Localization ntawm Infratentorial Lesion tuaj yeem kwv yees Patent ForamenOvale Raws li Etiology hauv Embolic Stroke Ntawm Qhov Tsis Taus

Hom phiaj

Embolic stroke of undetermined source (ESUS) yog ib qho chaw kho mob tau qhia los piav qhia txog tus mob stroke cryptogenic nrog kev kuaj mob tsis meej,Mob plawv ua rautau lees paub tias yog ib qho tseem ceeb ntawm ESUS, thiab Patent foram erovale (PFO) yog nyob ntawm lawv. Peb tsom mus soj ntsuam kev sib raug zoo ntawm tus qauv infarct thiab PFO inpatients nrog ESUS.

Cistanche Supplement SupportLub raum Function Supplement

Txoj kev:Peb tau soj ntsuam 190 tus neeg mob sib law liag nrog ESUS sau npe hauv Tokyo Women's MedicaUniversity Stroke Registry, Ntawm lawv, 94 tus neeg mob uas tau txais kev sib nqus resonance imaging thiab giography, nrog rau kev hloov pauv thiab transesophageal.echocardiography, tau suav nrog hauv qhov kev tshawb fawb no. Cov qauv infarct raug cais raws li qhov chaw (infratentorial lossis non-infratentorial lesions), qhov loj (me me thiab loj infarcts), thiab tus lej (ib zaug lossis ntau qhov txhab).

Cov txiaj ntsig:Prevalence ntawm PFO tau ntau dua nyob rau hauv cov neeg mob nyob rau hauv infratentorial tshaj li cov nyob rau hauv tsis. infratentorial lesion pawg (40.7% piv rau 14.9%, feem; P-0.007). Txawm li cas los xij, tsis muaj qhov mob loj lossis tus lej tsis cuam tshuam nrog PFO, Hauv kev tshuaj xyuas ntau yam logistic regression, muaj cov kab mob infratentorial tau ntawm nws tus kheej cuam tshuam nrog PFO hauv ESUS cov neeg mob (qhov txawv piv txwv: 2.18; 95% kev ntseeg siab interval1.24-3.95; P< 0.007). In 21 patients with PFO, large PFOs were more prevalent in the infratentorial than in the non-infratentorial lesion group.

Cov lus xaus:Infratentorial lesions tuaj yeem cuam tshuam nrog PFO hauv cov neeg mob ESUS. Qhov muaj cov kab mob infratentorial tuaj yeem kwv yees pom muaj PFO hauv ESUS cov neeg mob.

Ntsiab lus:Patent foramen ovale, Transesophageal echocardiography, Embolic stroke ntawm undetermined qhov chaw,Mob stroke ischemic, Infratentorial lesion

Taw qhia

Lub ntsiab lus ntawm embolic stroke ntawm tsis paub (ESUS) tsis ntev los no tau tshwm sim los ua ib lo lus kho mob uas xav tias tsim cov cryptogenic strokes rau embolism uas tsis muaj pov thawj ntawm lacunar stroke ipsilateral stenosis hauv intracranial thiab extracranial hlab ntsha,loj cardioembolicCov peev txheej, lossis lwm yam ua rau muaj txiaj ntsig, ESUS yog ib pawg neeg sib txawv nrog ntau yam muaj peev xwm pathologies raws li cov txheej txheem ntawm kev mob stroke (xws li, ntau qhov chaw muaj peev xwm embolic suav nrogtsawg-risk los yog cov ntaub ntawv cardiac,cov leeg ntawm paradoxical embolism, thiab non-occlusive atherosclerotic plaques nyob rau hauv lub aortic arch, ncauj tsev menyuam, los yog cerebralcov hlab ntsha)

1)Patent foramen ovale (PFO)-kawm mob stroke yog dav paub tias yog ib qho tseem ceeb tshaj plaws ntawm ESUS2. Cov kev tshawb fawb yav dhau los tau qhia tias cov shunts loj thiab muaj cov concomitant atrial septum aneurysm tau txuam nrog ntau qhov pib ntawm oPFO-txog mob stroke3, 4, Qhov kev kuaj pom ntawm feem ntau tau lees paub los ntawm transesophageal echocardiography (TEE). Txawm li cas los xij, qhov kev ntsuam xyuas no cuam tshuam thiab yuav ua rau tsis xis nyob hauv cov neeg mob; Hauv lwm lo lus, TEE tsis tuaj yeem ua tiav hauv txhua tus neeg mob. Ntau qhov kev tshawb fawb tau qhia txog kev sib raug zoo ntawm cov qauv hluav taws xob ntawm lub paj hlwb infarction; Tshwj xeeb tshaj yog, cov kev tshawb fawb tau pom muaj vertebrobasilar artery territory infarction thiab PFO nyob rau hauv cov neeg mob nrog cryptogenic stroke. Txawm li cas los xij, cov txiaj ntsig tau muaj kev tsis sib haum xeeb vim tias cryptogenic mob stroke suav nrog tsis yog tsuas yog mob stroke ntawm qhov ua tsis tau tiav tom qab kev ua haujlwm tiav tab sis kuj mob stroke nrog kev tshawb nrhiav tsis tiav lossis vim muaj ob lossis ntau qhov ua tau tshwm sim. Hauv cov xwm txheej ntawm ESUS, qee qhov kev tshawb fawb tau tshaj tawm txog kev sib raug zoo ntawm cov qauv hluav taws xob ntawm lub paj hlwb infarction thiab PFO ntsig txog mob stroke.

