后循环梗死的临床特点及危险因素分析

目的阐明后循环梗死常见临床症状、体征及危险因素。方法分析2008年10月-2011年10月在本院神经内科住院的急性后循环梗死患者61例资料。结果患者常见的症状头晕(54.1%)、偏侧肢体无力(45.9%)、恶心及呕吐(39.3%)和言语不清(31.1%);少见症状为视物成双(4.9%)、抽搐(4.9%)及记忆障碍(4.9%)。常见的体征为单侧或双侧肢体运动障碍(45.9%)、共济失调(29.5%)、交叉性瘫痪(3.3%)和眼球活动障碍(4.9%)。在所调查的危险因素中,高血压(72.1%)、高脂血症(63.9%)、糖尿病(36.1%)、既往卒中史(31.2%)及心脏病(27.9%)。结论后循环梗死临床表现复杂,常见的症状为头晕、偏侧肢体无力、恶心及呕吐、言语不清,常见体征为肢体运动障碍,高血压为后循环梗死的主要危险因素,特征性临床表现及体征有助于后循环梗死的诊断及治疗。     

The Hallym Stroke Registry: a web-based stroke data bank with an analysis of 1,654 consecutive patients with acute stroke

OBJECTIVES: In Korea, stroke ranks as one of the leading causes of death along with cancer and ischemic heart disease. The purpose of this study was to better understand clinical characteristics, risk factors and subtypes of acute stroke among Korean people. METHOD: 1,654 acute stroke patients within 7 days of onset were consecutively enrolled in the Hallym Stroke Registry (HSR). The study was a prospective hospital-based registry aided with a web-based, computerized data bank system. The project began in January 1996 and the data obtained until September 2002 were analyzed. The analysis was basically carried out regarding demographic features, risk factors, time elapsed before coming to the hospitals after the symptom onset, duration of hospitalization, and 30-day mortality rate. RESULTS: 1,567 patients had ischemic stroke and 87 patients had hemorrhagic stroke. The mean age of the patients was 63.6 +/- 11.8 years, and 815 patients (56.8%) were men. The estimated time interval between stroke onset and hospital visit was 1.3 days on average and the mean duration of hospital stay was 12.1 days. Only a small fraction (12%) of patients reached the hospital within 3 h after the symptom onset. As for the risk factors, hypertension topped for both ischemic and hemorrhagic strokes followed by smoking and prior history of stroke, diabetes, hyperlipidemia and cardioembolism. With respect to subtype classification of ischemic stroke, large-artery atherosclerosis was most frequent (42.0%), followed by small-vessel occlusion (31.0%), cardioembolism (8.7%), other determined etiology (1.9%), and undetermined etiology (16.4%). The 30-day mortality rate was 7.2%. CONCLUSION: In the HSR, demographic features were essentially comparable with other major registries. However, the data analysis varies from registry to registry. This may in part be due to a different study design, racial-ethnic differences and patient selection methods.     

后循环脑梗死的临床和影像学分析

目的 研究后循环脑梗死的影像学表现、病因、危险因素、临床表现、责任病灶及预后的特点。方法 收集自2007年9月至2010年3月在我院住院治疗的53例后循环脑梗死病例的临床资料,总结患者的临床症状和体征,分析其影像学表现、病因和危险因素,根据Caplan使用的后循环供血区分段标准,将患者分为近段组、中段组、远段组、混合组四组。所有患者的预后均进行改良Rankin残障量表（mRS）评估,了解患者的预后情况。结果 后循环梗死最常见的症状为眩晕28例（52.8%）,恶心、呕吐23例（43.4%）,肢体瘫痪21例（39.6%）,言语不利17例（32.1%）;最常见的体征是中枢性面舌瘫31例（58.5％）,运动障碍21例（39.6％）,感觉障碍17例（32.1％）及共济失调15例（28．3％）;最常见的危险因素包括高血压、糖尿病、吸烟、饮酒、心脏病变、脂代谢异常。其中中段组发病率最高21例（39.6%）,其次为远段组13例（24.5%）,混合组10例（18.9%）,近段组9例（17.0%）。根据mRS评估,34.0%的患者预后不良。结论 后循环梗死的临床表现复杂多变,最常见的病变部位在中段,特征性临床表现和临床综合征有助于后循环脑梗死的诊断,大部分患者预后良好。     

