卵圆孔未闭所致急性缺血性脑血管病影像学特征的早期临床诊断价值

Imaging Characteristics of Patent Foramen Ovale Induced Acute Cerebrovascular Diseases

目的研究卵圆孔未闭所致急性缺血性脑血管病的临床表现及影像学特征,并探讨该影像学特征作为早期临床诊断的价值。方法收集2019年1月~2019年8月在华中科技大学同济医学院附属同济医院神经内科住院诊治,经头部磁共振成像、经颅多普勒(transcranial doppler,TCD)发泡实验及经食道超声心动图(transesophageal echocardiography,TEE)确诊的隐源性急性缺血性脑血管病合并卵圆孔未闭患者5例。回顾性分析其临床特征,总结其临床表现及影像学特征。结果5例患者经系统的脑血管病因筛查均未找到明确病因。5例患者TCD发泡试验结果均为阳性,4例TEE结果阳性,1例因肺部感染未行TEE检查。1例为短暂性脑缺血发作(transient ischemic attack,TIA),4例为急性脑梗死。5例患者前循环均受累,其中1例同时累及前后循环。5例患者NIHSS评分为(2.2±1.7)分,均为轻型卒中。磁共振成像显示5例患者除1例TIA患者未见梗死灶外,余4例均发现皮层或皮层下梗死灶,其中2例为多发病灶;2例皮层下受累,2例皮层受累。5例患者中4例行卵圆孔封堵术,未发生围手术期并发症。结论卵圆孔未闭与隐源性缺血性脑血管病关系密切,临床症状体征多表现为轻型卒中,磁共振成像显示病灶以皮层及皮层下分布为特征,可为单一或多发病灶。TCD发泡实验早期筛查卵圆孔未闭的敏感度高,结合TEE检查可及时作出诊断。

Objective To explore the value of magnetic resonance imaging(MRI)in early diagnosis of stroke,we studied the clinical manifestations and imaging characteristics of patent foramen ovale induced stroke.Methods We enrolled 5 patients with acute cerebrovascular disease and patent foramen ovale who were admitted to Neurology Department of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology(HUST)from January 2019 to August 2019 and confirmed by MRI and Transesophageal echocardiography(TEE),and the clinical data were analyzed.Finally,we summarized the clinical manifestations and imaging characteristics.Results We didn’t find a clear etiology through systemic cerebrovascular etiology screening.All the patients’results of transcranial Doppler(TCD)test were positive.Except that 1 patient didn’t undergo TEE due to pneumonia,the other 4 patients all did with positive results.One patient showed transient ischemic attack(TIA)and 4 patients suffered from acute cerebral infarction.The anterior circulation was involved in all the 5 patients,and only 1 patient had anterior and posterior circulatory involved simultaneously.The NIHSS score of the 5 patients was(2.2±1.7),and all the patients showed mild stroke.Except 1 patient with TIA didn’t showed lesion in MRI,the remaining 4 patients had cortical or sub-cortical lesions in MRI.Of them,2 patients showed single lesion and 2 patients showed multiple lesions;2 patients showed sub-cortical lesions and 2 patients showed cortical lesions.Foramen oval occlusion was performed in 4 of the 5 patients,with no perioperative complications.Conclusion Studies had shown that patent foramen ovale was closely related to ischemic cerebrovascular disease,with moderate stroke and cortical and sub-cortical lesions in MRI,which could be single and multiple lesions.TCD foam test has a high sensitivity in early screening of patent foramen ovale,and combination with TEE can make early diagnosis.