Clinical Manifestations and Mechanisms of Autoimmune Disease-Related Multiple Cerebral Infarcts
Clinical Manifestations and Mechanisms of Autoimmune Disease-Related Multiple Cerebral Infarcts
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自身免疫性疾病相关多发性脑梗死的临床表现及机制
DOI：
10.1177/0963689719846838
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发表时间：
2019-08-01
影响因子：
3.3
通讯作者：
Liu, Zun-Jing
中科院分区：
文献类型：
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作者：
Sun, Li-Li;Tang, Wen-Xiong;Liu, Zun-Jing
研究自身免疫性疾病相关性脑卒中患者的临床特点，明确其发病机制，对于早期病因诊断、准确治疗和预防具有重要意义。在这篇文章中，我们回顾性研究了8例与自身免疫性疾病相关的急性缺血性卒中，并且没有竞争的传统卒中病因。对所有8例患者的卒中特征（临床和放射学特征）、实验室检查尤其是血清D-二聚体水平（作为高凝状态的标志物）和经颅多普勒栓塞信号进行了评价。高分辨率磁共振成像（HRMRI），这可以帮助评估血管炎进行了4例。根据这些临床表现，讨论了这些病例的可能机制。因此，我们研究中的自身免疫性疾病包括系统性红斑狼疮（n=5）、混合性结缔组织病（n=1）、中枢神经系统血管炎（n=1）和大动脉炎（n=1）。所有8例患者均在≥2个血管区域出现急性梗死病变。大多数患者表现为位于皮质和皮质下区域的大量中小型梗死病灶。这些病例涉及多种卒中机制，包括高凝状态（n=4）、心脏栓塞（n=1）和血管炎（n=3）。在所有三种卒中机制中，经颅多普勒均可检测到栓塞信号。总之，我们的研究揭示了自身免疫性疾病相关卒中的特征。对于非单一动脉区域的多发性急性脑梗死患者，自身免疫性疾病是一个不容忽视的重要病因。这些病例涉及多种卒中机制。
It is important to investigate the clinical characteristics and identify the stroke mechanisms of patients with autoimmune disease-related stroke, which are necessary for early etiology diagnosis, accurate treatment and preventive strategies. In this article we retrospectively studied eight cases of acute ischemic stroke associated with autoimmune diseases, and without competing conventional stroke etiologies. The characteristics of stroke (clinical and radiological features), the laboratory tests especially serum D-dimer levels (as a marker of hypercoagulable state), and embolic signals on transcranial Doppler were evaluated for all eight patients. High-resolution magnetic resonance imaging (HRMRI), which can help to evaluate vasculitis was performed in four patients. The possible underlying mechanisms of these cases were discussed based on these manifestations. As a result, autoimmune diseases in our study included systemic lupus erythematosus (n=5), mixed connective tissue disease (n=1), central nervous system vasculitis (n=1), and Takayasu arteritis (n=1). All eight patients presented with acute infarction lesions in ≥2 vascular territories. Most patients presented with numerous small and medium infarction lesions located in the cortical and subcortical areas. Multiple stroke mechanisms were involved in these cases, including hypercoagulability (n=4), cardiac embolism (n=1) and vasculitis (n=3). Embolic signals could be detected on transcranial Doppler in all three stroke mechanisms. In conclusion, our study revealed the characteristics of autoimmune disease-related stroke. For patients with multiple acute cerebral infarcts within non-single arterial territories, autoimmune disease is an important etiology not to be neglected. Multiple stroke mechanisms were involved in these cases.