自发性脑出血急性期弥散加权像异常影响因素分析

【摘要】
目的 研究自发性脑出血急性期磁共振成像（magnetic resonance imaging,MRI）弥散加权像（diffusion-weighted imaging,DWI）异常的发生率、影响因素及其与脑出血90 d预后的相关性。
方法 2010年12月～2012年5月,连续入组北京天坛医院急诊就诊的发病24 h之内的自发性脑出血患者,于发病72 h内进行MRI检查,收集患者临床、影像学、实验室检查信息。应用多元Logistic回归分析的方法分析与DWI异常可能的相关因素,并分析DWI异常与90 d预后的相关性。
结果 共有93例自发性脑出血病例纳入本研究,其中11例出现DWI异常,弥散异常发生率为11.8%。DWI异常主要位于皮层、皮层下,多数无临床症状（90.9%）。Logistic回归分析显示与DWI异常相关的因素包括：微出血病灶数目［优势比（odds ratio,OR）1.08;95%可信区间（confidence interval,CI）1.00～1.17;P=0.04］,脑叶出血（OR 5.84;95%CI 1.27～26.96;P=0.02）及发病72 h平均动脉压升高（OR 0.94;95%CI 0.88～0.99;P=0.04）。脑出血后急性期DWI弥散异常的发生和患者短期（90 d）预后相关性无显著统计学意义（P=0.74）。
结论 脑出血后急性期微出血病灶数目、脑叶出血,发病72 h平均动脉压升高与脑出血后急性DWI异常的发生相关,急性期弥散异常的发生和脑出血患者90 d临床预后无显著相关性。     

脑微出血与老年高血压性脑出血血肿扩大的相关性研究

目的探讨脑微出血对老年高血压性脑出血血肿扩大的预测作用。方法采用磁敏感加权成像对98例老年高血压性脑出血患者进行脑微出血灶观察,据发病后24 h头部CT血肿扩大和实验室指标变化,采用多因素Logistic回归分析评价脑微出血对脑出血后血肿扩大的预测价值。结果 98例患者中25例于发病后24 h复查CT显示血肿扩大,发生率约为25.51%,脑微出血组为43.75%(14/32),高于非脑微出血组的16.67%(11/66;χ2=8.319,P=0.004)。多因素Logistic回归分析显示,脑微出血为老年高血压性脑出血血肿扩大的独立影响因素(OR=0.241,95%CI:0.065~0.861;P=0.017)。结论老年高血压性脑出血急性期(24 h)合并脑微出血患者血肿扩大风险明显增加,应及时采取相关预防措施以改善预后。     

双侧小脑梗死模式的探讨

目的探寻双侧小脑梗死的模式和机制。方法经MRI弥散成像(DWI)证实急性期小脑梗死的患者,根据梗死灶的分布将患者分为单侧小脑梗死组(UCI)和双侧小脑梗死组(BCI),并对两组的人口学特征、血管分布、小脑以外梗死灶以及病因进行了比较。结果因急性卒中入院的115例后循环脑梗死患者中,56例为小脑梗死或小脑合并其它部位梗死,其中单侧小脑梗死36例(64.3%),双侧小脑梗死20例(35.7%)。基线资料比较显示,脑卒中史(P=0.002)、纤维蛋白元水平(P=0.036)和入院时NIHSS评分(P=0.001)在双侧小脑梗死组明显高于单侧小脑梗死组。按血管分布区划分,小脑后下动脉(PICA)供血区小脑梗死发生率最高,且更多发生单侧小脑梗死(P=0.006);而双侧小脑梗死更常见于PICA+小脑上动脉(SCA)供血区(P=0.004)。双侧小脑梗死组合并小脑以外梗死灶的发生率明显高于单侧小脑梗死组(P=0.002),特别是合并幕下梗死灶常见(P=0.022)。在卒中机制上,双侧小脑梗死以大动脉粥样硬化性病变更多见(P=0.041),责任动脉病变主要是在椎动脉V4段、V4段与BA接合处的重度狭窄或闭塞。结论双侧小脑梗死并不少见,常见于PICA+SCA供血区;大动脉粥样硬化所致动脉源性栓塞是其卒中重要机制之一。     

