29例青年脑梗死患者的TOAST分型、临床特征及治疗结果分析

TOAST Types,Clinical Characteristics and Treatment Outcome in 29 Young Adult Patients with Cerebral Infarction

目的分析29例青年脑梗死患者的TOAST分型、临床特征及治疗结果。方法选取2015年10月—2016年10月西安市第四医院神经内科收治的青年脑梗死患者29例,回顾性分析其TOAST分型、临床特征、实验室检查指标、辅助检查结果、临床转归等。结果 (1)TOAST分型:大动脉粥样硬化型(LAA)9例(占31.0%),小动脉闭塞型(SAO)13例(占44.8%),心源性栓塞型(CE)2例(占6.9%),其他明确病因型(SDE)3例(占10.3%),不明原因型(SUE)2例(占6.9%)。(2)临床特征:吸烟13例(占44.8%);合并症:高脂血症20例(占69.0%),高血压18例(占62.1%),糖尿病10例(占34.5%),肥胖5例(占17.2%);临床表现:29例患者均表现为偏瘫和/或失语(轻者为言语不清),感觉障碍9例(占31.0%),痴呆3例(占10.3%),视野缺损3例(占10.3%),癫痫发作2例(占6.9%),视力减退1例(占3.4%),排尿、排便功能障碍1例(占3.4%),心功能不全1例(占3.4%);梗死部位:基底核区19例(占65.5%),枕叶4例(占13.8%),小脑3例(占10.3%),额叶2例(占6.9%),脑干2例(占6.9%),颞叶1例(占3.4%),顶叶1例(占3.4%)。(3)实验室检查指标:超氧化物歧化酶(SOD)降低17例(占58.6%),同型半胱氨酸升高14例(占48.3%)。(4)辅助检查结果:颅脑磁共振弥散加权成像(DWI)发现高信号梗死灶27例(占93.1%),磁共振血管成像(MRA)发现脑动脉硬化10例(占34.5%),颈部血管超声提示颈动脉粥样硬化12例(占41.4%),心电图异常14例(占48.3%),脑电图、脑地形图异常22例(占75.9%),经颅多普勒超声(TCD)提示脑供血不足18例(占62.1%)。(5)临床转归:经治疗,基本痊愈6例,显著进步16例,进步5例,无变化2例,无一例恶化或死亡。结论 LAA、SAO是青年脑梗死患者的主要TOAST分型,男性及伴有高脂血症、高血压、SOD降低、高同型半胱氨酸血症的青年易发生脑梗死,常见梗死部位为基底核区,经治疗临床转归较好。

Objective To analyze the TOAST types,clinical characteristics and treatment outcome in 29 young adult patients with cerebral infarction.Methods From October 2015 to October 2016,a total of 29 young adult patients with cerebral infarction were selected in the Department of Neurology,the Forth Hospital of Xi'an,the TOAST types,clinical characteristics,index of laboratory examination,auxiliary examination results and clinical outcome were retrospectively analyzed.Results (1)TOAST types:9 cases(accounting for 31.0%)were large-artery atherosclerosis(LAA),13 cases(accounting for 44.8%)were small artery occlusion(SAO),2 cases(accounting for 6.9%)were cardiogenic embolism,3 cases(accounting for 10.3%)were else definite causes(SDE),2 cases(accounting for 6.9%)were stroke unknown cause(SUE).(2)Clinical characteristics:13 cases(accounting for 44.8%)with smoking;merger diseases:20 cases(accounting for 69.0%)with hyperlipidaemia,18 cases(accounting for 62.1%)with hypertension,10 cases(accounting for 34.5%)with diabetes,5 cases(accounting for 17.2%)with obesity;clinical manifestations:all of the 29 cases performed as hemiplegia and/aphasia(some mild cases performed as alalia),9 cases(accounting for 31.0%)performed as disturbance of sensation,3 cases(accounting for 10.3%)performed as dementia,3 cases(accounting for 10.3%)performed as visual field defect,2 cases(accounting for 6.9%)performed as epileptic seizure,1 case(accounting for 3.4%)performed as hypopsia,1 case(accounting for 3.4%)performed as dysuria and dysporia,1 case(accounting for 3.4%)performed as heart dificiency;infarction locations:19 cases(accounting for 65.5%)with basal nucleus region,4 cases(accounting for 13.8%)with occipital lobe,3 cases(accounting for 10.3%)with cerebellum,2 cases(accounting for 6.9%)with frontal lobe,2 cases(accounting for 6.9%)with brainstem,1 case(accounting for 3.4%)with temporal lobe,1 case(accounting for 3.4%)with parietal lobe(.3)Index of laboratory examination:17 case(s accounting for 58.6%)with decrease of SOD,14 case(s accounting for 48.3%)with homocysteine elevation.(4)Auxiliary examination results:27 cases(accounting for 93.1%)found increased signal intensity of infarction location by craniocerebral DWI,10 cases(accounting for 34.5%)found cerebral arteriosclerosis by craniocerebral MRA,12 cases(accounting for 41.4%)found carotid athersclerosis by neck ultrasound examination,14 cases(accounting for 48.3%)with electrocardiographic abnormality,22 cases(accounting for 75.9%)with abnormality of electroencephalogram and brain electrical activity mapping,18 cases(accounting for 62.1%)found insufficiency of cerebral blood supply TCD.(5)Clinical outcome:after treatment,6 cases were basically cured,16 cases were remarkably improved,5 cases were improved,2 cases without change,no one occurred deterioration or death.Conclusion LAA and SAO are the main TOAST types,male young adults with hyperlipidaemia,hypertension,decrease of SOD and hyperhomocysteinemia have high risk of cerebral infarction,basal nucleus region is the most common infarction location,but the treatment outcome is relatively good after treatment.