Filling the gap between science & clinical practice: prevention of stroke recurrence

Because of its high recurrence rate, active secondary prevention is mandatory once an episode of stroke has occurred. In non-cardioembolic stroke, in addition to lifestyle changes and to targeted treatments, current guidelines recommend Aspirin, Clopidogrel or Aspirin+extended-release dipyridamole. In cardioembolic stroke (due to atrial fibrillation or flutter [AF]), Vitamin K antagonists (VKAs) are recommended in most of patients. A favorable risk/benefit ratio of these treatments has been demonstrated also in elderly patients. However, registry data emphasize that such interventions are often under-used, especially in AF patients. A poor knowledge of current guidelines may play a role in hampering their application in clinical practice. The risk of major bleeding associated with antithrombotic drugs, their inherent limitations, such as socio-demographic (age > 80 years, living alone) and clinical (previous or recent bleeding, trauma, cancer, dementia) features, may account for the gap between current guidelines for stroke/TIA prevention and clinical practice.The objective of the present report is to evaluate the gap between current recommendations/guidelines for stroke/TIA prevention and clinical practice (registry findings). In our opinion new antithrombotic drugs and detailed educational programs (especially devoted to general practitioners and to some medical specialists), concerning efficacy, safety and limitations of these strategies, are needed to better manage stroke epidemics in the third millennium.     

Information needs after stroke: What to include and how to structure it on a website. A qualitative study using focus groups and card sorting

Background: Use of the Internet to obtain health and other information is increasing. Previous studies have identified the specific information needs of people with stroke but not in relation to the Internet. People with aphasia (PwA) may face barriers in accessing the Internet: Navigating websites requires an ability to categorise information and this ability is often impaired in PwA. The website categorisation preferences of people with stroke and with aphasia have not yet been reported.

Aims: This study aimed: (a) to determine what information people who have had a stroke would like to see on a website about living with stroke; (b) to determine the most effective means of structuring information on the website so that it is accessible to people with stroke; and c) to identify any differences between people with and without aphasia in terms of preferences for structuring information on the website.

Methods & Procedures: Participants were recruited from a hospital's Stroke Database. Focus groups were used to elicit what information participants wanted on a website about living with stroke. The themes raised were depicted on 133 cards. To determine the most effective way of structuring information on the website, and whether there were any differences in preferences between PwA and PwoA, participants used a modified closed card-sorting technique to sort the cards under website categories.

Outcomes & Results: A total of 48 people were invited, and 12 (25%) agreed to take part. We ran three focus groups: one with PwA (n?=?5) and two with people without aphasia (PwoA) (n?=?3, n?=?4). Participants wanted more information about stroke causes and effects (particularly emotional issues), roles of local agencies, and returning to previous activities (driving, going out). All participants completed the card-sorting exercise. Few cards (6%) were categorised identically by everyone. Cards relating to local agencies and groups were not consistently categorised together. Cards relating to emotions were segregated. The categorisation preferences for PwA were more fragmented than those for PwoA: 60% of PwA agreed on the categorisation of 51% of the cards, whereas 60% of PwoA agreed on the categorisation of 76% of the cards.

Conclusions: Information needs covered all stages of the stroke journey. The card sorting was accessible to everyone, and provided evidence of structuring preferences and of some of the categorisation difficulties faced by PwA. More research is needed on what an accessible website looks like for PwA.     

中国脑卒中防控管理模式探索

随着我国老龄化进程的加快,慢性病成为严重威胁国民健康的重要因素,特别是脑卒中,近年来已居国民疾病死亡原因之首位,然而我国脑卒中防控管理体系仍存在明显不足,尚未建立覆盖全国且行之有效的脑卒中防控管理模式,整体水平较低。欧美等发达国家的脑卒中防控管理措施已取得良好成果,国家卫生部(现为国家卫生和计划生育委员会)已启动脑卒中筛查与防治工程,吸取各国经验,探索适合中国国情的脑卒中防控管理新模式。     

Assessing the psychosocial and academic needs of Latino youth to inform the development of school-based programs

A survey was made of the leaders in the Latino community from four East coast cities on the mental health, academic, and behavioral needs of Latino youth, services available to them, and recommendations to better address their needs. Of the 112 Latino leaders recruited, 46 responded to the survey, expressing their views that Latino youth experience significant stress in the United States, present behavioral and academic adjustment problems, and generally have difficulty accessing appropriate services and resources. Programs for these youth were presented as limited in number and lacking in cultural sensitivity. Community leaders endorsed the development of comprehensive and culturally sensitive programs for Latino youth in schools that address their psychosocial and academic needs.     

