短暂性脑缺血发作患者经颅多普勒超声和CT检查结果比较

背景短暂性脑缺血发作是完全性脑卒中的危险因素.通过影像学和超声等检测手段早期发现短暂性脑缺血发作并及时干预以防止发展为完全性脑卒中.目的比较经颅多普勒超声和CT检查对短暂性脑缺血发作的早期评估价值.设计病例分析.单位一所区级医院神经内科、CT室、经颅多普勒超声室.对象赤峰市元宝山区医院2001-01/2003-04门诊和住院的短暂性脑缺血发作患者30例,男22例,女8例;年龄26～85岁,平均年龄59.6岁.干预短暂性脑缺血发作患者30例住院后均给予常规量活血通脉、肝素或低分子肝素钙治疗,所有入选患者均行头颅CT检查,并采用经颅多普勒超声诊断系统检测双侧颈内动脉、椎基底动脉的收缩期流速舒张期流速、平均血流速度及脉动指数等有关动力学的情况.通过随访1个月和1年观察发生脑梗死情况.主要观察指标①头颅CT检查结果.②经颅多普勒超声检查结果.③30例患者随访1个月和1年发生脑梗死情况.结果在出院后1个月和1年时30例患者全部获得随访.①CT检查10例有病灶性改变,占34%(10/30).②经颅多普勒超声检查24例有血流异常改变,占80%(24/30).③30例应用肝素或低分子肝素钙治疗的短暂性脑缺血发作患者,1个月之内发生脑梗死4例,1个月～1年发生脑梗死6例.结论对于短暂性脑缺血发作患者,经颅多普勒超声检查发现血流异常情况早于CT检查,短暂性脑缺血发作后要及早给予抗凝治疗,可使短暂性脑缺血发作再发率减少,预防完全性脑卒中的发生.

Comparison of the results between transcranial Doppler ultrasonography and CT examination of patients with transient ischemic attack

BACKGROUND: Transient ischemic attack is a risk factor in the causation of complete stroke. Early detection of transient ischemic attack by the examinations of imaging and ultrasonography together with timely interventions can prevent it from developing to complete stroke.OBJECTIVE: To compare the values of early transcranial Doppler ultrasonography and CT examination in the evaluation of early transient ischemic attack.DESIGN: A case analysis.SETTING: Department of Neurology, CT Room and Transcranial Doppler Ultrasonography Room in a municipal hospital.PARTICIPANTS: Thirty in- and out-patients with transient ischemic attack (22 males and 8 females), at the age of 26 to 85 with an average of 59.6 years old in the Yuanbaoshan District Hospital of Chifeng City between January 2001 and April 2003 were involved in the study.INTERVENTIONS: After admission, all the 30 patients with transient ischemic attack were given routine lose of medication for promoting blood circulation and invigorating pulse-beat, and heparin or low molecular hepacarin calcium; Cranial CT examination was performed for all selected patients, and the transcranial Doppler ultrasonic diagnostic system was also used to detect the related dynamic parameters of systolic and diastolic flow rate, mean flow velocity and pulse index of bilateral internal carotid artery and vertebral basilar artery. The occurrence of cerebral infarction was observed through follow up for 1 month and 1 year.MAIN OUTCOME MEASURES: ① Results of cranial CT examination;② Results of transcranial Doppler ultrasonography; ③ The occurrence of cerebral infarction in the 30 patients after follow up for 1 month and 1 year.RESULTS: All the 30 patients were followed up for 1 month and I year after discharge. ① Focal changes were detected with CT examination in 10 cases (34%, 10/34); ② Abnormal changes of hemorheology were detected with transcranial Doppler ultrasonography in 24 cases (80%, 24/30). ③ Among the 30 patients treated with heparin or low molecular hepacarin calcium, cerebral infarction occurred in 4 cases within 1 month, and 6 cases between 1 month and 1 year.CONCLUSION: For patients with transient ischemic attack, the hemorheological abnormality can be detected earlier with transcranial Doppler ultrasonography than with CT examination; treatment for anti-coagulation should be given as early as possible after the transient ischemic attack to reduce the reoccurrence rate and prevent the occurrence of complete stroke.