症状性脑内动脉粥样硬化性血栓形成性狭窄的前瞻性研究:GESICA研究

Background: Symptomatic intracranial atherothrombotic stenoses (ICAS) are associated with high rates of cerebrovascular ischemic events. Objective: To conduct a prospective multicenter study to evaluate the natural history of ICAS and, in those patients refractory to medical treatment, the outcomes associated with intracranial angioplasty. Methods: Patients aged 18 to 80 were enrolled with symptoms attributed to a single ICAS of ≥50%. Optimal medical therapy of vascular risk factors and preventive antithrombotic therapy were at the discretion of the local investigator. Patients were eligible for intracranial angioplasty after experiencing recurrent stroke despite medical therapy. Neurologic and ultrasonographic examinations were performed at study inclusion, 3 months after enrollment, and every 6 months of follow-up thereafter, for 36 months. Results:One hundred two patients were included, with a mean age of 63.3 ±10.4 years. Intracranial artery stenoses involved the vertebral artery in 22.5%, the basilar artery in 25.5%, the middle cerebral artery in 26.5%, and the internal carotid artery in 25.5%. In 27.4%of the patients, the stenoses had clinical hemodynamic characteristics. During a mean follow-up of 23.4 months, 38.2%of the patients had a cerebrovascular event: ischemic stroke in 13.7%and TIA in 24.5%. Among patients with a hemodynamically significant stenosis, 60.7%had a recurrent stroke or TIA in the territory of the stenotic artery; this association was significant in univariate analysis.Twenty-eight patients underwent an endovascular procedure with a neurologic periprocedural complication rate of 14.2%.The overall vascular death rate was 8.8%. Conclusions: Despite medical treatment, the 2-year recurrence rate of ischemic events in the territory of the stenotic artery was 38.2%. Cardiovascular events occurred in 18.6%of patients. Clinically significant hemodynamic stenoses were associated with stroke recurrence and may help identify a high risk subset of patients.

ID偏头痛问卷调查在颞下颌关节痛及口面疼痛诊所中的应用

Objective. -The aim of this study was to determine whether the ID Migraine questionnaire could be applied successfully to assess the migraine patients in TMJ and Orofacial Pain Clinic. Background. -As migraine pain represents a substantial personal and social burden worldwide, there has been a great deal of effort in developing a screening instrument for migraine. Methods. -Each subject completed a self-administered screening questionnaire consisting of nine items. Based on the International Headache Society criteria, the clinical diagnosis of migraine was assigned. The sensitivity and specificity of the individual items were evaluated. An analysis of the data was performed using the SAS (Statistical Analysis System) V8.01. Results. -This study found that nausea, photophobia, and headache-related disability had the highest individual sensitivities and specificities, and the performance of the three-item screener was equivalent to that reported in a previous study. Although the sensitivity of the three-item screener in this study (0.58) was lower than in a previous study (0.81), the specificity (0.98) was higher and the positive predictive value was 93.9%. This suggests that the ID Migraine questionnaire is relatively efficient in this setting. Conclusion. -The ID Migraine questionnaire, which is a three-item screener consisting of nausea, photophobia, and headache-related disability, could be used as a self-administered report for detecting migraine headaches in patients with temporomandibular disorders and orofacial pain.

先兆性偏头痛临床亚型的意义

Objective. -To compare the clinical characteristics of familial hemiplegic migraine (FHM), sporadic hemiplegic migraine (SHM), and nonhemiplegic migraine with aura (NHMA) and further, to compare subtypes of NHMA. Background. -To discover distinct underlying genetic and pathophysiological mechanisms it is crucial to drive clinical subdivision of migraine with aura as far as possible. The documentation of subtypes of migraine with aura depends on the clinical characteristics as the genetic mechanisms are unknown except for the dominantly inherited FHM. Methods. -Patients with FHM, SHM, or familial NHMA were recruited from specialist practice and diagnosed according to the International Classification of Headache Disorders (ICHD) in a validated interview by a physician. Patients with hemiplegic migraine had a physical and neurological examination. Patients with population-based NHMA from a previous Danish study were used for comparison. Results. -We recruited 147 patients with FHM, 105 with SHM, and 362 with familial NHMA. FHM and SHM had similar aura and headache characteristics. Patients with FHM and SHM were more likely to experience two or more aura symptoms (100%vs. 31%, P < .0001), they more often had prolonged aura symptoms, they almost always had a headache associated with the aura (93%vs. 58%, P < .0001), and they more frequently had basilar-type symptoms (69%vs. 10%, P < .0001) than patients with population-based NHMA. Patients with familial NHMA were more likely to experience two or more aura symptoms than patients with population-based NHMA (61%vs. 32%, P < .0001). Within the subtypes of NHMA, patients with typical aura with migraine headache had an earlier age at onset (20 ±10 vs. 23 ±13 years, P = .044) and a higher co-occurrence of migraine without aura (43%vs. 22%, P= .002) than patients with typical aura with nonmigraine headache. Conclusions. -The present study proves that distinct subtypes of migraine with aura exist. It further underlines the phenotypic differences between the different subtypes of migraine with aura which likely are caused by different etiological mechanisms. In future studies FHM, SHM, and NHMA therefore should be analyzed as separate entities and patients with NHMA may be stratified by ICHD-2 subtype of NHMA.