复发性后循环脑梗死患者血管病变特点

目的探讨复发性后循环脑梗死患者脑血管病变的特点。方法对62例复发性后循环脑梗死患者进行DSA检查,分析血管病变的部位、性质和程度。结果本组58例(93.5%)患者有血管狭窄,其中重度狭窄41例(66.1%),轻中度狭窄17例(27.4%);血管动脉硬化的患者4例(6.4%)。单纯前循环血管病变3例(4.8%),单纯后循环血管病变18例(29.0%),前后循环血管均病变41例(66.1%)。椎动脉病变53例(85.5%),颈内动脉38例(61.3%),基底动脉14例(22.9%),大脑中动脉6例(9.7%),颈总动脉3例(4.8%)。结论复发性后循环脑梗死患者的主要血管病变部位在椎动脉和颈内动脉,血管病变的主要病理特征为动脉粥样硬化及在此基础上形成的血管狭窄,且以重度狭窄最为多见。     

后循环脑梗死溶栓治疗成败的分析

目的 观察后循环脑梗死溶栓成功和失败病例,提出后循环脑梗死溶栓成败的因素.方法 将后循环脑梗死11例患者按其溶栓疗效分为两组,成功组和失败组,并从溶栓时间窗,临床表现,血压情况,血管狭窄,侧支循环建立,及临床症状恢复情况进行对比分析.结果 (1)两组病例均有高血压病史,基础血压偏高,发病后血压较平时略有增高;(2)成功组较失败组临床症状轻,侧支循环建立好;(3)两组病例均有重度血管狭窄.结论 (1)后循环脑梗死溶栓成败关键是重视临床,及早发现后循环脑梗死,在有效时间窗内及早进行溶栓治疗;(2)后循环脑梗死多有重度脑血管狭窄,须注意控制血压;(3)侧支循环建立的好坏是判断溶栓成败的关键.     

后循环脑梗死的血管影像学检查

动脉粥样硬化性血管狭窄或闭塞是后循环脑梗死的主要病因之一。对后循环脑梗死患者进行血管检查,有助于明确病因及发病机制,对制定临床治疗策略有重要指导意义。本文综述了不同影像学检查方法在评估后循环血管状况方面的临床价值及研究进展。     

后循环脑梗死的影响因素与生存状况研究

目的探讨后循环脑梗死的影响因素与生存状况。方法选取我院2013-06—2015-06收治的304例急性脑梗死患者,按梗死部位分为前循环脑梗死组158例和后循环脑梗死组146例,分析临床资料与后循环脑梗死的关系。结果后循环脑梗死组和前循环脑梗死组合并糖尿病、房颤、总胆固醇(TC)、甘油三酯(TG)和空腹血糖(FBG)水平比较有显著性差异(P0.05)。Logistic回归分析显示,合并糖尿病、房颤,TC、TG和FBG水平是后循环脑梗死的独立危险因素。146例后循环脑梗死患者入院30d时,预后良好者88例(60.27%),严重致残者51例(34.93%),死亡7例(4.79%)。结论合并糖尿病、房颤,TC、TG和FBG水平是后循环脑梗死的独立危险因素,短期预后良好。     

动脉溶栓治疗后循环急性脑梗死与静脉溶栓的回顾分析

目的研究动脉溶栓治疗后循环急性脑梗死的术后即刻疗效和短期预后。方法选择2013年4月~2015年1月在我院采用尿激酶行责任血管动脉溶栓的患者39例为动脉溶栓组(IAT组),回顾2010年7月~2013年3月在我院采用rt-PA行静脉溶栓的患者34例为静脉溶栓组(IVT组)作为对照,比较两组病死率以及治疗前、后以及3 m后NIHSS评分。结果与治疗前比较,IVT组和IAT组治疗后即刻以及治疗后3 m NIHSS评分均显著减低;与治疗后即刻比较,两组治疗后3 m NIHSS评分均显著减低。与IVT组比较,治疗后即刻以及治疗后3 m IAT组NIHSS评分均显著减低。IVT组34例患者中16例(47.1%)于3 m内死亡,IAT组39例患者中7例(17.9%)于3 m内死亡,两组比较具有统计学差异(P=0.008)。IVT组并发出血4例(10.3%),IAT组3例(8.8%),两组比较无统计学差异(P=0.836)。结论后循环急性脑梗死患者动脉溶栓治疗后病死率、溶栓后即刻及3 m后神经功能评估均优于静脉溶栓治疗。     