短暂性脑缺血发作后发生脑梗死风险的预测研究

目的 探讨ABCD2评分和ABCD2评分结合MRI弥散加权成像(DWI)和颅内动脉MR血管成像(MRA)对短暂性脑缺血发作(TIA)后脑梗死的预测价值.方法 分别采用ABCD2评分及ABCD2+ DWI+MRA评分对182例TIA患者进行评定,观察TIA后2d、7d和30 d内的脑梗死发生率.采用ROC曲线评估ABCD2及ABCD2+ DWI+ MRA评分对TIA后脑梗死风险的预测准确度.结果 本组56例(30.8％)患者于30 d内发生脑梗死,其中42例(23.1％)发生于7d内,19例(10.4％)发生于2d内,均无脑出血发生.与低危组比较,中危组与高危组各时间点脑梗死发生率显著升高(均P＜0.05).DWI异常患者各时间点脑梗死发生率明显高于正常者(均P＜0.05).30 d时颅内动脉狭窄≥50％的患者脑梗死发生率明显高于颈内动脉狭窄＜50％的患者(P＜0.05).伴DWI异常及颅内动脉狭窄≥50％的低危组患者各时间点脑梗死发生率显著高于DWI正常和颅内动脉狭窄＜50％的患者(均P＜0.05).ABCD2+ DWI+ MRA评分预测TIA第2d、第7d及第30 d的脑梗死率的曲线下面积显著高于ABCD2评分(均P＜0.001).结论 ABCD2评分结合DWI和MRA能进一步提高预测TIA后发生脑梗死的准确性.     

脑微出血在不同脑血管病患者中的患病率及相关危险因素分析

目的研究不同脑血管病患者中脑微出血的患病率及相关危险因素,并探讨其临床意义。方法对连续入组的385例神经内科住院患者中常规行核磁共振T2梯度回波加权扫描,并登记所有患者的基线资料,分析不同类型脑血管病患者脑微出血的患病率,采用Logistic回归分析探索脑微出血的相关危险因素。结果脑出血、脑梗死、短暂性脑缺血发作及脑白质病患者中脑微出血的患病率分别为68.75%、49.52%、12.5%及63.13%;多变量Logistic回归分析显示脑微出血的相关危险因素为男性(OR=0.45,P=0.01)、高血压病(OR=2.92,P=0.01)、脑白质病(OR=9.57,P=0.00)、脑梗死(OR=2.91,P=0.00)及脑出血(OR=13.09,P=0.00)。结论脑出血、脑梗死及脑白质病患者中脑微出血患病率较高,脑微出血的相关危险因素为男性、高血压病、脑梗死、脑白质病及脑出血。     

缺血性脑卒中/短暂性脑缺血发作患者脑动脉病变分布相关危险因素分析

目的 探讨缺血性脑卒中(ischemic stroke,IS)/短暂性脑缺血发作(transient ischemic attack,TIA)脑动脉病变分布的相关危险因素.方法 对169例IS/TIA患者行颈部及颅内脑血管检查,记录血管病变危险因素如年龄、性别、高血压、糖尿病、长期吸烟、长期饮酒等病史,同时记录实验室、心电图、超声心动图、腹部B超、胸X片等检查结果.确定单变量与不同狭窄模式的相关性采用单变量Logistic回归分析,确定不同颅内外大动脉狭窄模式的独立危险因素采用多元逐步和多变量多项分类Logistic回归分析.结果 高龄、长期吸烟及高低密度脂蛋白(LDL-C)是颅内外大动脉狭窄的独立危险因素,发生颅内外大动脉狭窄的风险分别增加了1.83、6.918、1.656倍;脑卒中史(OR=4.816)、长期吸烟(OR=121.608)、高LDL-C(OR=3.067)是单纯颅内大动脉狭窄的独立危险因素;高龄(OR =2.486)、长期吸烟(OR=25.072)、高LDL-C(OR=5.160)是颅内外大动脉狭窄并存的独立危险因素;而高纤维蛋白原(OR =4.790)是单纯颅外大动脉狭窄的独立危险因素.结论 不同类型颅内外大动脉狭窄病变的独立危险因素不同.     