Risk factors of young ischemic stroke in Qatar

OBJECTIVES: There is limited information about risk factors of young ischemic stroke in Qatar. The aim of this study was to describe the risk factors and subtypes of young ischemic stroke among Qatari and non-Qatari residents. PATIENTS AND METHODS: Hospital based prospective observational study involving all young adults (15-45 years of age) admitted to Hamad General Hospital with first-ever ischemic stroke from September 2004 to September 2005. A stroke was defined according to WHO criteria. RESULTS: Stroke was confirmed in 40 (32 males and 8 females). Their ages ranged from 17 to 44 years (mean 37.1+/-13.27). Thirty (75%) of the patients were non-Qatari. The most common risk factors were hypertension 16 (40%), diabetes mellitus 13 (32.5%), hypercholesterolemia 11 (27.5%), smoking 11 (27.5%), and alcohol intake 9 (22.5%). Regarding stroke subtypes, lacunar stroke syndrome (LACS) was diagnosed in 17 (42.5%), total anterior circulation stroke syndrome (TACS) in 16 (40%), partial anterior circulation stroke syndrome (PACS) in 5 (12.5%) and posterior circulation stroke syndrome (POCS) in 2 (5%). Partial anterior circulation stroke syndrome (PACS) was observed with a higher frequency in Qatari patients compared with non-Qataris (p=0.009), whereas total anterior circulation stroke syndrome (TACS) was observed more in non-Qatari than in Qatari patients (p=0.03). Average hospital stay was 18 days. In-hospital mortality was 2.5%. CONCLUSION: The risk factors of ischemic stroke in young adults are numerous. The most common were hypertension, diabetes mellitus, hypercholesterolemia, smoking and alcohol intake. Only one Indonesian male patient with POCS died in the hospital.     

Ischemic stroke in young adults: classification and risk factors

Our aim was to analyze an important subgroup represented by young adult patients (19–45 years) with acute ischemic stroke according to stroke classification (including the novel ASCO score), infarct types and risk factors. All patients up to 45 years of age with an acute ischemic stroke confirmed by MRI and treated in our stroke unit from 2006 to 2009 were recruited for this study. Patients were neurologically examined and underwent thorough stroke work-up. One hundred four patients (58 women, 46 men) with a mean age of 38 ± 6.9 years were evaluated. The mean NIHSS score (±SD) was 3 ± 5 on admission and 1 ± 4 on discharge. The classification using TOAST/ASCO (grade 1) was as follows: Macroangiopathic 10.6%/8.7%, cardiac origin 21.2%/10.6%, microangiopathic 9.6%/9.6%, other causes 19.2%/13.5% and undetermined 39.4%/19.2% (for A0S0C0O0). The most common risk factors were smoking (55.2%), hypertension (31.4%) and hyperlipidemia (27.6%). Twenty nine of 74 patients with TEE (39.2%) had a patent foramen ovale (PFO). Hypoplastic posterior circulation (21.9%) and migraine (21.0%) were also quite common. Young adult ischemic stroke patients share many of the characteristic risk factors with the general elderly ischemic stroke population. If regular work-up includes TEE, a high percentage of young patients reveal comorbidities with PFO, hypoplasia of the posterior circulation and migraine. The ASCO classification should be favored for a better classification of coexisting stroke subtypes and lower number of undetermined etiologies in this patient group.     

Arterial ischemic stroke: experience in Chinese children

The aim of this study was to review cases of pediatric arterial ischemic stroke among Chinese subjects and thereby evaluate risk factors, clinical and neuroimaging features, and treatment, to establish a reasonable guideline for assessment and management of the disease. Between 1996 and 2006, 157 children (male:female ratio, 1.4:1) with arterial ischemic stroke were identified at Beijing Children's Hospital. The median age at stroke was 32 months (range, 4-192). Among patients with determined etiology, infections (12.1%), moyamoya disease (12.1%), and trauma (10.8%) were the most common. In 51 patients, there were no obvious risk factors (32.5%). Hemiplegia was the most common presenting feature (81.5%). The region of left middle cerebral artery was most frequently affected (36.3%), followed by the right middle cerebral artery (29.9%). Of the 157 patients, 56 were treated by intravenous thrombolytic agents (35.7%), all but one of them successfully (the one exception involving hemorrhagic complication). Randomized controlled trials are needed to establish primary prevention, acute treatment, and secondary prevention of pediatric ischemic stroke.     