Plasticity of the human motor cortex and recovery from stroke

By a variety of mechanisms, the human brain is constantly undergoing plastic changes. Plasticity can be studied with phenomena such as peripheral deafferentation and motor learning. Spontaneous recovery from stroke in the chronic stage likely comes about because of plasticity, and the best recovery seems to result from reorganization in the damaged hemisphere. Knowledge about the physiology of brain plasticity has led to the development of new techniques for rehabilitation.     

The measure of stroke environment (MOSE): development and validation of the MOSE in post-stroke populations with and without aphasia

Objectives. The purpose of this paper is to present the development and psychometric properties of a new environmental measure that identifies barriers and facilitators in receptivity, physical environment and communication for post-stroke populations, including survivors with aphasia.

Methods. The Measure of Stroke Environment (MOSE) was developed using information from semi-structured interviews and three pilot studies. Reliability and validity were assessed in 43 post-stroke participants.

Results. The MOSE contains 47 items across 33 questions in three domains (receptivity, physical environment, communication). Internal consistency reliability was high (.83 to .85) across each domain and over the entire assessment (.91). Convergent validity showed moderate correlation with the Stroke Impact Scale (.33 to .37), the National Institute of Health Stroke Scale (-.31 to -.46) and the Boston Diagnostic Aphasia Examination (.55 to .61). Persons with aphasia had significantly lower scores on the communication domain. Stroke survivors with (26% overall difficulty) and without aphasia (31% overall difficulty) continue to experience difficulty ≥ 2 years post-stroke.

Discussion. The MOSE offers a brief, reliable and valid assessment of environmental barriers and facilitators to participation for post-stroke survivors reintegrating into their communities. Stroke survivors with very mild deficits continue to experience barriers from the environment many years post-stroke. These barriers are not typically identified during the rehabilitation process but persist post-reintegration.

Conclusion. The MOSE is able to determine how frequently a stroke survivor faces challenges in their environment and how that impacts his or her participation.     

Optimal INR for prevention of stroke and death in atrial fibrillation: a critical appraisal

INTRODUCTION: Patients with nonvalvular atrial fibrillation are at increased risk for systemic embolism, predominantly disabling stroke. To study how stroke and mortality rates vary with different degrees of anticoagulation reflected by the international normalised ratio (INR) we critically assess information from different sources. MATERIALS AND METHODS: 1. Computerized search of the medical literature published between 1980 and July 2004 was performed using MEDLINE applied to various combinations of the search terms of atrial fibrillation, warfarin, anticoagulation, anticoagulation intensity, and INR, not restricted by language. 2. We performed a record linkage analysis with death hazard estimated as a continuous function of INR based on 21,967 patients. Similarly the risk of admission to hospital or death due to diseases of the vessels of the brain was estimated. 3. Re-analysis of data earlier published by Hylek et al. from year 2003.RESULTS AND CONCLUSIONS: 1. One randomised study showed a significantly lower risk of stroke for mean INR 2.4 compared to mean INR 1.3 combined with aspirin. Remaining studies found INRs of 2-2.5 to be as efficacious as higher anticoagulation intensities.2. Mortality as well as risk of admission to hospital or death due to diseases of the vessels of the brain followed U-shaped curves with minimum at INR 2.2 and 2.4, respectively. At high INR the risk increased 2.3 times per 1 unit increase of INR for death and 1.7 times for events in the vessels of the brain.3. The re-analysing of data of Hylek et al. indicated that there might be a substantial increase of the risk of intracranial hemorrhage when INR is increased from 2.5 to 4.We conclude that INRs in the interval 2.0--2.5 give the lowest risk of stroke and death in patients with nonvalvular atrial fibrillation.     

Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation in Taiwan

Background

Economic evaluation of dabigatran, a new anti-antithrombotic agent, is done mostly in Western countries. It remains to be seen whether dabigatran will be cost effective in a practice environment where warfarin is significantly underused and the costs of both warfarin and international normalized ration INR monitoring are cheap.

