中青年隐源性DWI阴性急性缺血性脑卒中合并卵圆孔未闭两例

该文报道2例中青年隐源性弥散加权成像(DWI)阴性急性缺血性脑卒中合并卵圆孔未闭男性患者,均为38岁,急性起病,以轻度神经功能缺损症状就诊,既往无脑血管病危险因素,以左侧肢体功能障碍为主要表现,DWI均阴性,经颅多普勒超声发泡检查和经食管心脏彩色多普勒超声检查发现卵圆孔未闭,其后均接受抗血小板、调脂等治疗,好转出院后随访显示2例均接受了卵圆孔未闭封堵治疗,均痊愈。应通过该2例的诊治过程提高对局灶性神经功能缺损合并卵圆孔未闭的认识,当患者出现局灶性神经功能缺损,即使DWI阴性亦不能排除急性缺血性脑卒中,应积极进行危险因素筛查,尤其是在中青年隐源性患者中,应高度重视卵圆孔未闭的检测及治疗,减少卵圆孔未闭所致的脑卒中及卒中复发。

Cryptogenic DWI-negative ischemic stroke complicated with patent foramen ovale: report of two cases

Two 38-year-old male patients with cryptogenic diffusion weighted imaging（DWI）-negative ischemic stroke complicated with patent foramen ovale （PFO） were reported. Both two patient presented with acute onset, mild neurological deficits, no previous risk factors of cerebrovascular disease and left limb dysfunction as the main manifestation. DWI yielded negative results. Transcranial Doppler （TCD） sonography and esophageal echocardiography confirmed the diagnosis of PFO. Two patients were treated with antiplatelet and lipid-reducing interventions and successfully discharged. Subsequent follow-up indicated that two patients received PFO occlusion and were healed. The diagnosis and treatment of these two cases deepened the understanding of focal neurologic deficit complicated with PFO. The possibility of ischemic stroke cannot be ruled out when the DWI is negative in patients presenting with focal neurological deficit. We should actively carry out risk factors screening, especially in young patients with cryptogenic stroke. We should attach great importance to the diagnosis and treatment of PFO, aiming to reduce the incidence and recurrence of stroke caused by PFO.