Risk factors,topographic patterns and mechanism analysis of intracranial atherosclerotic stenosis ischemic stroke

Background: The association between topographic patterns, risk factors and stroke mechanisms of ICAS in first-ever stroke remains unknown. Methods: A large sample sized retrospective study was performed on first-ever ICAS ischemic stroke using DWI and MRA. Results: Hypertension (60.92%), cigarette smoking (26.82%), MCA (76.65%) and multiple vessels (65.37%) stenosis, were the major factors favoring different mechanisms. Subcortical lesions were the most occurring topographic patterns (41.4%). The common mechanism was LBO (66.3%). Statistical analysis showed a significant relationship between lesion patterns and mechanisms (r = 0.384, P = 0.001). Single mechanism had the higher apoB/apoAI ratio (P = 0.005) and levels of plasma apoB (P = 0.007) compared with multiple mechanisms. The anterior circulation stroke were more multiple mechanisms as compared to the posterior circulation stroke (P = 0.001). LBO was more prevalent in posterior circulation stroke than in anterior circulation stroke (P = 0.001). Conclusions: The topographic patterns of ischemic lesions is helpful in early identification of different mechanisms of ICAS. Monitoring apoB and apoB/apoA1 may help to predict the mechanism of stroke with ICAS. The prevalence of mechanisms differ between anterior and posterior circulation stroke with ICAS.     

责任性颅内动脉粥样硬化性狭窄致首发缺血性脑卒中解剖模式与发病机制的关系

目的探讨责任性颅内动脉粥样硬化性狭窄(Intracranial atherosclerotic stenosis,ICAS)致首发缺血性脑卒中(Ischemic stroke,IS)解剖模式与发病机制的关系。方法回顾性分析261例责任性ICAS致首发IS患者的临床资料。根据弥散加权成像(DWI)的影像学表现分为单发病灶(皮质-皮质下梗死、皮质梗死、皮质下梗死),弥散病灶,多发病灶(单侧前循环或后循环多发梗死);卒中机制分为动脉到动脉栓塞、原位血栓形成、穿支动脉闭塞、低灌注、多发机制等。结果单发皮质下梗死是责任性ICAS致首发IS最常见的卒中模式(41.38%,108/261);责任性ICAS致IS主要发病机制为穿支动脉闭塞(41.38%,108/261);责任性ICAS致IS的解剖模式与发病机制显著相关(r=0.384,P=0.001),穿支动脉闭塞与皮质下梗死相关(r=0.805,P=0.001),弥散梗死、单侧前循环多发梗死、后循环多发性梗死,分别与动脉到动脉栓塞(r=0.853,P=0.001;r=0.860,P=0.001;r=0.281,P=0.001)、及多发机制(r=0.792,P=0.001;r=0.883,P=0.001;r=0.213,P=0.001)相关。结论卒中解剖模式有助于明确责任性ICAS致缺血性脑卒中的发病机制,有利于指导其临床诊治及预防措施的拟定。     

Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging

We examined whether the presence of diffusion-weighted imaging (DWI) lesions and vessel occlusion on acute brain magnetic resonance images of minor stroke and transient ischemic attack patients predicted the occurrence of subsequent stroke and functional outcome. 120 transient ischemic attack or minor stroke (National Institutes of Health Stroke Scale < or = 3) patients were prospectively enrolled. All were examined within 12 hours and had a magnetic resonance scan within 24 hours. Overall, the 90-day risk for recurrent stroke was 11.7%. Patients with a DWI lesion were at greater risk for having a subsequent stroke than patients without and risk was greatest in the presence of vessel occlusion and a DWI lesion. The 90-day risk rates, adjusted for baseline characteristics, were 4.3% (no DWI lesion), 10.8% (DWI lesion but no vessel occlusion), and 32.6% (DWI lesion and vessel occlusion) (p = 0.02). The percentages of patients who were functionally dependent at 90 days in the three groups were 1.9%, 6.2%, and 21.0%, respectively (p = 0.04). The presence of a DWI lesion and a vessel occlusion on a magnetic resonance image among patients presenting acutely with a transient ischemic attack or minor stroke is predictive of an increased risk for future stroke and functional dependence.     