Methods

We performed a cost-effectiveness analysis with a Markov model to evaluate the value of dabigatran to prevent stroke and systemic embolism in patients with atrial fibrillation (AF) in Taiwan. Dabigatran was given through sequential dosing, where patients < 80 years old received 150 mg of dabigatran twice a day and the dosage was reduced to 110 mgs for patients ≥ 80 years old. Dabigatran was compared with warfarin under two scenarios: the “real-world adjusted-dose warfarin” assuming all AF patients eligible for warfarin were given the medication and maintained at the INR observed in routine clinical practice in Taiwan, and the “real-world prescribing behaviour” similar to the treatment with antithrombotics in real-world practice in Taiwan, where eligible patients could receive warfarin, aspirin, or no treatment.

Results

The percentage of AF patients who received warfarin, aspirin or no treatment in Taiwan was 16%, 62% and 22%, respectively. The event rates of ischemic stroke per 100 patient-years were 4.5, 8.0, and 6.0 for sequential dabigatran, real-world prescribing behaviour and real-world warfarin use, respectively. The incremental cost-effectiveness ratio was $280 US per quality-adjusted-year (QALY) in the real-world prescribing scenario and $10,551 US/QALY in real-word warfarin use.

Conclusions

Dabigatran was highly cost-effective in a clinical practice setting where warfarin has been significantly underused.     

三种抗抑郁药物改善脑卒中后抑郁及神经功能恢复的疗效对比

目的 对比舒肝解忧胶囊、盐酸文拉法辛、百忧解对脑卒中后抑郁及神经功能恢复的疗效及安全性,指导临床用药.方法 将我院收治有抑郁状态的脑卒中患者120例随机分成4组,分别为对照组和3个实验组,每组各30例.同时无抑郁状态组30例.实验组分别用舒肝解郁胶囊、盐酸文拉法辛、百忧解治疗,并于治疗前后行 HAMD、BI、SSS量表评分.结果 3个实验组的HAMD评分较对照组均有改善,其中盐酸文拉法辛改善程度最大,与其他相比差异有统计学意义（P〈0.05）.同时实验组ADL、SSS评分也明显优于对照组 （P〈0.05）,而百忧解组与其他组比较差异有统计学意义（P〈0.05）.结论 舒肝解忧胶囊、盐酸文拉法辛、百忧解这三种常用抗抑郁药物对脑卒中后抑郁状态的改善及神经功能康复均有促进作用,盐酸文拉法辛在改善抑郁状态方面有更明显作用,百忧解则更能促进脑卒中后患者神经功能康复.     

A flow sensitive alternating inversion recovery (FAIR)-MRI protocol to measure hemispheric cerebral blood flow in a mouse stroke model

Blood flow imaging is an important tool in cerebrovascular research. Mice are of special interest because of the potential of genetic engineering. Magnetic resonance imaging (MRI) provides three-dimensional noninvasive quantitative methods of cerebral blood flow (CBF) imaging, but these MRI techniques have not yet been validated for mice. The authors compared CBF imaging using flow sensitive alternating inversion recovery (FAIR)-MRI and (14)C-Iodoantipyrine (IAP)-autoradiography in a mouse model of acute stroke. Twenty-nine male 129S6/SvEv mice were subjected to filamentous left middle cerebral artery occlusion (MCAo). CBF imaging was performed with (14)C-IAP autoradiography and FAIR-MRI using two different anesthesia protocols, namely intravenous infusion of etomidate or inhalation of isoflurane, which differentially affect perfusion. Using (14)C-IAP autoradiography, the average CBF in ml/(100 g*min) was 160+/-34 (isoflurane, n=5) vs. and 59+/-21 (etomidate, n=7) in the intact hemisphere and 43+/-12 (isoflurane, n=5) vs. 36+/-12 (etomidate, n=7) in the MCAo hemisphere. Using FAIR-MRI, the corresponding average CBFs were 208+/-56 (isoflurane, intact hemisphere, n=7), 84+/-9 (etomidate, intact hemisphere, n=7), 72+/-22 (isoflurane, MCAo hemisphere, n=7) and 48+/-13 (etomidate, MCAo hemisphere, n=7). Regression analysis showed a strong linear correlation between CBF measured with FAIR-MRI and (14)C-IAP autoradiography, and FAIR-MRI overestimated CBF compared to autoradiography. FAIR-MRI provides repetitive quantitative measurements of hemispheric CBF in a mouse model of stroke.     