急性后循环脑梗死动脉溶栓及动静脉联合溶栓的对比分析

目的比较急性后循环脑梗死动脉溶栓及动静脉联合溶栓的有效性和安全性。方法回顾急性后循环缺血性卒中患者79例,其中动脉溶栓42例,动静脉联合溶栓37例;比较两组血管的再通率以及患者治疗前及治疗后1 h、24 h美国国立卫生院卒中量表(NIHSS)评分。结果单纯动脉溶栓组再通率59.5%,动静脉联合溶栓组血管再通率75.7%;两组患者治疗后1 h、24 h的NIHSS评分和治疗前相比有明显差异(P<0.05),两组之间评分有明显差异(P<0.05)。结论急性后循环脑梗死动静脉联合溶栓可以增加血管的再通率,可以明显改善患者的预后。     

急性后循环多发与单发脑梗死病因分析

目的 分析急性后循环多发与单发脑梗死的病因差异.方法 选择后循环急性脑梗死患者71例,根据磁共振弥散加权成像（DWI）病灶特点分为多发组和单发组,按TOAST分型标准对卒中病因进行分类.结果 28例多发脑梗死中大动脉粥样硬化性卒中19例,心源性栓塞4例,小动脉闭塞性卒中2例,其他原因所致缺血性脑卒中1例,不明原因的缺血性脑卒中2例;43例单发脑梗死中大动脉粥样硬化性卒中10例,心源性栓塞4例,小动脉闭塞性卒中25例,其他原因所致缺血性脑卒中2例,不明原因的缺血性脑卒中2例.多发组与单发组相比,多发组大动脉粥样硬化性卒中更常见（P=0.000）,单发组小动脉闭塞性卒中更常见（P=0.000）.结论 急性后循环多发脑梗死的主要病因是大动脉粥样硬化性卒中,单发脑梗死的主要病因是小动脉闭塞性卒中.     

高龄后循环脑梗死患者预后的相关影响因素分析

目的探讨高龄(年龄≥80岁)后循环脑梗死(PCI)患者的预后及其影响因素。方法收集233例高龄PCI患者的临床资料。根据发病3个月后的mRS评分,分为预后良好组和预后不良组。比较两组人口统计学和临床资料之间的差异,采用非条件Logistic回归法分析影响其预后的独立危险因素。结果预后不良组为66例(28.33%),与预后良好组相比,预后不良组心房纤颤(31.82%)和卒中/TIA史比率(27.76%)均明显高于预后良好组(17.96%,14.37%)(均P0.05)。预后不良组患者入院时NIHSS评分、血总胆固醇、低密度脂蛋白胆固醇(LDL-C)和纤维蛋白原(Fib)水平均明显高于预后良好组(均P0.05)。多元素Logistic回归分析显示,入院时NIHSS评分(OR=1.181,95%CI:1.054~1.325)、血LDL-C(OR=1.815,95%CI:1.085~3.039)和Fib(OR=2.106,95%CI:1.319~3.361)水平是高龄PCI患者预后不良的独立危险因素(均P0.05)。结论高龄PCI患者预后相对较差,入院时NIHSS、血LDL-C和Fib水平是高龄PCI患者发病3个月后预后不良的独立危险因素。     

丁苯酞治疗急性期后循环脑梗死的疗效观察

目的 观察丁苯肽治疗急性期后循环脑梗死的临床疗效.方法 选取80例急性期后循环脑梗死患者随机分为治疗组和对照组,对照组按脑血管病防治指南给予规范治疗,治疗组在规范治疗基础上加用丁苯肽软胶囊,分别在治疗第7天、14天用NIHSS和日常生活能力评分量表进行评分.结果 治疗组的NIHSS评分显著降低,日常生活能力显著提高,2组比较差异有统计学意义(P＜0.05).结论 丁苯肽治疗急性期后循环脑梗死有显著疗效.     

