Deterioration following spontaneous improvement - Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia
Deterioration following spontaneous improvement - Sonographic findings in patients with acutely resolving symptoms of cerebral ischemia
复制标题
DOI：
10.1161/01.str.31.4.915
复制
发表时间：
2000-04-01
期刊：
影响因子：
8.3
通讯作者：
Grotta, JC
中科院分区：
文献类型：
--
作者：
Alexandrov, AV;Felberg, RA;Grotta, JC
背景和目的：一些脑卒中患者在改善后会恶化，但这种波动的原因往往不清楚。虽然神经功能障碍的解决通常与自发再通或侧支血流的恢复有关，但DFI患者的血管影像学尚未得到很好的表征。方法：我们前瞻性研究了出现局灶性神经功能障碍并在症状出现后6小时内自行消退的患者。床边经颅多普勒（TCD）对患者进行评估。可行时进行数字减影血管造影（DSA）、计算机断层血管造影（CTA）或磁共振血管造影（MRA）。DFI定义为在最初症状出现的24小时内，神经功能缺损的随后恶化大于或等于美国国立卫生研究院卒中量表的4分。结果：我们研究了50例连续出现在症状出现165+/-96分钟的患者。平均年龄61±14岁；50%是女性。所有患者在就诊时都有TCD， 68%的患者随后进行了血管造影检查（DSA 10%, CTA 4%, MRA 44%）。总体而言，16%的患者发现TCD上的大血管闭塞（n=8）；狭窄发生率为18% (n=9)；54% （n=27）有正常研究；6例（12%）患者无颞窗。50例患者中有16% （n=8）发生DFI: TCD和血管造影证据闭塞的患者中有62%发生DFI，狭窄患者中有22%发生DFI，血管检查正常的患者中有4%发生DFI
Background and Purpose-Some stroke patients will deteriorate following improvement (DFI), but the cause of such fluctuation is often unclear. While resolution of neurological deficits is usually related to spontaneous recanalization or restoration of collateral flow, vascular imaging in patients with DFI has not been well characterized.Methods-We prospectively studied patients who presented with a focal neurological deficit that resolved spontaneously within 6 hours of symptom onset. Patients were evaluated with bedside transcranial Doppler (TCD). Digital subtraction angiography (DSA), computed tomographic angiography (CTA), or magnetic resonance angiography (MRA) were performed when feasible. DFI was defined as subsequent worsening of the neurological deficit by greater than or equal to 4 National Institutes of Health Stroke Scale points within 24 hours of the initial symptom onset.Results-We studied 50 consecutive patients presenting at 165+/-96 minutes from symptom onset. Mean age was 61+/-14 years; 50% were females. All patients had TCD at the time of presentation, and 68% had subsequent angiographic examinations (DSA 10%, CTA 4%, and MRA 44%). Overall, large-vessel occlusion on TCD was found in 16% of patients (n=8); stenosis was found in 18% (n=9); 54% (n=27) had normal studies; and 6 patients (12%) had no temporal windows. DFI occurred in 16% (n=8) of the 50 patients: in 62% of patients with TCD and angiographic evidence of occlusion, in 22% with stenosis, and in 4% with normal vascular studies (P