Early ischemic lesion recurrence within a week after acute ischemic stroke

Previous observations suggested that multiple ischemic lesions on diffusion-weighted imaging (DWI) are common in acute stroke patients. We hypothesized that a source of these multiple lesions was the recurrence of ischemic lesions within a week after a clinically symptomatic stroke. We analyzed 99 acute ischemic stroke patients scanned within 6 hours of onset and at subsequent times within the first week. Ischemic lesion recurrence was defined as any new lesion separate from the index lesion. Recurrent lesions occurring outside initial perfusion deficit were termed 'distant lesion recurrence'. We estimated the hazard ratio (HR) of recurrence associated with clinical and imaging characteristics using log-rank test. Any lesion recurrence was found in 34%, with distant lesion recurrence in 15%, while clinical recurrence was evident in 2%. Initial multiple DWI lesions were associated with any lesion recurrence (HR, 2.83; 95% confidence interval [CI], 1.65-10.29; p = 0.002) and with distant lesion recurrence (HR, 5.99; 95% CI, 4.05-64.07; p < 0.0001). Large-artery atherosclerosis was the most frequent stroke subtype associated with any lesion recurrence (p = 0.026). These results may indicate a prolonged state of increased ischemic risk over the first week and suggest DWI as a possible surrogate measure for recurrent stroke.     

Factors affecting the first recurrence of noncardioembolic ischemic stroke

Studies of the factors affecting the first recurrence of ischemic stroke have reported inconsistent findings. Types of initial stroke and the racial differences in study samples are among the explanations that may account for this inconsistency. The aims of this study were to estimate the cumulative recurrence rates of noncardioembolic ischemic stroke and identify the factors that influence the first recurrence of noncardioembolic ischemic stroke in the Taiwanese Chinese population. Four hundred and sixty-six patients with noncardioembolic ischemic stroke from thirteen hospitals in Taiwan were followed up in this study to ascertain first recurrence of noncardioembolic ischemic stroke between October 1992 and April 1995. The Kaplan-Meier method was used to estimate the cumulative recurrence rate. The Cox regression model was used to ascertain the significant factors affecting the first recurrence of noncardioembolic ischemic stroke. The overall cumulative recurrence rate was 10.5% (49/466) from the follow-up period of 30 months. After adjustment for age, sex, treatment modes, and variables pertinent to blood pressure, the site of brain lesion remained a significant factor. The relative risk of first recurrence for the basal ganglion vs. the region of middle cerebral artery was 3.06 (95% CI: 1.29-7.26). The brain lesion site was demonstrated to be an independent predictor of risk for the first recurrence of noncardioembolic ischemic stroke among the Taiwanese Chinese population. Whether this finding was also seen in other populations should be corroborated in future research.     

青年缺血性卒中患者前后循环发病相关因素研究

目的 对比前循环和后循环青年缺血性卒中患者的临床特征及病因分型特点。 方法 将2010年8月-2017年9月于上海市第一人民医院神经内科病房住院的18～55岁缺血性卒中患 者纳入研究,通过回顾性收集患者的临床资料,分析青年患者前后循环缺血性卒中的临床特征及病 因分型之间的区别。 结果 研究纳入678例青年缺血性卒中患者,其中包括203例（29.9%）后循环卒中及475例（70.1%） 前循环卒中。高血压均是两组最常见的危险因素,分别占前循环卒中的68.6%和后循环卒中的66%。多 因素回归分析提示糖尿病（OR 1.569,95%CI 1.082～2.277）作为危险因素对后循环发挥的作用更大。 结论 青年前、后循环缺血性卒中的病因学和危险因素分布大体相似,糖尿病作为危险因素对后循 环发挥的作用更大。     

