颈内动脉系统频发短暂性脑缺血发作CTA分析

目的探讨颈内动脉系统频发短暂性脑缺血发作(TIA)颈内动脉系统血管狭窄率及特点。方法分析43例颈内动脉系统频发TIA患者的脑CT血管成像(CTA),并与非频发TIA进行对比。结果43例颈内动脉系统频发TIA患者中,有15例(35%)表现为颈内动脉系统颅内动脉狭窄,10例(23%)颅外动脉狭窄,4例(9%)颅内动脉、颅外动脉均有狭窄,14例(33%)无狭窄,狭窄率为67%。轻度、中度、重度狭窄患者分别为7例(16%)、9例(21%)、13例(30%)。33例颈内动脉系统非频发TIA颈内动脉系统血管狭窄率为79%,两组之间无显著性差异(P=0.273)。结论67%的颈内动脉系统频发TIA患者存在颈内动脉系统血管狭窄,但与非频发TIA患者颈内动脉系统狭窄比较无统计学差异。     

颈内动脉闭塞侧颈外动脉狭窄致反复脑缺血发作1例

1病例资料患者,男性,75岁,因反复发作性左侧肢体无力、失语15d入院。患者为左利手,既往无特殊病史。非发作期体格检查未发现阳性体征。头颅MRI：双侧脑室旁、放射冠区、半卵园中心、额顶叶多发腔隙性脑梗死,右侧额顶枕有软化灶,脑萎缩。颈部血管超声示,左侧椎动脉内径2.9 mm,最大血流速度71.5 cm/s;右侧椎动脉内径2.7 mm。     

基底动脉闭塞致颈内动脉系统短暂性脑缺血发作五例报告

例1男，62岁。因反复发作性左上下肢体偏瘫15天入院。每次发作持续约10min，神志清醒，言语流利，BP140／100mmHg。临床诊断右侧颈内动脉系统短暂性脑缺血发作(TIA)。给抗凝、抗血小板及扩张血管药物治疗，入院后仍有反复发作，32天共发作14次，发作时表现左中枢性面舌瘫，左上下肢体肌力0级，     

颈内动脉内中膜厚度与短暂性脑缺血发作的关系

目的探讨颈内动脉内中膜厚度与短暂性脑缺血发作的关系。方法通过对本院短暂性脑缺血发作83例患者行ABCD2评分及颈内动脉内中膜厚度检查,并对所有患者随访1月,了解其脑梗死的发生情况,评估颈内动脉内中膜厚度对TIA患者的诊断作用。结果 TIA患者颈内动脉内中膜厚度为(0.95±0.16)mm,随访1月后TIA患者发生脑梗死有17例(19%),无脑梗死TIA患者与有脑梗死TIA患者颈内动脉内中膜厚度有显著差异(χ2=3.95,P<0.05)。ABCD2评分曲线下面积(95%CI)为0.776(0.639～0.913);颈内动脉内中膜厚度曲线下面积(95%CI)为0.710(0.571～0.850)。结论颈内动脉粥样硬化为TIA疾病发生的高危因素,且颈内动脉内中膜增厚程度可能与TIA后脑梗死的发生有关。     

短暂性脑缺血发作患者的记忆功能研究

目的 观察颈内动脉系统短暂性脑缺血发作(TIA)的患者在症状消失后是否遗留记忆障碍;并探讨颈内动脉狭窄、TIA的病程,次数及持续时间的长短对记忆功能的影响。方法 35例颈内动脉系统TIA患者在末次发作后平均(8±6)天接受临床记忆量表(甲套)的测试,61名正常对照者也接受同样的量表测试。结果(1)TIA患者的记忆商(memory quotient,MQ),总量表分及其指向记忆、联想学习、图像自由回忆和人像特点联系回忆项的等值量表分与正常对照相比,均有明显下降,而两组在无意义图形再认项的评分上无显著性差异(P>0.05)(2)TIA组内伴颈内动脉狭窄者的总量表分和无意义图形再认项的等值量表分均明显低于无狭窄者(P<0.05)。(3)TIA的病程、发作次数及持续时间的长短与临床记忆量表的MQ及各项等值量表分之间均无明显的相关性(P>0.05)。结论(1)颈内动脉系统TIA患者在症状消失后可遗留不同程度的短时记忆障碍。(2)伴颈内动脉狭窄的TIA患者与无狭窄者相比短时记忆尤其是视觉记忆损害更重。(3)TIA患者的病程、发作次数及每次发作持续时间的长短对记忆功能无明显影响。     