Sensitivity to change and responsiveness of the Stroke and Aphasia Quality-of-Life Scale (SAQOL) in a Singapore stroke population

Background: The health-related quality of life (HRQoL) of people with aphasia (PWA) in Singapore is unknown.

Aims: To compare outcomes between stroke survivors with and without aphasia in Singapore and examine the sensitivity and responsiveness to change of the Stroke and Aphasia QOL Scale (SAQOL-39g) and its Singapore (Mandarin) variant, SAQOL-CSg.

Methods & Procedures: A longitudinal cohort study was conducted with stroke survivors with and without aphasia. Participants underwent a series of questionnaires at 3 and 12 months post-stroke including SAQOL-39g/SAQOL-CSg, Barthel Index, Modified Rankin Scale (MRS), Mini Mental State Examination, Frontal Assessment Battery, Center for Epidemiologic Studies Depression Scale and the EQ-5D. The following data analyses were conducted: comparison of stroke outcomes between participants with and without aphasia, computation of floor and ceiling effects, calculation of effect sizes (ESs) to determine sensitivity to change and estimation of minimally important differences (MIDs) for examining responsiveness.

Outcomes & Results: A total of 78 participants (29.5% female, 29.5% PWA, mean age 64.1 years) completed all the assessments on both occasions. At 12 months post-stroke, PWA had higher levels of disability on the MRS (Mann–Whitney U = 294.5, p < 0.01) and reported significantly lower quality of life on the SAQOL-39g/SAQOL-CSg (U = 349, p < 0.01) and the EQ-5D index (U = 447, p < 0.05). In terms of sensitivity to change, the SAQOL-39g/SAQOL- 35CSg showed a small degree of improvement for the entire sample (ES, r = 0.22) but change was only significant for participants without aphasia. MID estimates for improvement were 0.21 on the SAQOL-39g/SAQOL-CSg and 0.17 on the EQ-5D index.

Conclusions: PWA reported poorer HRQoL even when physical function was comparable. SAQOL-39g/SAQOL-CSg was found to have adequate sensitivity to change (i.e., reflect at least small change) up to 12 months post-stroke. MID estimates of the SAQOL-39g/SAQOL-CSg may assist in the interpretation of changes in scores in the clinical setting.     

A double blind placebo RCT to investigate the effects of serotonergic modulation on brain excitability and motor recovery in stroke patients

Motor excitability is increased in both hemispheres in stroke patients during motor recovery. Pharmacologically controlled changes of cortical excitability might be beneficial for synaptic plasticity and therefore facilitate functional recovery after a brain lesion. In particular, it has been suggested that antidepressant drugs can modulate motor excitability. Several recent reports suggest the possibility of monitoring pharmacological effects on brain excitability through transcranial magnetic stimulation (TMS). The aim of this study was to investigate motor area excitability in patients with stroke after oral administration of citalopram. We conducted a prospective randomised placebo controlled study. Twenty patients with unilateral stroke were included in the study: ten patients treated by antidepressive drug and ten patients with placebo. A selective serotonergic drug (citalopram) or a placebo was administered using a mean dosage of 10 mg/day in combination with physiotherapy. Motor cortex excitability was studied by single and paired transcranial magnetic stimulation. TMS recording was tested before (T1) and 1 month after (T2) beginning drug treatment. Patients treated by the serotonergic drug, compared to patients that received a placebo, showed a significant improvement in neurological status as measured by NIHSS and a decrease of motor excitability over the unaffected hemisphere, while no differences were observed over the affected hemisphere. Our findings suggest that treatment with serotonergic drugs can bring about a significant decrease of the motor cortex excitability in stroke patients with effects on both the affected and unaffected hemispheres associated with a better motor recovery. M. Acler and P. Manganotti equally participated to the work.     