The Khorasan Stroke Registry: results of a five-year hospital-based study

The hospital-based stroke registry is useful for understanding the diverse clinical characteristics of stroke related to geographical, racial or environmental differences. The Khorasan Stroke Registry (KSR) was established for the evaluation of incidence, clinical manifestations, risk factors, topography and etiology of ischemic stroke in Southern Khorasan, Iran, during 2001-2005. Consecutive stroke patients underwent a standard battery of diagnostic investigations by a stroke neurologist. The topography and etiology of brain infarction were determined by the Practical Iranian Criteria classification. The incidence of ischemic stroke in the Persian population is 43.17 cases per 100,000 people per year. A total of 1,392 ischemic stroke patients (738 females, 654 males) were evaluated in the KSR. The etiologies included atherosclerosis (53.6%), followed by uncertain causes (19.9%), cardioembolism (11.8%) and miscellaneous etiologies (2.9%). Of our patients, 11.7% had both atherosclerosis and cardioembolic mechanisms. Rheumatic valvular disease was present in 44.8% of cardioembolic stroke patients and caused 4.31 preventable stroke cases per 100,000 Persian people per year. Hypertension and history of ischemic cerebrovascular events were the most frequent risk factors, 53.1 and 22.3%, respectively. The in-hospital mortality of our ischemic stroke patients was 7.3%. A total of 336 patients with intracerebral hemorrhage (189 females, 147 males) were evaluated in the KSR. The incidence of intracerebral hemorrhage in the Persian population is 10.43 cases per 100,000 people per year. The high frequency of atherosclerotic etiology in the KSR is due to its classification criteria, which do not separate small vessel territory infarcts as a different etiologic subtype. Rheumatic valvular disease is an important cause of stroke in the Persian population.     

Ischaemic posterior circulation stroke in State of Qatar

Background:  Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region.
Methods:  We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded.
Results:  Mean age was 53 years with 25% aged ≤45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was ≤2 in 53% and ≥4 in 13% patients. At 30-day follow-up, 68% had mRS of ≤2. Ninety-day survival status showed 89% alive with mRS ≤ 2 in 73%.
Conclusion:  The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.     

卵圆孔未闭相关缺血性卒中的临床和神经影像学特征分析

目的 探讨卵圆孔未闭（patent foramen ovale,PFO）相关缺血性卒中的临床和神经影像学特征,并 根据不同的PFO解剖特点,确定其缺血性病变类型是否存在差异。 方法 本研究为单中心回顾性研究,入选2015年5月-2019年9月在首都医科大学附属北京天坛医院 心血管内科连续住院接受PFO介入封堵治疗的缺血性卒中患者。所有患者均接受颅脑MRI检查,并通 过TCD确定右向左分流（right-to-left shunt,RLS）量,经食道超声检查确定PFO诊断及其解剖结构。总 结PFO相关缺血性卒中的影像学特征,并根据不同的PFO解剖特点,确定其缺血性病变类型是否存在 差异。 结果 共入组108例患者,平均年龄46±11岁,其中男性78例（72.2%）。PFO直径（静息状态）平 均1.5±1.1 mm,雨帘状RLS 75例（69.4%）,原发隔活瓣长度平均9.5±3.7 mm,长隧道型PFO 37例 （34.3%）,PFO伴过间隔血流76例（70.4%）。PFO相关缺血性卒中患者MRI显示梗死血管累及前循环42 例（38.9%）（单侧前循环29例+双侧前循环13例）,后循环39例（36.1%）,皮层梗死22例（20.4%）, 皮层下梗死7例（6.5%）,深部梗死 44例（40.7%）,皮层、皮层下梗死+深部梗死35例（32.4%）;单 一梗死31例（28.7%）,多发梗死77例（71.3%）。不同的RLS量、PFO大小之间比较,脑梗死分布、梗死 部位和梗死数量方面未发现影像学差异。长隧道组和非长隧道组的梗死部位（P =0.037）和梗死 数量（P =0.016）差异均有统计学意义,其中长隧道组更多见皮层梗死（35.1% vs 12.7%）和单一梗死 （43.2% vs 21.1%）。有过间隔血流组和无过间隔血流组在梗死分布上差异有统计学意义（P =0.014）, 有过间隔血流组后循环梗死发生率更高（43.4% vs 18.8%）。 结论 PFO相关缺血性卒中患者影像学上梗死血管累及前循环和后循环的比率相似,梗死部位以 深部梗死和多发梗死为主。长隧道型PFO与非长隧道型相比,皮层梗死和单一梗死更多见。伴有过 间隔血流的PFO多发生后循环梗死。     

