Cerebral emboli and paradoxical embolisation in dementia: a pilot study
Cerebral emboli and paradoxical embolisation in dementia: a pilot study
复制标题
DOI：
10.1002/gps.1202
复制
发表时间：
2005-01-01
影响因子：
4
通讯作者：
McCollum, C
中科院分区：
文献类型：
--
作者：
Purandare, N;Welsh, S;McCollum, C
常见痴呆症的病因尚不清楚。静脉血栓通过心脏或肺循环中的静脉到动脉分流（v-aCS）而引起的脑循环的反常栓塞已知发生在隐源性卒中和髋关节置换术后的术后混乱中。方法对41例痴呆患者的颈动脉病变和静脉-动脉分流（v-aCS）进行了研究。采用DSM-IV标准诊断的24例阿尔茨海默病患者和17例血管性VaD患者和16例对照者接受经颅多普勒（TCD）检测双侧大脑中动脉自发性脑栓塞。通过静脉注射空气/生理盐水超声造影剂，在休息时和咳嗽和Valsalva动作激发后检测v-aCS。结果11例（27.5%）痴呆患者和1例（7%）对照组中检测到脑栓塞（p = 0.15），VaD患者脑栓塞发生率最高（41%）[OR（95%CI）：10.5（1.1，98.9），p = 0.04]。在25例（61%）患者和7例（44%）对照中检测到v-aCS（p = 0.24）。在痴呆患者的脑栓塞; v-aCS中检测到7（64%）和中度至重度颈动脉狭窄存在于3（30%）。结论脑栓塞和v-aCS可能更频繁的VaD和AD患者比对照组，这表明矛盾栓塞作为一个潜在的脑损伤机制。该初步研究证明了确定性病例对照研究的合理性。版权所有（C）2004约翰威利父子有限公司。
Background The causes of the common dementias remain unknown. Paradoxical embolisation of the cerebral circulation by venous thrombi passing through venous to arterial shunts (v-aCS) in the heart or pulmonary circulation is known to occur in cryptogenic stroke and post-operative confusion following hip replacement.Objectives To explore the role of paradoxical embolisation in dementia by investigating for cerebral emboli, venous to arterial circulation shunt (v-aCS) and carotid artery disease.ethods Forty-one patients with dementia (24 Alzheimer's AD and 17 vascular VaD) diagnosed using DSM-IV criteria and 16 controls underwent transcranial Doppler (TCD) detection of spontaneous cerebral emboli in both middle cerebral arteries. A v-aCS was detected by intravenous injection of an air/saline ultrasound contrast at rest and after provocation by coughing and Valsalva's manoeuvre. Carotid artery disease was assessed by duplex imaging.Results Cerebral emboli were detected in 11 (27.5%) dementia patients compared with one (7%) control (p = 0.15) with emboli being most frequent in VaD (41%) compared to controls [OR (95% Cl): 10.5 (1.1, 98.9), p = 0.04]. A v-aCS was detected in 25 (61%) patients and seven (44%) controls (p = 0.24). In dementia patients with cerebral emboli; v-aCS was detected in seven (64%) and moderate to severe carotid stenosis was present in three (30%).Conclusion Cerebral emboli and v-aCS may be more frequent in patients with both VaD and AD than in controls, which suggest paradoxical embolisation as a potential mechanism for cerebral damage. This pilot study justifies a definitive case-control study. Copyright (C) 2004 John Wiley Sons, Ltd.