伴发卵圆孔未闭的隐源性卒中的神经影像学特征分析

发布时间：2018-03-17 00:18

本文选题：隐源性卒中　切入点：卵圆孔未闭　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的比较伴卵圆孔未闭(PFO)卒中患者与无卵圆孔未闭的隐源性卒中(CS)患者的影像学表现,以期发现PFO相关卒中的特定影像学特征,有助于对归因于PFO的隐源性卒中的病因学诊断。方法分析2013年1月至2016年4月在郑州大学人民医院就诊的发病2周内的隐源性卒中(急性脑梗死或短暂性脑缺血发作)患者,均行经食管超声心动图右心声学造影(cTTE)或经食管超声心动图(TEE)检查,共纳入患者70例,根据有无伴发卵圆孔未闭分为两组,PFO(+)隐源性卒中组40例,PFO(-)隐源性卒中组30例;收集临床一般资料:年龄、性别、发病至检查时间、脑血管病危险因素(高血压病、糖尿病、心脏病、吸烟史、饮酒史)、有无偏头痛、入院NIHSS评分;分析弥散加权成像(DWI)上的脑梗死灶的梗死类型(数量、位置、大小)、梗死灶责任血管分布区域、有无颅内动脉狭窄、既往有无脑梗死病史等,进行组间差异的比较,并进行偏头痛与PFO(+)卒中相关性检验。结果70例患者中,男性51例,女性19例,平均年龄为36.54±12.14;两组间一般临床资料差异无统计学意义。偏头痛在PFO相关性卒中患者发病率多于PFO(-)CS患者,差异有统计学意义(15%vs 0%,P=0.027);PFO(+)卒中的在DWI上的梗死类型多为多血管分布区域的多发梗死灶(25%vs.6.7%,P=0.004),梗死灶更多分布于椎基底动脉系统(40%vs.16.7%,P=0.035),尤其是大脑后动脉区域(44.5%vs.10%,P=0.016)。相反,PFO(-)的CS多见于单血管区域的大于15mm的融合性病灶(30%vs.7.5%,P=0.013),分布于左侧颈内动脉最常见(46.7%vs.20.0%,P=0.017);PFO(+)卒中与偏头痛显著相关(χ2=5.216,P=0.022)。结论1.多血管分布区域的多发梗死灶且后循环梗死占优势的急性脑梗死其发病机制应考虑为PFO相关的反常栓塞;2.隐源性卒中梗死灶在DWI上表现为单血管分布区域的融合性病灶(15mm)考虑为非PFO相关的隐源性脑梗死。3.偏头痛与PFO(+)卒中具有相关性,提示伴偏头痛的隐源性脑梗死患者需常规进行PFO的筛查。
[Abstract]:Objective to compare the imaging findings of patients with patent foramen ovale (PFOO) and cryptogenic apoplexy (CSS) without patent foramen ovale in order to find the specific imaging features of PFO related stroke. Methods from January 2013 to April 2016, patients with cryptogenic stroke (acute cerebral infarction or transient ischemic attack) who were admitted to the people's Hospital of Zhengzhou University from January 2013 to April 2016 were analyzed. All patients were examined by transesophageal echocardiography (cTTEE) or transesophageal echocardiography (TEE). According to the presence or absence of patent foramen ovale, they were divided into two groups: PFO-PFO-PFO-induced stroke group (30 cases). General clinical data were collected: age, sex, time from onset to examination, risk factors of cerebrovascular disease (hypertension, diabetes, heart disease, smoking history, alcohol history, migraine, admission NIHSS score). The types of cerebral infarction (number, location, size, distribution of responsible vessels, stenosis of intracranial artery and history of cerebral infarction) on DWI were analyzed, and the differences between the two groups were compared. Results among 70 patients, 51 were male and 19 were female. The average age was 36.54 卤12.14. There was no significant difference in general clinical data between the two groups. The incidence of migraine in patients with PFO related stroke was higher than that in patients with PFO(-)CS. The type of infarction on DWI was 25vs.6.7% P0.004, and the infarct was distributed in the vertebrobasilar artery system 40vs.16.7P0.035, especially in the area of posterior cerebral artery (44.5vs.10P 0.016). More than 15mm fusion lesion was found in single vessel area, which was more than 15mm. Conclusion: 1. Multiple infarct and posterior circulation infarction in multi-vessel distribution area are most common in the left internal carotid artery, 46.7 vs.20.0. 0 PFOO (PFOO) stroke is significantly associated with migraine (蠂 2 25.216P0.0222.Conclusion 1. Multi-vessel distribution area with multiple infarct and posterior circulation infarction is dominant. The pathogenesis of acute cerebral infarction should be considered as PFO related abnormal embolism 2.The infarct focus of cryptogenic apoplexy on DWI is presented as a fusion lesion with a single vascular distribution area (15 mm). (3) Migraine and migraine are associated with cryptogenic cerebral infarction. PFOO () stroke has a correlation, The results suggest that PFO screening should be performed routinely in patients with migraine cryptogenic cerebral infarction.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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