颈内动脉系统短暂性脑缺血发作的经颅多普勒超声表现

短暂性脑缺血发作（tramsient ischemic atlack，TIA）被认为是发生脑梗死的独立危险因素，颈内动脉系统TIA是其中最常见类型。我们对2001年1月-2003年8月在我院神经内科住院的80例颈内动脉系统TIA患行经颅多普勒（transeranial doppler,TCD）超声检查，结果报告如下。     

磁共振弥散成像在短暂性脑缺血发作的初步研究

目的:探讨磁共振弥散成像在短暂性脑缺血发作(transient ischemiaat tack,TIA)诊断与治疗中的价值及相关因素分析。方法:42名TIA患者在发病3天内行头颅MRI的DWI检查,观察DWI异常率及与发作持续时间、发作次数的关系。结果:16例(38．1％)在DWI有病灶显示,症状发作持续时间长和发作次数多的TIA患者更易于出现DWI异常。     

颈内动脉狭窄并额叶动静脉畸形致抖动性短暂性脑缺血发作1例报告

颈内动脉狭窄并额叶动静脉畸形致抖动性短暂性脑缺血发作临床少见,现报告1例如下。1病例男,56岁。因"发作性右侧肢体抖动1年,加重半个月"于2010年8月25日入住本院。患者近1年无明显原因出现发作性右侧肢体抖动,以上肢为主,与劳累、精神紧张     

肢体抖动性短暂性脑缺血发作临床分析

目的探讨肢体抖动性短暂性脑缺血发作的临床表现及诊断,提高临床医师对这一症候的认识。方法采用动态脑电图、经颅多普勒超声、颈部血管超声、头部核磁共振、核磁共振血管成像、全脑血管造影等辅助检查,对4例肢体抖动性短暂性脑缺血发作患者进行临床表现、辅助检查及影像学资料分析。结果4例患者均表现为肢体发作性短暂不能控制的抖动,其发作均有明显诱因,其中2例曾被误诊为癫,给予抗癫治疗无效。全部患者均有抖动肢体对侧至少1条以上颅内和（或）颅外动脉严重狭窄或闭塞,头部核磁共振3例显示抖动肢体对侧分水岭脑梗死,发作期脑电图检查未见癫波释放,给予抗血小板聚集、扩容或者血管内支架治疗后,症状均消失。结论肢体抖动性短暂性脑缺血发作常表现为发作性、无意识的肢体抖动,和局灶性运动性癫发作相似,易误诊为局灶性癫,通常提示大血管严重的狭窄或闭塞,低灌注是其最可能的发病机制,通过脑电图及全脑血管造影等检查可以明确诊断,防止漏诊及误诊。     

磁共振弥散加权成像与短暂性脑缺血发作预后的相关性研究

短暂性脑缺血发作(transient isclneroic attack,TIA)是临床常见的脑血管病,也是一种可以控制的脑血管病.磁共振弥散加权成像(diffusion weight imaging,DWI)是利用水分子弥散运动的特件进行弥散测量和成像,对急性腩缺血的榆测较传统MRI检查更为敏感.近年来随着DWI的广泛应用,对TIA的定义、诊断及预后的评价取得了较人的进展.本文主要对DWI异常与TIA患者的预后的相关性进行概括综述.     

Magnetic resonance imaging in patients with transient ischemic attack

<正>Transient ischemic attack(TIA)is a temporary event,which portends a higher risk of a disabling stroke following the TIA.However,the evaluation and management of TIA vary worldwide and is debated and controversial.With the development of brain imaging,particularly diffusion weighted imaging-magnetic resonance imaging(DWI-MRI),the diagnosis of TIA changed from time-based definition to a tissue-based one.DWI-MRI became a mandatory tool in the TIA workup.The DWI-MRI provides not only the evidence to distinguish between TIA and acute ischemic stroke,furthermore it predicts TIA patients who are at higher risk of disabling stroke,which can be prevented by an immediate evaluation and treatment of TIA.     