Hom phiaj

Txoj kev tshawb no tsom los txheeb xyuas qhov kev sib raug zoo ntawm tus qauv infarct thiab PFO cov neeg mob nrog ESUS.

Cov ntaub ntawv thiab cov txheej txheem

Kev ncaj ncees

Txoj kev kawm tam sim no ua raws li kev coj ncaj ncees! Cov lus qhia ntawm 1975 Kev Tshaj Tawm ntawm Helsinki raws li Txoj Cai Kev Ncaj Ncees rau Kev Tshawb Fawb Txog Kab Mob los ntawm tsoomfwv Nyij Pooj thiab tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Tokyo Medical University Tsev Kho Mob (tus lej pom zoo: 2955-R2).

Study ProtocolTokyo Women's Medical University Stroke Registry (https://upload.umin.ac.jp,UMIN000031913)is an ongoing, prospective cohort for acute ischemic stroke and transient ischemic attack. All patients gave written informed consent for the inclusion of their data in our study and underwent brain magnetic resonance imaging(MRI) or computed tomography scanning. The present cross-sectional study included 190 consecutive patients with ESUS registered between November 2013 and March 2019. The following patients were, then, excluded: 3 patients who could not undergo MRI and 90 patients who did not receive TEE during hospitalization. In total, 94ESUS patients who had a complete poststroke workup, including brain imaging, vessel imaging, and extensive cardiac assessments(12-lead electrocardiography, Holter electrocardiography, transthoracic echocardiography, and TEE), were included in the current analysis (Fig.1). ESUS was defined according to the Cryptogenic Stroke/ESUSInternational Working Group criteria (i.e., stroke detected by computed tomography or MRI that is notacunar; absence of extracranial or intracranial atherosclerosis causing >50% luminal stenosis nyob rau hauv cov hlab ntsha muab qhov chaw ntawm ischemia; tsis muaj kev pheej hmoo loj ntawm cardioembolic qhov chaw ntawm embolism lossis lwm yam ua rau mob stroke tau txheeb xyuas [xws li, arteritis, dissection, migraine lossis vasospasm, siv tshuaj tsis raug, thiab lwm yam) 1. Qhov hnyav ntawm qhov kev tshwm sim tau raug ntsuas los ntawm National Institutes of Health Scale (NIHSS) cov qhab nia; NIHSS cov qhab nia nyob ntawm 0 txog 42,nrog cov txiaj ntsig siab dua uas cuam tshuam ntau dua qhov tsis txaus neurologic)

Yam Tseem Ceeb

Cov neeg mob tau kuaj pom tias muaj ntshav siab muaj pov thawj ntawmsystolic ntshav siab> 140theymm Hg, diastolic ntshav siab> 90 mm Hg, lossis yog tias lawv tau txais cov tshuaj tiv thaiv hypertensive.Mob ntshav qab zib mellitus was specified as having a fasting serum glucose level > 126 mg/dL, serum glucose level!> 200 mg/dL on 2 random measurements, glycated hemoglobin level > 6.5%, or use of antidiabetic therapy (oral hypoglycemic agents or insulin)Dyslipidemia was diagnosed if the patient had low-density lipoprotein cholesterol > 140 mg/dL, total cholesterol>220 mg / dL, lossis yog tias tus neeg mob tau kho nrog cov tshuaj lipid-txo qis. Qhov kwv yees glomerular filtration tus nqi tau suav nrog Kev Hloov Kho Kev Noj Qab Haus Huv hauv Cov Kab Mob Raum Raum nrog cov Japanese coefficient. Cov kab mob raum ntev tau txhais tias yog qhov kwv yees glomerular pom tus nqi<60mL/min per 1.73 m. Smoking status was defined based on current use. Intracranial arterial stenosis >50% on magnetic resonance angiography(MRA),3-dimensional computed tomography angiography, or digital subtraction angiography was considered a significant finding. Findings of carotid artery ultrasonography were evaluated by trained neurologists, and stenosis >50% txhais tau tias yog qhov tseem ceeb ntawm cov hlab ntsha extracranial stenosis.