青年缺血性脑卒中患者甲状腺自身免疫性抗体的检验

目的探讨青年缺血性脑卒中患者甲状腺自身免疫性抗体检测的临床意义,为临床进一步认识甲状腺自身免疫性抗体与颅内大动脉狭窄(ILAS)之间的关系提供参考。方法回顾性分析2012-04-2014-04来我院诊治的青年缺血性脑卒中甲状腺功能正常的350例患者资料,根据临床确认颅内大动脉狭窄(ILAS)症状120例,无颅内大动脉狭窄(Non-ILAS)的症状230例。比较2组甲状腺功能及甲状腺自身免疫性抗体,分析青年缺血性脑卒中患者出现颅内大动脉狭窄的独立性因素。结果 ILAS组患者的年龄明显高于对照组,房颤的发生率显著低于对照组,各项指标差异有统计学意义(P0.05),其他临床资料无差异;2组TSH、TT3、TT4及fT3、fT4均在正常范围内,差异无统计学意义(P0.05),而实验组TPOAb阳性率与TGAb阳性率明显高于对照组,差异有统计学意义(P0.05);采用Logistic逐步回归分析得知,TPOAb阳性率(OR=3.651)、TGAb阳性率(OR=3.371)、年龄(OR=2.803)及房颤(OR=2.946)等因素是青年缺血性脑卒中患者出现颅内大动脉狭窄的独立性因素。结论甲状腺自身免疫性抗体与青年缺血性脑卒中患者存在颅内大动脉狭窄的独立因素,提示免疫机制可能在颅内大动脉狭窄中起作用。     

脑静脉窦血栓形成早发性痫性发作影响因素研究

目的探讨脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)患者早发性痫性发作的相关因素。方法选取CVST患者为研究对象,按照发病2周内有无痫性发作分为早发性痫性发作组和对照组进行回顾性分析,收集患者急性期临床表现、影像学、脑电图等临床资料,对可能影响CVST早发性痫性发作的因素进行单因素和多因素分析。结果研究纳入CVST患者64例,其中早发性痫性发作组19例(29.7%),对照组45例(70.3%)。单因素分析显示早发性痫性发作组妊娠期或产褥期(52.6%vs 20.5%,P=0.01)、意识障碍(31.6%vs8.89%,P=0.02)、多脑叶病变(52.6%vs 24.4%,P=0.03)、静脉性脑梗死合并出血(52.6%vs11.1%,P=0.01)、脑电图异常(73.7%vs 46.6%,P=0.01)率均显著高于对照组。Logistic回归分析显示多脑叶病变[比值比(odds ratio,OR)12.89,95%可信区间(confidence interval,CI)2.12~78.41)]、静脉性脑梗死合并出血(OR 12.92,95%CI 1.68~99.25)、脑电图异常(OR 2.19,95%CI 1.07~4.49)是CVST早发性痫性发作的独立危险因素。结论多脑叶病变、静脉性脑梗死合并出血、脑电图异常是CVST早发性痫性发作的独立危险因素。     

急性脑梗死患者脑动脉狭窄的分布及危险因素分析

目的探讨急性脑梗死患者脑动脉狭窄的分布特点及危险因素。方法 232例经MRI、MRA检查的脑梗死患者及健康对照者,存在狭窄患者根据狭窄部位分为单纯颅内狭窄组、单纯颅外狭窄组、颅内外狭窄组,分析脑动脉狭窄的分布特点及影响因素。结果 (1)单纯颅内动脉狭窄者114例(62.0%),单纯颅外动脉狭窄者30例(16.3%),合并颅内外动脉狭窄者40例(21.7%)。前循环狭窄(76.6%)比后循环(33.7%)常见。分别主要发生在MCA(64.4%)、PCA(53.8%)。(2)年龄、高血压、糖尿病、吸烟、纤维蛋白原(fibrinogen,Fbg)为脑动脉狭窄的独立危险因素(OR分别为1.049、10.063、3.873、3.311、6.085)。(3)高血压、糖尿病、吸烟为单纯颅内动脉狭窄的独立危险因素(OR分别为10.779、3.593、4.408),高血压、糖尿病、Fbg为单纯颅外动脉狭窄的独立危险因素(OR分别为6.143、8.179、2.410)。(4)合并颅内外动脉狭窄组CRP(C-reactive protein,C-反应蛋白)平均值显著高于单纯狭窄的两组(P=0.001、P=0.018),单纯狭窄组间比较无统计学意义。结论 (1)研究人群中脑动脉狭窄以颅内动脉狭窄为多见。(2)年龄、高血压、糖尿病、吸烟、Fbg为脑动脉狭窄的独立危险因素。(3)高血压、糖尿病为单纯颅内、颅外动脉狭窄共同的独立危险因素。吸烟为单纯颅内动脉狭窄的独立危险因素。Fbg为单纯颅外动脉狭窄的独立危险因素。(4)CRP可能为脑动脉狭窄的炎性预测因子。     

