15例卒中预警综合征的临床分析

目的探讨卒中预警综合征的临床特点、病理生理机制、治疗方案及预后。方法回顾性分析2017年5月至2019年5月收治于朝阳市中心医院神经内科的15例卒中预警综合征患者,分别采集其一般资料(年龄、性别、个人史及既往史)及临床资料(临床症状、影像检查结果、入院时ABCD2评分、发病1周时NIHSS评分、治疗方案、出院时mRS评分)。结果本组15例卒中预警综合征患者年龄45～78岁,男9例,女6例,高血压病6例、糖尿病4例、高脂血症2例、高尿酸血症1例、冠心病1例,吸烟者8例,高同型半胱氨酸血症5例,既往有卒中病史者3例。临床症状表现为构音障碍-手笨拙综合征2例,纯运动性卒中8例,纯感觉性卒中1例,感觉运动性卒中4例。15患者中进展成脑梗死12例,占80%,12例患者在不同部位存在责任病灶,内囊后肢6例,侧脑室旁、半卵圆中心病灶2例,丘脑2例,脑桥2例,3例患者DWI未见异常弥散信号。15例患者的ABCD2评分为(4.20±0.86)分(3～6分),发病1周时NIHSS评分(2.67±1.09)分(0～6分)。本组患者均在不同时间行抗血小板聚集治疗,溶栓3例,扩容3例,抗凝1例。出院时15例患者中3例mRS评分为0分,1～2分4例,3分3例,4分5例。结论卒中预警综合征在治疗方面无明确的指南,需根据患者不同的危险因素、临床症状、影像学表现等多方面结合后选择相应的治疗方案,进行个体化治疗。临床医生需早期发现,尽量减轻患者的神经功能缺损程度,提高其生活质量,改善预后。

Clinical analysis of 15 cases of stroke early warning syndrome

Objective To investigate the clinical features,pathophysiological mechanism,treatment scheme and prognosis of stroke early warning syndrome.Methods A total of 15 patients with stroke early warning syndrome admitted to the department of neurology of Chaoyang Central Hospital from May 2017 to May 2019 were analyzed retrospectively,and their general data(age,gender,personal history and past medical history) and clinical data(clinical symptoms,image examination results,ABCD2 score at admission,NIHSS score at 1 week after onset,treatment scheme and mRS score at discharge) were collected respectively.Results A total of 15 patients with stroke early warning syndrome aged 45-78 years old,including 9 males,6 females,6 cases of hypertension,4 cases of diabetes,2 cases of hyperlipidemia,1 case of hyperuricemia,1 case of coronary heart disease,8 cases of smokers,5 cases of hyperhomocysteinemia and 3 cases of patients with previous stroke history.The clinical symptoms were dysarthria-hand clumsiness syndrome in 2 cases,pure motor stroke in 8 cases,pure sensory stroke in 1 case and sensory motor stroke in 4 cases.Among the 15 patients,cerebral infarction was developed in 12 cases (80%),and there were responsible lesions in different positions in 12 patients,including 6 cases of posterior extremity of internal capsule,2 cases of paraventricular and semioval center lesions,2 cases of thalamus,2 cases of pons,and 3 cases of no abnormal diffusion signal on DWI.The ABCD2 score of 15 patients was (4.20±0.86) points (3-6 points),and the NIHSS score was (2.67±1.09) points (0-6 points) at 1 week after onset.All patients were treated with antiplatelet aggregation therapy at different times,including thrombolysis in 3 cases,dilatation in 3 cases and anticoagulation in 1 case.Among the 15 patients discharged from hospital,mRS scores were 0 point in 3 cases,1-2 points in 4 cases,3 points in 3 cases and 4 points in 5 cases.Conclusion There are no clear guidelines for the treatment of early warning syndrome of stroke,so it is necessary to select the corresponding treatment scheme and carry out individualized treatment according to the different risk factors,clinical symptoms and medical imaging manifestations of patients.Clinicians need to find out early,try to reduce the degree of neurological deficits,improve their quality of life and improve their prognosis.