CTP低灌注区,10例(20.8%)患者复查DWI阴性且未见大血管异常。诊断为急性脑梗死的48例患者,根据急性卒中治疗低分子肝素试验病因分型法(Trial of Org 10172 in acute stroke treatment,TOAST),23 例(47.9%)为大动脉粥样硬化,25 例(52.1%)为小动脉闭塞。诊断为其他疾病的25例患者中,有12例(48%)诊断为短暂性脑缺血发作(Transient ischemic attack,TIA),4例(16%)诊断为良性发作性位置性眩晕,诊断为其他疾病者较少见。[结论]1.DWI阴性的急性脑梗死患者男女比例约2:1,以男性居多,且人群偏向老年人;2.DWI阴性的急性脑梗死患者危险因素与常见的缺血性卒中危险因素分布一致。3.根据TOAST分型,大动脉粥样硬化性闭塞/狭窄和小动脉闭塞是DWI阴性急性脑梗死患者主要病因。4.DWI阴性急性脑梗死多为小卒中,症状偏轻,引起脑梗死后遗症如偏瘫、失语者较少,出院后绝大多数可以生活自理。5.当疑似急性脑梗死患者DWI为阴性时,不应将脑梗死简单排除在外,需警惕读片遗漏、显影延迟的可能和病情加重的风险,同时当排除卒中模拟病后,应当根据患者临床表现、体征、病史等综合分析进行脑梗死诊断,而不能仅依赖影像学检查。
[Abstract]:[objective] to investigate the clinical features of diffusion-weighted diffusion weighted imaging (DWI) negative patients with suspected acute cerebral infarction (ACI), including etiology, clinical manifestations, imaging manifestations, prognosis and so on. [methods] data of suspected acute cerebral infarction patients with DWI negative were collected from January 2011 to June 2016 in Department of Neurology, fourth affiliated Hospital of Kunming Medical University, and their demographic characteristics, etiology and clinical characteristics were analyzed retrospectively. [results] A total of 73 patients with acute cerebral infarction (DWI negative) diagnosed by neurologist in our hospital were collected. The median age of 73 patients with acute cerebral infarction was 45 male and 28 female, respectively. The median age of 73 patients was 68 years old (4-quartile interval 60-76D). The median time between onset and completion of DWI was 420 mins (quartile spacing 255-640). The median score of the National institutes of Health Stroke scale (NIH) was 3 (48 out of 73 patients with quartile spacing 1-40.73) and 25 patients with acute cerebral infarction were finally diagnosed as other diseases. Of the 48 patients who were eventually diagnosed as acute cerebral infarction, 13 were diagnosed with acute cerebral infarction. There was 1 case with 2. 1) after symptom aggravation, 9 cases with DWI were found to have infarct foci, 9 cases were found infarct focus after symptom aggravation, 2 cases were found infarct focus on DWI) after symptom aggravation, no infarct focus was found after reexamination of DWI. But the symptoms of 13 patients with head and neck computed Tomography angiography (computed Tomography angiographyography), large vessel occlusion / stenosis, or computed Tomography perfusion (CTP) low perfusion area, which can explain the symptoms, were not aggravated and DWI negative was rechecked. There were 10 patients with large vessel occlusion / stenosis or hypoperfusion area of craniocerebral CTP with CTA in the head and neck. DWI was negative and no major vascular abnormalities were found in the patients. According to the etiological classification of low molecular weight heparin test (LMWH) for acute stroke, 23 patients with acute cerebral infarction were treated with trial of Org 10172 in acute stroke (47.9%) as arteriosclerosis and 52.1% as arteriole occlusion. Among the 25 cases diagnosed as other diseases, 12 cases were diagnosed as transient ischemic attack-TIAA (4 cases) were diagnosed as benign paroxysmal positional vertigo, and few cases were diagnosed as other diseases. [conclusion] the male / female ratio of acute cerebral infarction patients with 1.DWI negative is about 2: 1, the male is the majority, and the risk factors of acute cerebral infarction with negative 1.DWI are consistent with the common risk factors of ischemic stroke. According to TOAST classification, arteriosclerotic occlusion / stenosis and arteriole occlusion are the main causes of DWI negative acute cerebral infarction. 4. DWI negative acute cerebral infarction is mostly a small stroke with mild symptoms, resulting in sequelae of cerebral infarction such as hemiplegia and fewer aphasia. Most of them can take care of themselves after discharge. When DWI is negative in suspected patients with acute cerebral infarction, cerebral infarction should not be excluded simply, the possibility of missed reading, delayed development and the risk of aggravation of the disease should be warned. At the same time, when the stroke mimic disease is excluded, it should be based on the patient's clinical manifestation. The diagnosis of cerebral infarction by comprehensive analysis, such as physical signs and history, should not rely on imaging examination alone.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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