血浆同型半胱氨酸及MTHFR基因多态性与颅内动脉粥样硬化的相关性研究

目的评价血浆半胱氨酸(Hcy)及亚甲基四氢叶酸还原酶(MTHFR)C677T基因多态性与非心源性脑梗死患者颅内动脉粥样硬化性大血管病变(LVD)的关系。方法共纳入非心源性脑梗死患者552例,测定血浆同型半胱氨酸浓度、MTHFR C677T基因型、脑核磁共振及核磁共振脑血管成像造影,以评价颅内动脉狭窄-闭塞程度和数目积分(LVD积分)。结果纳入552例脑梗死患者中,MTHFR C677T基因型中CC基因型148例(26.8%),CT基因型293例(53.1%),TT基因型111例(20.1%),基因型分布符合Hardy-Weinberg遗传平衡(χ~2=2.371,P0.250);合并颅内动脉狭窄342例,无颅内动脉狭窄210例,颅内动脉狭窄组血浆Hcy浓度显著高于无颅内动脉狭窄组(t=10.502,P=0.032),组间MTHFR C677T基因型分布有显著性差异(χ~2=7.066,P=0.039),多元回归分析显示,高Hcy血症为急性脑梗死患者存在颅内动脉狭窄的独立危险因素(OR1.650,95%CI 1.123～3.021,P=0.034),MTHFR C677T的TT基因型并非为颅内动脉狭窄的独立危险因素(OR1.015,95%CI 1.010～2.532,P=0.079);MTHFR C677T不同基因型组间血浆Hcy浓度有显著性差异(F=7.283,P 0.001),LVD积分无显著性差异(F=2.993,P=0.067),血浆Hcy浓度与颅内血管LVD积分呈正相关关系(r=0.365,P=0.009),高Hcy血症与颅内动脉LVD积分相关(OR1.531,95%CI 1.172～1.463,P=0.040)。结论高同型半胱氨酸血症与颅内动脉LVD具有相关性,MTHFR C677T基因多态性与高同型半胱氨酸血症有相关性,但与颅内动脉动脉粥样硬化无相关性。     

急性脑梗死散在和单一弥散加权成像病损与其供血动脉狭窄的关系

目的 探讨急性脑梗死弥散加权磁共振成像(DWI)上大脑中动脉(MCA)供血区散在性或单一性缺血性病损与其脑供血动脉狭窄或闭塞的关系.方法 回顾性分析73例连续积累的DWI显示一侧MCA供血区脑梗死的病例,入组病例均排除心源性栓塞性脑梗死,所有患者均在发病24 h内进行MRI和MRA等检查,7例患者并进行DSA.采用DWI急性缺血性病损分类方法 分为散在病损组和单一病损组,比较两组的病灶同侧MCA、颈内动脉(ICA)颅内段和颅外段狭窄或闭塞的发生率.结果 散在病损组42例,单一病损组31例.在病损同侧ICA颅外段和MCA闭塞或重度狭窄方面两组差异有统计学意义(28.6%与0,x2=10.6,P=0.001).在病损同侧ICA颅内段并MCA轻中度狭窄方面,两组间差异具有统计学意义(31.0%与9.7%,x2=4.717,P=0.03).散在病损与MCA和(或)ICA严重或多发狭窄呈正相关(OR值为13.7,95%CI:3.6～52.5).在MRA或DSA未发现颅内外大血管狭窄方面,两组间差异具有统计学意义(11.9%与32.3%,x2=4.526,P=0.033).散在病损组与无明显血管狭窄呈负相关(OR值为0.284,95%CI:0.09～0.94).结论 (1)脑梗死急性期DWI显示的MCA区散在性病损患者,MCA和ICA狭窄、甚至闭塞的可能性较大,以ICA颅外段闭塞较为常见;(2)DWI显示单一病损时提示脑供血动脉狭窄程度较轻,范围较局限,小血管病变的可能性相对较高,很少为严重的ICA颅外段狭窄或闭塞.