Fatigue after stroke: the development and evaluation of a case definition

OBJECTIVE: While fatigue after stroke is a common problem, it has no generally accepted definition. Our aim was to develop a case definition for post-stroke fatigue and to test its psychometric properties. METHODS: A case definition with face validity and an associated structured interview was constructed. After initial piloting, the feasibility, reliability (test-retest and inter-rater) and concurrent validity (in relation to four fatigue severity scales) were determined in 55 patients with stroke. RESULTS: All participating patients provided satisfactory answers to all the case definition probe questions demonstrating its feasibility For test-retest reliability, kappa was 0.78 (95% CI, 0.57-0.94, P<.01) and for inter-rater reliability kappa was 0.80 (95% CI, 0.62-0.99, P<.01). Patients fulfilling the case definition also had substantially higher fatigue scores on four fatigue severity scales (P<.001) indicating concurrent validity. CONCLUSION: The proposed case definition is feasible to administer and reliable in practice, and there is evidence of concurrent validity. It requires further evaluation in different settings.     

同型半胱氨酸对高血压患者脑卒中复发风险的影响

目的探讨高血压合并脑卒中患者的血浆同型半胱氨酸（Hcy）水平与其他危险因素对于脑卒中复发的影响。 方法分析徐州市中心医院心内科和徐州医科大学附属医院神经外科自2012年5月至2013年12月收治的1623例高血压脑卒中患者的基线资料，中位随访4.9年，根据随访事件中是否发生脑卒中分为复发组（312例）与未复发组（1311例）。Kaplan-Meier生存分析比较不同危险因素脑卒中复发率的差异，单因素与多因素Cox回归模型分析影响脑卒中复发的独立危险因素，以及危险因素之间的交互作用。 结果复发组年龄、空腹血糖、Lg Hcy的水平，以及糖尿病、房颤的患病率均高于未复发组（P<0.05）。Kaplan-Meier生存分析显示，糖尿病、房颤、年龄≥60岁、空腹血糖≥7.0 mmol/L、Hcy≥15 μmol/L的脑卒中复发率明显升高（Log-rank检验，P<0.05）。多因素Cox回归模型分析显示，高龄、Lg Hcy水平升高，以及房颤、糖尿病是脑卒中复发的独立危险因素。Lg Hcy分别与糖尿病、空腹血糖、年龄存在交互作用。 结论血浆Hcy水平升高既是高血压合并脑卒中患者卒中复发的独立危险因素，又通过与糖尿病、高龄、空腹血糖水平升高的交互作用显著增加脑卒中复发风险。     

126例脑卒中患者老年抑郁量表筛查及治疗的临床分析

目的 研究脑卒中患者抑郁的发生率以百优解以其的治疗效果。方法 对126例脑卒中患者用老年抑郁量表（GDS）和欧洲卒中评分量表（ESS）进行证实,GDS两次评定5分以上可诊断为卒中合并抑郁。百忧解治疗4周后,再行GDS和ESS评定。结果 126例卒中患者中51例（40．5％）并发抑郁,百忧解治疗4周后51例中39例评分恢复正常（＜5分）,8例明显好转（评分较治疗前减少4以上）。有效率92．2％（47／51）。结论 百忧解治疗卒中后抑郁是有效的。     

Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke*

Background: The Mini-BESTest is a recently developed balance assessment tool that incorporates challenging dynamic balance tasks. Few studies have compared the psychometric properties of the Mini-BESTest to the commonly used Berg Balance Scale (BBS). However, the utility of these scales in relationship to post stroke walking speeds has not been explored.

Objectives: The purpose of this study was to compare the sensitivity and specificity of the Mini-BESTest and BBS to evaluate walking speeds in individuals with stroke.

Design: A retrospective exploratory design.

Methods: Forty-one individuals with chronic stroke were evaluated with the Mini-BESTest, BBS, and 10-meter self-selected walk test (10MWT). Based on their self-selected gait speeds (below or above 0.8 m/s), participants were classified as slow and fast walkers.

Results: Significant linear correlations were observed between the Mini-BESTest vs. BBS (r = 0.72, p ≤ 0.001), Mini-BESTest vs. 10MWT (r = 0.58, p ≤ 0.001), and BBS vs. 10MWT (r = 0.30, p = 0.05). Independent t-tests comparing the balance scores for the slow and fast walkers revealed significant group differences for the Mini-BESTest (p = 0.003), but not for the BBS (p = 0.09). The Mini-BESTest demonstrated higher sensitivity (93%) and specificity (64%) compared to the BBS (sensitivity 81%, specificity 56%) for discriminating participants into slow and fast walkers.

Conclusions: The Mini-BESTest has a greater discriminative ability than the BBS to categorize individuals with stroke into slow and fast walkers.     

