卒中预警综合征的临床研究进展

Clinical research advances in stroke warning syndrome

卒中预警综合征(stroke warning syndrome,SWS)是一种特殊类型的短暂性脑缺血发作(transient ischemic attack,TIA),占所有TIA的1.5%~8.5%。SWS临床表现为反复、刻板的一侧面部、上肢和/或下肢的感觉和/或运动功能缺损,但无皮质受损表现。根据受累部位不同,SWS可以分为内囊预警综合征、脑桥预警综合征和胼胝体预警综合征。SWS常见的危险因素包括高血压、糖尿病、吸烟和高脂血症。目前认为SWS可能的发病机制是脑小血管病、动脉粥样硬化、动脉到动脉的栓塞、血流动力学不稳定和缺血病灶周围去极化等。SWS进展成脑梗死的风险很高,并且缺乏公认有效的治疗方法。时间窗内就诊的SWS患者给予静脉溶栓(intravenous thrombolysis,IVT)治疗可能会改善患者的预后,并且IVT治疗SWS是安全的,尚未见IVT引起SWS患者出血转化的文献报道。超时间窗就诊的SWS患者及时给予双联抗血小板治疗可能可以有效终止缺血发作。SWS进展成脑梗死的比例为60%~100%。虽然SWS患者发生脑梗死风险很高,但大多数神经功能恢复良好,且很少复发。该文系统总结了SWS的流行病学、临床特点、可能的发病机制,以及治疗和预后,旨在提高临床医生对该病的认识,以便更好地诊治该类患者。

Stroke warning syndrome(SWS)is a special type of transient ischemic attack(TIA)and accounts for 1.5%⁃8.5%of all TIA cases.The clinical manifestations of SWS include repeated and stereotyped sensory and/or motor neurological deficits affecting the face,arm,and/or leg at one side,but without cortical symptoms.Depending on its location,it is classified into capsular warning syndrome,pontine warning syndrome,and callosal warning syndrome.Common risk factors for SWS include hypertension,diabetes,smoking,and hyperlipidemia.Current studies show that the possible pathogenesis of SWS include cerebral small vessel disease,atherosclerosis,artery⁃to⁃artery embolism,hemodynamic instability,and periinfarct depolarization.SWS has a high risk of progression to cerebral infarction,and there is still a lack of universally accepted effective treatment regimens.Intravenous thrombolysis(IVT)may improve the prognosis of SWS patients who attend the hospital within time window,and IVT is safe for the treatment of SWS,with no reports on hemorrhagic transformation caused by IVT.For the SWS patients who attend the hospital after the time window,timely administration of dual antiplatelet therapy may effectively terminate ischemic attacks.About 60%⁃100%of SWS cases progress to cerebral infarction.Although SWS is associated with a high risk of ischemic stroke,most patients with SWS have good neurological function recovery,with a relatively low recurrence rate.This article systematically reviews the epidemiology,clinical features,possible pathogenesis,treatment,and prognosis of SWS,so as to improve the awareness of this disease among clinicians and achieve better diagnosis and treatment of this disease.