Abstract：

Objective To investigate the relationship between scattered or single lesion of acute cerebral infarction in middle cerebral artery territory on diffusion-weighted imaging (DWI) and stenosis of middle cerebral artery (MCA) or internal carotid artery (ICA). Methods With exclusion of cardioembolism, 73 consecutive patients with acute cerebral infarction of the unilateral MCA territory on DWI were analyzed. All patients got magnetic resonance imaging (MRI) and angiography (MRA) within 24 hours after onset, and 7 patients also had digital subtraction angiography (DSA). The patients were classified into single lesion group or scattered lesions group according to the DWI findings. The incidence of stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 42 patients had scattered lesions and 31 patients had single lesion. The scattered-lesions group had a high incidence of ipsilateral extracranial ICA or MCA occlusion or severe stenosis ( 25.6%versus 0, x2 = 10.6, P = 0.001 ) and a high incidence of ipsilateral intracranial ICA or MCA moderate or mild stenosis (31.0% versus 9.7% ,x2 =4.717, P =0.03 ). A positive correlation was found between the scattered lesions and severe or multifocal stenosis of ipsilateral ICA and MCA ( OR: 13.7, 95% CI: 3.6 to 52.5). There was a low incidence of absence of extra- and intracranial stenosis on MRA or DSA in the scattered-lesions group ( 11.9% versus 32.3%, x2= 4.526, P = 0.033 ). A negative correlation was found between the scattered lesions and absence of large-artery stenosis ( OR: 0.284, 95% CI: 0.09 to 0.94).Conclusions ( 1 ) Patients with acute cerebral infarction and scattered lesions on DWI were more likely to suffer from stenosis or occlusion of ICA or MCA, especially over the extracranial ICA. (2) Patients with single lesion were less likely to have severe or multiple stenosis of MCA and ICA, indicating the relevance of small-vessel pathogenesis.     

Diffusion- and perfusion-weighted MRI: influence of severe carotid artery stenosis on the DWI/PWI mismatch in acute stroke

BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) have been used increasingly in recent years to evaluate acute stroke in the emergency setting. In the present study, we compared DWI and PWI findings in acute stroke patients with and without severe extracranial internal carotid artery (ICA) disease. METHODS: Twenty-seven patients with nonlacunar ischemic stroke were selected for this analysis. DWI, PWI, and conventional MRI were performed in all patients within 24 hours of symptom onset and after 1 week. To exclude patients with partial or complete reperfusion, we included only patients with a PWI deficit larger than the DWI lesion. Severe ICA disease (>70% stenosis) was present unilaterally in 9 and bilaterally in 2 patients. Acute DWI lesion volume, the size of the acute PWI/DWI mismatch, and final infarct size (on T2-weighted images) were determined. RESULTS: The PWI/DWI mismatch was significantly larger in patients with severe ICA disease than in patients without extracranial carotid stenosis, both when time-to-peak and mean transit time maps (P<0.01) were used to calculate the mismatch. Quantitative analysis of the time-to-peak delay in the mismatch indicated that a relatively smaller fraction of the total mismatch was critically ischemic in patients with carotid stenosis than in those without. Average lesion volume increased less in the stenosis group (P=0.14), despite the larger PWI/DWI mismatch, and final infarct size was smaller in the stenosis group (P<0.05). In the 2 patients with bilateral ICA disease, variable hemodynamic involvement of the contralateral hemisphere was found in addition to the ipsilateral PWI deficit. CONCLUSIONS: In most acute stroke patients with severe ICA stenosis, a considerably smaller fraction of the total PWI/DWI mismatch is at risk than in patients without carotid disease.     