Vertebrobasilar transient ischemic attacks in internal carotid artery occlusion or tight stenosis

We studied 12 patients with internal carotid artery (ICA) occlusion or tight stenosis but without vertebrobasilar and subclavian atherosclerosis who suffered vertebrobasilar insufficiency (VBI). The patients with ICA occlusion were compared with a sex- and age-matched control group that had ICA occlusion but no VBI. Visible infarct on computed tomographic scan, greater size of visible infarct, weak collateral circulation, and bilateral atherosclerosis of the ICA significantly correlated with the occurrence of VBI. No significant difference was demonstrated for emboligenic lesions, but posterior to anterior flow through the posterior communicating arteries was demonstrated only in the patients with VBI. These facts suggested hemodynamic disturbances with "steal VBI." In ICA tight stenosis, VBI symptoms disappeared after endarterectomy but persisted in patients with more than 50% stenosis; this was also suggestive of hemodynamic VBI. Vertebrobasilar insufficiency had a prognostic significance, being associated with an increased occurrence of delayed stroke.     

缺血性脑血管病患者颈内动脉颅外段血管折曲的影响因素分析

目的 探讨缺血性脑血管病患者颈内动脉颅外段血管折曲的影响因素. 方法 选择行DSA检查的334例缺血性脑血管病患者,根据颈内动脉颅外段血管走行分为血管折曲组(血管成角小于90°定义为血管折曲,110例)和血管无折曲组(血管成角大于90°或盘曲成环状定义为血管无折曲,224例),根据患者年龄分为青年组(18～45岁)、中年组(46～64岁)和老年组(≥65岁).对于可能影响患者颈内动脉颅外段血管折曲的影响因素,如性别、年龄、身高、颈动脉狭窄程度和脑血管病危险因素等进行统计学分析. 结果 单因素分析发现,患者年龄、高血压病史、吸烟史、酗酒史、身高、性别比例在血管折曲组和血管无折曲组中差异有统计学意义(P＜0.05);logistic回归分析显示,高血压病史(OR=2.546,95%CI:1.376～4.712,P=0.003)、年龄(以18～45岁为参照组,46～64岁组OR=2.610,95%CI:1.056～6.452,P=0.038;≥65岁组OR=2.929,95%CI:1.159～7.401,P=0.023)与患者颈内动脉颅外段血管折曲有明显相关性. 结论 高血压病史和年龄是缺血性脑血管病患者颈内动脉颅外段血管折曲的重要影响因素.

Abstract：

Objective To investigate the influencing factors of kinking of extracranial internal carotid artery (EICA) in patients with transient ischemic attack. Methods Three hundred and thirty-four patients with ischemic cerebrovascular disease performed digital subtraction angiography (DSA) were chosen; they were divided into 2 groups according to vascular morphology through DSA detection: kinking group (angulation smaller than 90°, n=110) and non-kinking group (angulation larger than 90°, n=224). According to the age, the patients were divided into youth group (18-45 years old),middle age group (46-64 years old) and elderly group (older than 65 years old). The influencing factors which may be related to the kinking of EICA, including gender, age, height and stenosis degree, and the risk factors for cerebrovascular diseases were statistically analyzed. Results Univariate analysis found that the kinking group and non-kinking group on the ratio of age, gender, height, and histories of hypertension, smoking and drinking were significantly different (P＜0.05). Multiple logistic regression analysis showed that the kinking of EICA was obviously correlated to the history of hypertension (OR=2.546, 95% CI: 1.376-4.712, P=0.003) and age (taking youth group as reference group, middle age group:OR=2.610, 95% CI: 1.056-6.452, P=0.038, elderly group: OR=2.929, 95% CI: 1.159-7.401, P=0.023).Conclusion The history of hypertension and age are identified as independent predictors for kinking of EICA in patients with ischemic cerebrovascular diseases.     

颈内动脉系统TIA型脑梗死与高同型半胱氨酸血症关系的临床研究

目的 探讨血同型半胱氨酸水平与颈内动脉系统短暂性脑缺血发作(transient ischemic attack,TIA)及颈内动脉系统短暂性脑缺血发作(TIA型)脑梗死的关系.方法 对颈内动脉系统TIA及颈内动脉系统TIA型脑梗死的患者血同型半胱氨酸水平进行分析.结果 颈内动脉系统TIA型脑梗死患者血同型半胱氨酸水平高于颈内动脉系统TIA患者,且两组患者的血同型半胱氨酸水平水平均高于对照组.结论 高同型半胱氨酸血症与颈内动脉系统短暂性脑缺血发作相关,且其升高水平与是否进展为脑梗死有关.     

