伴卵圆孔未闭的隐源性脑卒中的临床表现及影像学特征

目的 探讨伴卵圆孔未闭(Patent foramen oval,PFO)的隐源性脑卒中(Cryptogenic stroke, CS)的临床表现及影像学特征。方法 收集2014年11月-2019年6月在华中科技大学同济医院神经内科住院确诊为PFO的患者,筛选出122例存在隐源性脑卒中患者,根据头颈血管影像学检查表现将其分为主动脉弓斑块(Aortic arch atheroma, AAA)合并PFO组、轻度动脉硬化(Mild atherosclerosis, MSA)合并PFO组及单纯PFO组,比较3组的一般临床资料及影像学特点。结果 与AAA合并PFO组及MSA合并PFO比较,单纯PFO组患者年龄更小,吸烟史、高血压病史及既往脑卒中病史比例更低,反常性风险栓塞评分量表(Risk of paradoxical embolism, RoPE)数值更高(P<0.05)。影像学上AAA合并PFO组患者与MAS合并PFO组及单纯PFO组比较,其梗死灶数量更多,小病灶及累及两根以上血管和同时累及前后循环的比例更高,而MAS合并PFO组及单纯PFO组中梗死灶数量更少,大病灶及累及单根血管的比例更高(P<0.05); 单纯PFO组病灶分布于后循环的比例高于AAA合并PFO组(χ²=4.854,P=0.028); MAS合并PFO组及单纯PFO组中梗死灶数量、大小、累及的血管情况无明显差异(P>0.05)。结论 PFO引起的反常栓塞及主动脉斑块脱落栓塞可能是引起CS的重要病因,CS患者的梗死灶影像学特点能作为寻找隐源性脑卒中发病机制的线索

Clinical and imaging findings in cryptogenic stroke with patent foramen ovale

ObjectiveTo investigate the clinical and imaging features of cryptogenic stroke(CS)with patent foramen ovale(PFO).Methods Clinical data of 122 cases with patent foramen ovale and cryptogenic stroke were recruited at Department of Neurology, Tongji Hospital Affiliated to Huazhong University of Science and Technology from November 2014 to June 2019. Patients were categorized into 3 groups according to extensive cerebrovascular imaging: aortic arch atheroma(AAA)with PFO group(n=26), mild atherosclerosis(MSA)with PFO group(n=34), and PFO only group(n=62). The general information and imaging characteristics were compared among three groups.Results Clinical and radiological features differed among three groups. The PFO only group had heathier vascular risk factor profile(age, smoking history, hypertension and history of stroke), and showed higher Risk of Paradoxical Embolism scores compared with other groups(P<0.05). The AAA plus PFO group intended to cause more but smaller lesions which scattered in multiple vascular territories. The PFO only group and MSA plus PFO group intended to cause larger lesions which affected single vascular territories(P<0.05). Further, the PFO only group showed posterior circulation involvement compared with AAA group(P<0.05). There was no significant difference in number, size, and involvement of infarcts between the MAS group and PFO group.Conclusion PFO mediated peradoxical embolism and artery plaque embolism were main etiologies of CS. The imaging features of infarcts in CS patients could be used as a clue of the pathogenesis of embolism