Location characteristics of early perihaematomal oedema

BACKGROUND: The natural history and triggers of perihaematomal oedema (PHO) remain poorly understood. Cerebral amyloid angiopathy (a common cause of lobar haemorrhage) has localised anticoagulant and thrombolytic properties, which may influence PHO. We hypothesised that early (within 24 hours) oedema to haematoma volume ratios are smaller in patients with lobar intracerebral haemorrhage (ICH) than in patients with deep ICH. METHODS: Haematoma and PHO volumes were measured in consecutive patients admitted to an acute stroke unit with a diagnosis of spontaneous supratentorial ICH proven by computed tomography. The oedema to haematoma volume ratios were calculated and compared in patients with lobar ICH and deep ICH. RESULTS: In total, 44 patients with ICH were studied: 19 patients had deep ICH, median haematoma volume 8.4 ml (interquartile range (IQR) 4.8 to 20.8), median PHO 8.2 ml (2.8 to 16), and 25 had lobar ICHs, median haematoma volume 17.6 ml (6.6 to 33.1) and median oedema volume 10.2 ml (3.4 to 24.2). Patients with lobar ICH were older than those with deep ICH (65.7 v 57.4 years, p = 0.009) but ICH location did not differ by sex or race. There was no evidence that haematoma or oedema volumes were related to type of ICH (p = 0.23, p = 0.39 respectively). The median oedema to haematoma volume ratios were similar in patients with lobar and deep ICH (0.67 v 0.58, p = 0.71). Controlling for age, sex, and race made little difference to these comparisons. CONCLUSIONS: There are no major location specific differences in PHO volumes within 24 hours of ICH onset. Deep and lobar ICH may have common therapeutic targets to reduce early PHO.     

Multiparametric MRI and ultrasound findings in patients with internal carotid artery dissection

In this study, clinical, MRI, and ultrasound findings in 33 patients with 37 MRI-confirmed internal carotid artery dissections (ICADs) were investigated. In 24 of 37 (64.9%) diffusion-weighted MRI (DWI) revealed acute ischemic brain lesions. ICADs with subsequent DWI lesions usually had a concentric position of the mural hematoma (14 of 24; 58.3%). In contrast, ICADs without DWI lesions (13 of 37; 35.1%) demonstrated an eccentric position of the mural hematoma (10 of 13; 76.9%), sometimes without ultrasound abnormality (5 of 13; 38.5%), while nonischemic clinical signs were frequent (11 of 13; 84.6%). A hemodynamic stroke pattern with comparatively large ischemic lesions along the hemodynamic risk zones was noted in 7 of 24 patients (29.2%).     

The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by diffusion-weighted MRI

OBJECTIVES: The cause of small infarction is mainly considered to be intracranial small-vessel disease. However, it is difficult to explain the mechanism of multiple, acute infarctions by small-vessel disease. We examined the differences of clinical parameters between patients with multiple small lesions and single lesion detected by Diffusion-weighted MRI (DWI). MATERIAL AND METHODS: We reviewed the clinical records of 86 consecutive stroke patients with lacunar size ischemic lesions on DWI during the acute stage (within 72 h of onset). The subjects were 55 males and 31 females (mean age 72.4 +/- 9.9 years). Small multiple acute ischemic lesions were defined using the following criteria 1): the lesions were detectable by DWI 2), the diameter of each lesion on DWI was less than 1.5 cm, and 3) more than one vascular territory was involved. Included in the analysis were age, sex, lipoprotein (a) levels, hematocrit, atrial fibrillation (Af), stenosis of middle cerebral artery (MCA), internal carotid artery (ICA) or basilar artery stenosis detected by magnetic resonance angiography (MRA), National Institute of Health Stroke Scale (NIHSS) at admission, and a history of hypertension, diabetes mellitus, hyperlipidemia, and smoking. RESULTS: Twenty-one (24.4%) out of 86 patients with small acute infarctions had multiple acute ischemic lesions. Multiple logistic regression analysis showed that Af and stenosis of ICA or basilar artery were significantly more prevalent in patients with multiple lesions than single lesions. CONCLUSION: Multiple, small lesions visible in DWI are likely to be caused by emboli from heart or atheroma of the large vessels than single small lesion.     