Ntshav thiab Echocardiography Examination

B-type natriuretic peptide (BNP) qib tau soj ntsuam rau txhua tus neeg mob thaum nkag. Transthoracic 2-dimensional thiab Doppler echocardiography tau ua tiav siv iE 33ultrasound system (Philips Healthcare, Bothell, WA) nrog rau S5 transducer, Sab laug atrial dimension tau ntsuas ntawm qhov kawg-systole thaum sab laug atrial chambers ntawm nws qhov loj tshaj plaws. Sab laug atrial o tau txhais tias yog sab laug atrial txoj kab uas hla tshaj 4.0 cm hauv cov txiv neej thiab 3.8 cm ntawm cov poj niam, E / e'ratio, uas yog ib qho tseem ceeb parameter rau sab laug ventricular diastolic muaj nuj nqi, txhais tau tias muaj ib tug txiav tawm. taw tes ntawm 14. Sab laug ventricular ejection feem yog suav nrog cov qauv biplane Simpson. Mitral annulus calcification tau txhais tias yog ib qho kev mob siab echocardiographic-tsim qauv uas nyob rau ntawm qhov sib tshuam ntawm atrioventricular zawj thiab posterior mitral leaflet ntawm parasternal ntev axis, apical 4-chamber, los yog parasternal luv-axis saib8)TEE tau ua. siv Affinity 30ultrasound system (Philips Healthcare) siv ntau lub dav hlau sojntsuam. Ua ntej ua TEE, intraoral xylocaine spray tau muab rau txhua tus neeg mob. Lub plawv dhia tau saib xyuas los ntawm electrocardiography thaum kuaj. Cov neeg mob tau muab tso rau ntawm sab laug sab decubitus txoj hauj lwm thaum lub sij hawm sojntsuam tso. Qhov kev sojntsuam tau nce mus rau qhov kawg ntawm txoj hlab pas thiab tshem tawm maj mam mus rau qhov chaw deb ntawm 40cm los ntawm qhov incisors, Kev sojntsuam ntau lub dav hlau tau siv los muab kev pom zoo, suav nrog cov duab axial thiab sagittal, thoob plaws hauv lub aorta. lub xub ntiag ntawm txoj cai. mus rau sab laug shunt, xws li PFO lossis pulmonary arteriovenous fistula, tau kuaj xyuas los ntawm kev tshawb fawb microbubble% luv luv, cov npuas me me tau tsim los ntawm kev tuav cov kua ntsev kom tsis muaj menyuam thiab txhaj rau hauv txoj cai antecubital leeg, PFO, thiab pulmonary arteriovenous fistula tau txhais tias yog Cov tsos mob ntawm microbubbles nyob rau hauv sab laug atrium nyob rau hauv peb lub plawv cycles los yog tom qab plaub lub plawv cycles, feem, Kev faib tawm ntawm shunt loj yog raws li tus naj npawb ntawm microbubbles uas tshwm nyob rau hauv sab laug atrium nyob rau hauv thawj peb lub plawv cycles tom qab opacification nyob rau hauv txoj cai atrium; Lub xub ntiag ntawm 1 mus rau 5 microbubbles raug cais raws li PFO me me, 6 mus rau 25 microbubbles li nruab nrab PFO thiab ntau tshaj 25 microbubbles li loj PFO1Atrial septal aneurysm (ASA) yog txhais raws li ib tug excursion ntawm septal cov ntaub so ntswg (feem ntau lub fossa ovalis) ntawm ntau dua. 10 hli los ntawm lub dav hlau ntawm lub atrial septum mus rau RA los yog LA los yog tag nrho cov excursion RA thiab LA ntawm 15 hli. Lub aortic arch tau pom ntawm 0 thiab 90 degrees. Cov plaques txawb tau raug kuaj xyuas raws li cov khoom siv txawb pom ua viav vias ntawm lawv cov peduncles. Cov plaque ulcerative tau kuaj pom tias yog ib qho kev sib cais ntawm qhov luminal nto ntawm cov quav hniav nrog lub hauv paus dav thiab qhov siab tshaj plaws ntawm qhov tsawg kawg nkaus 2 hli txhua. complex aortic atheroma tau txhais tias yog cov quav hniav loj dua lossis sib npaug li 4 hli hauv tuab lossis cov quav hniav nrog cov kab mob lossis cov khoom txawb!

Kev tshuaj ntsuam xyuas

Txhua tus neeg mob tau txais lub hlwb MRI, suav nrog cov duab diffusion-weighted, pom meej diffusion-hnyav duab, thiab MRA hauv 7 hnub ntawm qhov pib mob stroke. Diffusion-weighted duab thiab MRA cov txiaj ntsig tau yuav tsum tau rau npe rau hauv txoj kev tshawb fawb kom paub meej tias qhov mob ischemic thiab tsis suav nrog lwm yam ua rau embolization, feem. Cov duab diffusion-hnyav cov duab raug txheeb xyuas los ntawm qhov chaw, qhov loj, thiab tus lej. Txhua qhov chaw kho mob tau muab faib ua supratentorial, infratentorial, thiab ob cheeb tsam. Qhov luaj li cas ntawm txhua qhov txhab raug soj ntsuam raws li qhov siab tshaj plaws txoj kab uas hla thiab muab faib ua ib qho ntawm ob pawg: me me! Qhov loj me me (cov uas me dua 1.5 cm) thiab qhov loj me me (cov uas loj dua 1.5 cm) Tus naj npawb ntawm cov kab mob ischemic tau pom tias yog ib leeg (cortical lossis subcortical) lossis ntau yam (me me thiab tawg nyob rau hauv 1 lub nkoj uas muaj qhov sib xyaw ua ke. nrog rau qhov txhab ntxiv, lossis ntau thaj chaw vascular)