Trends in mortality from different subtypes of stroke in the population of Belgrade (Serbia)

OBJECTIVE: To estimate trends in mortality due to different stroke subtypes in the population of Belgrade during the period 1989-2003. PATIENTS AND METHODS: Mortality data for stroke were compiled from material of the Municipal Institute of Statistics. Stroke mortality rates were standardized by world standard population. Linear regression coefficient in time trend analysis of mortality rates was assessed by Fisher's test. RESULTS: In Belgrade, 1989-2003, the highest values of mortality rates were for ischemic stroke in both sexes: 50.1/100,000-men, and 39.9/100,000-women. The mortality rate from subarachnoid hemorrhage (SAH) was lower in men (3.9/100,000) compared to women (5.3/100,000). For intracerebral hemorrhage (ICH), the death rate was 3.1 times higher than that for SAH. Stroke due to hemorrhage was a more common cause of death than ischemic stroke for both sexes in all age groups up to 59. In older age, ischemic stroke became the more frequent cause of death. The time trends of stroke mortality rates in the Belgrade population during the period 1989-2003 showed that the most excessive statistically significant increase in death rates was related to ICH in both sexes. The death rates from SAH had increasing tendency in both sexes, especially in women (p=0.017). Upward trends were observed for ischemic stroke mortality rates too, with statistical significance in men (p=0.048). CONCLUSION: Further research is needed to explain the causes of the increasing burden of stroke in Serbia. Since different profiles of risk factors play a role in the etiology of different stroke subtypes, these facts should be taken into account in the creation of both prevention and management strategies.     

静脉溶栓桥接动脉取栓成功治疗左房黏液瘤所致急性脑梗死一例

心房黏液瘤作为心脏最常见的良性肿瘤,常由肿瘤或肿瘤表面血栓引起栓塞,黏液瘤所致脑梗死的治疗目前仍是一个临床和技术挑战。惠州市第三人民医院收治了1例61岁左侧大脑中动脉栓塞的男性患者,NIHSS评分16分,发病1 h后接受静脉溶栓并桥接动脉取栓,取出栓子病理提示黏液瘤,术后没有颅内出血,进一步检查发现了左心房肿瘤,3周后手术切除心脏肿瘤,病理报告为心房黏液瘤。在术后1个月的随访中,患者NIHSS评分为1分,改良Rankin量表评分为0分,术后未再出现栓塞发作。推测对心房黏液瘤所致脑梗死进行静脉溶栓并桥接动脉取栓是安全有效的,而尽早的心房黏液瘤切除能有效避免脑梗死复发。     

前置式与后置式踝足矫形器对脑卒中患者步行功能恢复的影响

目的观察前置式与后置式踝足矫形器对脑卒中患者步行功能恢复的影响。方法将52例脑卒中患者随机分为前置组26例和后置组26例。前置组佩戴前置式踝足矫形器,后置组佩戴后置式踝足矫形器。观察指标为恢复至扶拐步行时间,恢复至独立步行时间,3个月时10m最大步行速度和Barthel指数。结果前置组恢复至扶拐步行时间（13．8±8．3）d较后置组（15．3±7．9）d快（P〈0．05）。前置组恢复至独立步行时间（27．4±14．9）d较后置组（35．9±18．0）d快（P〈0．05）。前置组10m最大步行速度（41．5士12．8）m／min较后置组（35．7±13．3）m／min快（P〈0．05）;前置组与后置组3个月时Barthel指数无显著差异（P〉0．05）。结论前置式踝足矫形器与后置式踝足矫形器相比,可加快脑卒中患者步行功能的恢复。     

前循环急性多发与单发脑梗死病因分析

目的分析前循环急性多发与单发脑梗死病因差异。方法纳入前循环急性脑梗死129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 69例多发脑梗死中大动脉粥样硬化性卒中44例,心源性栓塞13例,小动脉闭塞性卒中3例,其他原因所致的脑缺血性卒中4例,不明原因的脑缺血性卒中5例;60例单发脑梗死中大动脉粥样硬化性卒中16例,心源性栓塞5例,小动脉闭塞性卒中34例,其他原因所致的脑缺血性卒中2例,不明原因的脑缺血性卒中3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）。结论前循环急性多发脑梗死的主要病因是大动脉粥样硬化性卒中,急性单发脑梗死的主要病因是小动脉闭塞性卒中。