IV tPA for acute ischemic stroke in the setting of intracranial tumor: A scoping review

ObjectiveA systematic review of published cases of standard-dose IV tPA for acute ischemic stroke (AIS) within 4.5 hours of symptom onset and intracranial tumor was performed.Materials and MethodsPubMed, Embase, and Cochrane were used to identify studies that included patients given standard-dose IV tPA for presumed AIS within 4.5 hours of symptom onset who had an intracranial tumor. The primary outcome measure was rate of ICH.ResultsTwenty-three studies were included, involving 495 patient cases. One case-control study presented data only in the form of an odds ratio (OR), with OR 0.72 (p=0.16) for risk of ICH in 297 benign brain tumors, and OR for ICH of 2.33 (p value <0.001) in 119 malignant brain tumors, compared to controls. The remaining 22 sources included 79 cases; 49 were classified as benign, 16 malignant, and 14 “not otherwise specified.” ICH occurred in 4; one was an asymptomatic parenchymal hematoma (5.1% total ICH, 3.8% symptomatic ICH). ICH only occurred in cases of malignant or metastatic intracranial tumors.ConclusionThere were no reports of ICH in cases of benign intracranial tumor, and the reported rate of ICH with standard-dose IV tPA in the setting of any brain tumor appears similar to the general AIS population. There is heterogeneity and risk of selection bias with the included studies, and findings are not confirmatory. Further research is indicated to assess the rate of ICH with IV tPA for AIS in the setting of brain tumor.     

Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A2 and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis

PurposeWe evaluated the relationship between plasma lipoprotein-associated phospholipase A₂ (Lp-PLA₂) concentration and plaque characteristics in patients with intracranial artery stenosis and their clinical relevance in acute ischemic stroke.MethodsEighty-seven patients with intracranial atherosclerotic stenosis (66 males, 21 females) were retrospectively enrolled. Plasma Lp-PLA₂ concentration was measured, and vessel wall magnetic resonance imaging (VW-MRI) was used to determine intracranial vascular stenosis and plaque characteristics, including plaque enhancement, surface morphology, and T₁ hyperintensity. Binary logistic regression was used to evaluate the relationship between Lp-PLA₂ concentration and plaque characteristics of intracranial artery after adjusting for demographic and confounding factors and to assess their diagnostic efficacy for the risk of acute ischemic stroke.ResultsAfter adjustment for demographic, medication and related lipid factors, Lp-PLA₂ elevation was associated with plaque enhancement (odds ratio [OR]=12.7, 95% confidence interval [CI] 2.51–64.82, P=0.002) and surface irregularity (OR=2.9, 95% CI 1.06–7.98, P=0.038). Both Lp-PLA₂ elevation (OR=8.8, 95% CI 1.64–47.72, P=0.011) and plaque enhancement (OR=34.3, 95% CI 5.88–200.4, P=0.001) were associated with acute ischemic stroke. Receiver operating characteristic curve analysis showed that the area under the curve for Lp-PLA₂ concentration and plaque enhancement combined in the diagnosis of acute ischemic stroke was 0.884, significantly higher than that for Lp-PLA₂ concentration (0.724) and plaque enhancement (0.794) alone.ConclusionElevated Lp-PLA₂ is associated with plaque enhancement and plaque surface irregularity. Combined assessment of Lp-PLA₂ concentration and plaque enhancement is of greater diagnostic value for the risk of acute ischemic stroke in patients with intracranial artery stenosis.     

伴脑出血史的缺血性卒中患者使用抗血小板药物二级预防的调查

目的 通过结局调查分析既往有脑出血史的缺血性卒中患者使用抗血小板药物(antiplatelet drugs,APD)的状况以及使用APD对再发脑出血和再发脑梗死的影响.方法 随访我院既往有过脑出血的脑梗死患者的单中心、回顾性队列研究.统计学方法采用生存曲线及Logistic回归分析APD对既往有过脑出血患者缺血性卒中二级预防结局的影响.结果 既往有过脑出血的缺血性卒中合并心房颤动和心肌梗死的患者在心内科就诊时更易接受服用APD.既往有过脑出血患者缺血性卒中二级预防中APD没有增加再发脑出血(OR=1.149,95%CI0.376～3.513,P=0.808);未良好控制的高血压和脑叶出血是再发脑出血的危险因素;APD的使用能明显降低再发脑梗死的发生(OR=0.410,95%CI0.203～0.826,P=0.013).既往有过脑出血的缺血性卒中患者服用APD再发脑出血间隔时间均值为39个月,未服APD患者为45个月(X2=1.257,P=0.262).既往有过脑出血的缺血性卒中患者服用APD再发脑梗死间隔时间均值为42个月,末服APD患者为22个月(X2=14.315,P=0.001).结论 既往有过脑出血的缺血性卒中患者,通过APD进行缺血性卒中二级预防可获益,再发肭出血未见增多.考虑到本调查中脑叶出血和高血压控制不良容易再发脑出血,使用APD时把血压控制在正常范围并排除既往有过脑叶出血的病例,也许是更为安全的选择.     