脑循环综合治疗仪对脑梗死后抑郁的影响

<正>本研究对脑循环综合治疗仪治疗脑梗死后抑郁的疗效进行探讨,并与抗抑郁药舍曲林进行对比,报告如下。1对象和方法病例为我院2012年1月至2013年9月住院患者,均符合CCMD-3脑梗死后抑郁的诊断标准;HAMD-17评分17分;病程≥半个月;经脑CT或MRI证实为脑梗死。排除脑     

Cerebral vasomotor reactivity of the posterior circulation in patients with carotid occlusive disease

We evaluated the hemodynamic features of the posterior circulation in patients with severe carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. Sixty symptomatic and 111 asymptomatic patients with unilateral severe (>70%) internal carotid artery stenosis were studied. The VMR was 19.2 +/- 18.9% for the MCA ipsilateral to the stenosis and 27.3 +/- 17.4% on the contralateral side (P < 0.0001) for all patients. It was 18.2 +/- 23.2% for the VA ipsilateral to the stenosis and 19.7 +/- 21% on the contralateral side (P = NS). The symptomatic patients' VMR of the MCA on the side of stenosis and the opposite side were 19.2 +/- 17.6 and 29 +/- 17.2%, respectively (P < 0.03). The VMR of the VA remained similar (15.1 +/- 21 and 21.6 +/- 6%, respectively, P = NS). The asymptomatic patients' VMR of the MCA on the side of the stenosis was also lower (19.2 +/- 19.7 vs. 26.5 +/- 17.5% on the opposite side, P < 0.001). In contrast, the VMR in the VA was similar (19.8 +/- 21.4 and 18.7 +/- 19.5%, respectively, P < 0.6, NS). Thus, the VMR of the posterior circulation remained similar regardless of carotid stenosis and a symptomatic/asymptomatic course of carotid occlusive disease, suggesting an independent cerebral vascular reserve capacity of the posterior circulation.     

Racial differences in the distribution of posterior circulation occlusive disease

We compared clinical and arteriographic features in 27 white and 24 black patients with symptomatic posterior circulation occlusive disease. The degree of arterial stenosis was measured independently by two examiners at 12 sites within the vertebrobasilar territory. Racial comparisons were made based upon the distribution of extra- and intracranial occlusive lesions and symptomatic sites of the lesions. White patients had significantly more angina pectoris, more lesions of the origin of the left vertebral artery and more high grade lesions of the extracranial vertebral arteries. Black patients had significantly higher mean diastolic blood pressure, more diabetes mellitus, more lesions of the distal basilar artery, more high grade lesions of intracranial branch vessels and more symptomatic intracranial branch disease. Race was found to be the only factor increasing the risk of intracranial posterior circulation occlusive disease. Knowledge of the contribution of race to the distribution of posterior circulation lesions will help guide evaluation and treatment strategies for patients with vertebrobasilar occlusive disease.     

Lesion patterns in patients with cryptogenic stroke with and without right-to-left-shunt

Background and purpose:  Despite numerous studies, the role of patent foramen ovale (PFO) as a risk factor for stroke due to paradoxical embolism is still controversial. On the assumption that specific lesion patterns, in particular multiple acute ischaemic lesions on diffusion-weighted magnetic resonance imaging, indicate a cardioembolic origin, we compared the MRI findings in stroke patients with right-to-left shunt (RLS) and those without.
Methods:  The records of 486 patients with diagnosis of cerebral ischaemia were reviewed. For detection of RLS, contrast-enhanced transcranial Doppler (c-TCD) was carried out in all patients. An MRI scan of the brain was performed in all patients. Affected vascular territories were divided into anterior cerebral artery, middle cerebral artery, vertebrobasilar artery system including posterior cerebral artery, brain stem and cerebellar stroke, and strokes occurring in more than one territory.
Results:  We did not find a specific difference in neuroradiological lesion patterns in patients with RLS compared with patients without RLS. In particular, 23 of 165 patients (13.9%) with RLS showed multiple ischaemic lesions on MRI in comparison with 45 of 321 patients (14.0%) without RLS ( P  = 0.98). These findings also applied for the subgroup of cryptogenic strokes with and without RLS.
Conclusion:  We found no association between an ischaemic lesion pattern that is considered as being typical for stroke due to cardiac embolism and the existence of PFO. Therefore, our findings do not provide any support for the common theory of paradoxical embolism as a major cause of stroke in PFO carriers.     