Relationship between microemboli in the internal carotid artery and the occurrence of ischemic stroke after transient ischemic attack

Microembolic signals (MES) have been reported to be an independent risk factor for stroke and transient ischemic attack (TIA). We examined the relationship between MES in the internal carotid artery and the occurrence of ischemic stroke in patients with TIA. A total of 67 patients who had a TIA were examined with transcranial Doppler ultrasonography to detect microemboli in the internal carotid artery 1, 3, and 7 days after admission, and 3 months after discharge. The relationship between the presence of MES and the subsequent occurrence of ischemic stroke was the primary outcome of interest. 35.8% (24/67) of patients were MES(+). During follow-up, ischemic stroke occurred significantly more frequently in patients who were MES(+) compared with patients who were MES(?) (6/24; 25.0% versus 2/43; 4.7%, p = 0.021), as did TIA (11/24; 45.8% versus 4/43; 9.3%). MES(+) status was significantly associated with the occurrence of ischemic stroke after adjusting for age, sex, hypertension, diabetes mellitus, and drug therapy (odds ratio: 8.30; 95% confidence interval: 1.37–50.42; p = 0.021). The positive and negative predictive values of MES status for predicting ischemic stroke were 25.0% and 95.4%, respectively. The presence of microemboli in the internal carotid artery appears to be an important risk factor for the occurrence of ischemic stroke after TIA. The MES(+) rate in patients with transient ischemic attack with severe internal carotid artery stenosis is markedly higher than in patients without internal carotid artery stenosis.     

颈内动脉系统TIA型脑梗死的临床特点分析

目的对颈内动脉系统短暂性脑缺血发作(TIA型)脑梗死的临床特点进行分析。方法对44例颈内动脉系统TIA型脑梗死患者危险因素、临床表现、影像学资料等进行分析。结果颈内动脉系统TIA型脑梗死高血压病史24例(54.5%),糖尿病病史12例(27.3%),基底节区梗死33例(75%)。结论颈内动脉系统TIA型脑梗死预后相对良好提示缺血耐受的存在。     

短暂性脑缺血发作与颅内外血管狭窄的关系

目的探讨短暂性脑缺血发作(TIA)与颅内外血管狭窄的关系。方法给68例TIA患者进行颈部B超、经颅多普勒(TCD)以及心脏超声检查,对其中56例有明显脑血管狭窄的患者进一步行数字减影血管造影(DSA)检查。结果56例行DSA检查的患者中,显示大脑中动脉狭窄(或闭塞)6例,颈内动脉狭窄(或闭塞)21例,锁骨下动脉狭窄8例,椎基底动脉狭窄(或闭塞)28例。大动脉狭窄性TIA44例,其中颈内动脉系统16例,椎基底动脉系统28例;栓塞性TIA18例,其中颈内动脉系统15例,椎基底动脉系统3例;腔隙性TIA4例;血管痉挛性TIA2例。结论TIA患者大多存在颅内外血管狭窄,其与TIA有密切关系。     

临床颈动脉系统TIA患者的脑血管造影分析

目的:以数字减影脑血管造影为手段,分析颈动脉系统TIA患者脑供血动脉狭窄或闭塞的分布、程度以及侧枝循环建立情况。方法:颈动脉系统TIA患者70例均行脑血管造影检查,包括主动脉弓上造影及至少双侧颈总及锁骨下动脉四根血管造影。明确有无脑供血动脉的狭窄、狭窄的位置、程度及侧枝循环情况。结果:62例患者存在脑供血动脉狭窄或闭塞,共检出病变132处,轻度狭窄40处(30.3%),中度狭窄34处(25.8%),重度39处(29.5%),闭塞19处(14.4%)。可判断责任血管者58例(85.0%):单纯前循环45例,前后循环联合病变有13例。以颈内动脉狭窄80处为对象,研究颈内动脉狭窄或闭塞的侧枝循环情况。汇总邻近可能引起同一侧枝循环通路的病变,共分析病变58处,发现合并侧枝的病变有23处,有侧支数量36处。各种侧支循环中,Willis环出现频度最高,包括前交通代偿13处和后交通代偿5处。其次为软膜血管代偿13处。结论:颈动脉系统TIA患者,颅外血管病变多于颅内血管病变。责任血管不单纯是在前循环,还可以是前后循环联合病变。颈内动脉狭窄或闭塞最常见的侧枝循环是Wlliis环和软脑膜血管,严重的脑供血动脉狭窄更易引发侧枝循环建立。