缺血性小卒中患者1年卒中复发的相关因素分析——来自中国颅内动脉粥样硬化研究的数据

目的通过分析急性期缺血性小卒中患者磁共振成像(magnetic resonance imaging,MRI)弥散加权成像(diffusion weighted imaging,DWI)的病灶模式及磁共振血管成像(magnetic resonance angiography,MRA)/增强磁共振血管成像(contrast enhanced magnetic resonance angiography,CE-MRA)反映的大血管病变情况,结合临床信息,探讨对小卒中1年卒中复发有较强预测作用的评价指标。方法以中国颅内动脉粥样硬化研究(Chinese Intra Cranial Atherosclerosis Study,CICAS)数据库中的患者资料为数据来源,纳入发病7 d内、病前改良Rankin量表(modified Rankin Scale,m RS)评分≤2分、脑部MRI-DWI发现新梗死病灶、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4分的缺血性卒中患者;收集患者的基线信息和影像信息所示不同病变模式及大血管病变情况,以单变量分析和多变量分析确定小卒中后1年卒中复发的预测因素。结果本研究最终纳入843例缺血性小卒中患者,平均年龄(61.67±11.04)岁。1年累计卒中复发率4.39%。1年预后的Cox回归分析结果显示:年龄75岁[风险比(hazard ratio,HR)3.18,95%可信区间(confidence interval,CI)1.140~7.211,P=0.006)],症状相关性动脉闭塞(HR 2.35,95%CI 1.094~5.030,P=0.029),多发非症状相关性动脉狭窄(HR 2.74,95%CI 1.311~5.730,P=0.007),多发皮层、皮层下和(或)深部白质梗死(HR 2.06,95%CI 1.006~4.229,P=0.048)是1年卒中复发的独立预测因子。结论急性缺血性小卒中患者影像学检查对于判断预后有重要意义,DWI所示多发皮层、皮层下和(或)深部白质病变、多发颅内外动脉狭窄是小卒中1年卒中复发的独立预测因子。     

Intracranial Artery Calcification: A Newly Identified Risk Factor of Ischemic Stroke

BACKGROUND AND PURPOSE: Calcification in cerebral arteries is understudied, although frequently observed on computed tomography of the brain (CT brain). We aimed to assess the incidence of intracranial artery calcification in ischemic stroke patients and to evaluate its correlation with ischemic stroke. METHODS: Our study included ischemic stroke patients and age-gender-matched nonischemic stroke patients referred for CT brain. RESULTS: One hundred and seventy-five ischemic stroke patients and 182 controls were enrolled. The highest prevalence of calcification was seen in intracranial internal carotid artery (IICA) (80.4%), and less commonly in the vertebral artery (35.6%). There was a higher prevalence of intracranial artery calcification in ischemic stroke patients than controls (92.6% vs. 76.4%, P < .001). Hypertension (OR = 2.056, 95% CI: 1.129 approximately 3.745), diabetes (OR = 2.483, 95% CI: 1.233 approximately 5.001), smoking (OR = 2.844, 95% CI: 1.542 approximately 5.243), intracranial artery calcification (OR = 3.172, 95% CI: 1.252 approximately 8.036), hyperlipidemia (OR = 6.714, 95% CI: 3.302 approximately 13.650), and atrial fibrillation (OR = 7.941, 95% CI: 2.790 approximately 22.599) were found to be independently associated with ischemic stroke. CONCLUSIONS: We demonstrated a higher incidence of intracranial artery calcification in ischemic stroke patients. Besides traditional risk factors, intracranial artery calcification was found to be an independent risk factor of ischemic stroke.