后循环缺血患者脑血管病变的特点

目的探讨后循环缺血患者脑血管病变的特点。方法对74例后循环缺血患者进行CT血管成像(CTA)检查,分析血管病变的部位、性质和程度。结果本组74例后循环缺血患者中61例(82.4%)被CTA证实有血管病变。其中,血管动脉粥样硬化病变8例(10.8%),血管狭窄38例(51.4%),血管纤细22例(29.7%),血管发育不良12例(16.2%)。单纯前循环血管病变7例(9.5%),单纯后循环血管病变21例(28.4%),前后循环均有血管病变例33例(44.6%);前循环血管病变以颈内动脉颅外段狭窄为主,后循环血管病变以椎动脉颅外段和大脑后动脉病变最为多见;前、后循环血管病变狭窄程度均以重度为主。结论后循环缺血患者的主要血管病变部位在椎动脉颅外段和大脑后动脉,其次为颈内动脉颅外段;最常见的病变性质是动脉粥样硬化和血管狭窄,且以重度狭窄最为多见。     

Orthostatic hypotension as a risk factor for symptomatic occlusive cerebrovascular disease

Thirteen patients presented with brief, repetitive, stereotyped transient ischemic attacks, large artery atherostenoses or occlusions with impaired collateral flow to a cortical perfusion borderzone, and orthostatic hypotension (OH). OH was caused by diabetes mellitus, aging, and treatments for ischemic heart disease and hypertension. Medical management of OH often eliminated the need for stroke prevention measures such as surgery or anticoagulation. Focal cerebral hypoperfusion from the combination of occlusive vascular disease and OH may be an underreported, treatable cause of TIA and stroke.     

后循环脑梗死患者的预后分析

目的评估后循环脑梗死患者的预后并分析影响预后的相关因素。方法对274例经头颅MRI确诊且资料完整的后循环脑梗死（PCCI）患者进行随访,评估残障量表（mRS）、Barthel指数（BI）以了解患者的预后情况,并分析预后相关因素。结果274例后循环梗死患者中,无残障或轻度残障（mRS0～3分）占87．6％,严重残障（mRS4—5分）占9．9％,死亡占2．6％。mRS评估的多因素回归分析显示发病至就诊时间、入院时美国国立卫生院卒中量表（NIHSS）评分、既往卒中史、高同型半胱氨酸（Hcy）（P〈0．05）与预后相关。结论后循环梗死患者的总体预后良好,病死率低。发病至就诊时间长、入院时NIHSS评分高、既往有卒中史者、伴高同型半胱氨酸血症者预后不良。     

Antiphospholipid antibodies and hyperhomocysteinaemia in patients with vascular occlusive disease

Hyperhomocysteinemia (HHcy), lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are independent risk factors for thrombosis. Even though risks are cumulative, the clinical impact of the association is unknown. Preliminary data suggested that HHcy might be associated with transient LA and ACA, disappearing after lowering HHcy. We prospectively evaluated the association of HHcy and LA/ACA, the effect of lowering HHcy with folic acid in LA behavior, and the correlation of the initial dRVVT with LA behavior after folic acid in 210 patients with thrombosis and adverse pregnancy outcomes. Prevalence of HHcy among patients with LA/ACA was 40%. Thirty-one patients exhibited only HHcy (15%; Group 1), 106 (50%; Group 2) had only LA/ACA, while 73 (35%; Group 3) had both. After therapy, 63% and 64% of LA/ACA remained positive in Group 3 and 2, respectively. We observed a trend towards a more positive dRVVT in persistent LA after lowering HHcy. No differences in clinical presentation or in outcomes after two years of followup were observed among the groups. Even though the association of HHcy and LA/ACA is common in patients with thrombosis, it might have no prognostic implications if Hcy levels are lowered. Currently, no laboratory findings correlate with LA behavior, which is independent of homocysteine levels and vitamin treatment.