大动脉粥样硬化性首发急性缺血性卒中的危险因素与分布特点

目的回顾性分析大动脉粥样硬化性狭窄(large artery atherosclerotic stenosis,LAAs)致首发急性缺血性卒中患者受累血管与相关危险因素的关系。方法收集2009年1月至2014年12月住院的责任LAAs致首发急性缺血性卒中342例患者的临床与影像学相关资料,进行组内比较和多因素logistic回归分析其危险因素。结果颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)以大脑中动脉(middle cerebral artery,MCA)多见(47.0%),颅外动脉粥样硬化性狭窄(extracranial atherosclerotic stenosis,ECAS)以颈内动脉(internal carotid artery,ICA)颅外段多见(65.0%)。与ECAS组相比,ICAS组脑梗死与代谢综合征(metabolic syndrome,Met S)(OR=1.586,95%CI:1.232~2.268)及载脂蛋白B(apolipoprotein B,Apo B)/载脂蛋白A1(apolipoprotein A-I,Apo A-I)(OR=1.926,95%CI:1.051~4.288)显著相关,与无脑动脉粥样硬化性狭窄(noncerebral atherosclerotic stenosis,NCAS)组相比,ICAS组与高血压(OR=3.603,95%CI:1.675~12.485)、Met S(OR=2.268,95%CI:1.274~6.103)、高糖化血红蛋白(Hb A1c)(OR=2.015,95%CI:1.182~5.613)及Apo B/Apo A I(OR=1.948,95%CI:1.157~4.285)相关。在ICAS患者中,与前循环动脉粥样硬化性狭窄脑梗死组相比,后循环动脉粥样硬化性狭窄致脑梗死组的独立危险因素包括高血压(OR=1,750,95%CI:1.042~2,953,P=0.009)、高血同型半胱氨酸(Hcy)(OR=2.437,95%CI:1.492~3.505,P=0.005)及高Hb A1c(OR=1.769,95%CI:1.034~3.121,P=0.005)。结论缺血性脑卒中患者ICAS的发生率可能高于ECAS,ICAS脑梗死的危险因素不同于NCAS及ECAS;后循环ICAS脑梗死的发生与代谢指标紊乱密切相关。     

Acute ischemic stroke and transient ischemic attack in the very old – risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years

Old age groups have different risk profile and stroke features compared to younger groups. Our aim was to examine the risk factor profile and stroke subtype in patients older than 80 years with ischemic stroke. Data of 535 patients with ischemic stroke or transient ischemic attack (TIA) were prospectively recorded. Cardiovascular risk factors and stroke subtype in individuals aged 80 years or older were compared with patients under 80. Of 535 patients a total of 179 were over 80 years (33.5%). The mean age was 84.4 ± 4.4 years (61.8%; 111 women). The most common risk factors included hypertension (82.7%) and hyperlipidemia (40.2%). Lacunar stroke was the most frequent subtype of stroke (41.7%). When the groups were compared, we observed the following risk factors more frequently in the group older than 80: female patients ( P  = <0.001), hypertension (OR = 1.62), atrial fibrillation (OR = 2.64); whereas diabetes (OR = 0.54), hyperlipidemia (OR = 0.57), smoking (OR = 0.17) and obesity (OR = 0.58) were more frequent in the group younger than 80. In the old group we found a high incidence of ischemic stroke in women. We also found a higher frequency of hypertension and atrial fibrillation. The available and future epidemiological data will provide a better knowledge about the effect of typical risk factors in old people.     

Manifestaciones neurológicas de los mixomas cardiacos. Experiencia en un centro de referencia

Introduction

Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma.

Objective

To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years.

Patients and methods

We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012.

Results

Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1 cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths.

Conclusions

Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion.     

缺血性卒中患者颅内外血管狭窄率研究

目的:研究缺血性卒中患者颅内外血管狭窄或闭塞的发生率,并对其相关病因进行分析。方法:对经CT/MRI/DWI诊断的缺血性卒中患者的人口构成情况进行登记,了解其相关危险因素。并经TCD和/或MRA了解其颅内外血管狭窄或闭塞的情况。结果:579例缺血性卒中患者中,颅内外血管狭窄的发生率为70.98%(411/579例);411例大动脉狭窄或闭塞患者中,以大脑中动脉狭窄或闭塞最常见(64.48%),其次为颈内动脉(50.36%)。大动脉狭窄或闭塞的主要原因为动脉粥样硬化,引起动脉粥样硬化的危险因素的发病率依次为:高血压病(77.24%),吸烟(63.68%)。通过Logistic回归分析发现,糖尿病、高血压、吸烟是血管狭窄的主要相关危险因素(P值均<0.05)。结论:国内缺血性卒中患者颅内外血管狭窄或闭塞的发生率高,其主要病因为动脉粥样硬化,糖尿病是大动脉狭窄或闭塞的最主要危险因素。