Palazzuoli A, Ricci D, Lenzi C, Lenzi J, Palazzuoli V
Istitute of Internal Medicine, University of Siena, Policlinico Le Scotte, Italy.
Neurol Sci. 2000 Aug;21(4):195-202. doi: 10.1007/s100720070076.
Pathologies of cerebral circulation are one of the most frequent causes of mortality and morbidity among the populations of Western countries. The incidence of ischemic events presumed to have a cardioembolic origin varies from 13% to 34% in the largest international multi-center studies. However, some authors have reported an incidence of general cardiogenic stroke ranging from 23% to 36% in younger patients. Transesophageal echocardiography (TEE) is a useful investigation for identifying cardiac sources of embolism in patients without vascular alterations involving the carotid and vertebral districts. This study comprised 73 patients with unexplained stroke who were investigated by both transthoracic echocardiography (TTE) and TEE. Vascular echocolor sonography had been performed in all of them with negative results. TEE demonstrated: atrial or ventricular thrombosis in 6 patients (8%), intracavitary neoplasm in 2 (2%), spontaneous echocontrast in 11 (13%), valve strands in 6 (7%), complex aortic plaque in 10 (11%), patency of the foramen ovale in 17 (19%), atrial septal aneurysm in 9 (11%), dystrophy and mitral calcifications in 9 (11%). In the other 18 patients, TEE did not reveal any anomalies. Definite sources of stroke (clots and tumors) were identified in 14% of all the lesions; however, the majority (86%) were potential sources. A comparison of the two echocardiographic techniques demonstrated a greater sensitivity and specificity of TEE. Although TEE was superior to TTE for identifying and evaluating potential embolic sources, we found both methods to be useful and would advise performing TTE before TEE. While TTE is not capable of identifying the majority of anomalies, it does provide useful information to guide subsequent transesophageal investigations.
脑循环病变是西方国家人群中最常见的死亡和发病原因之一。在最大规模的国际多中心研究中，推测具有心源性栓塞起源的缺血性事件发生率在13%至34%之间。然而，一些作者报告称，年轻患者中的心源性卒中总体发生率在23%至36%之间。经食管超声心动图（TEE）对于识别无涉及颈动脉和椎动脉区域血管改变的患者的心脏栓塞来源是一项有用的检查。本研究纳入了73例不明原因卒中患者，他们均接受了经胸超声心动图（TTE）和TEE检查。所有患者均进行了血管彩色超声检查，结果均为阴性。TEE检查发现：6例（8%）患者存在心房或心室血栓，2例（2%）存在心腔内肿瘤，11例（13%）存在自发显影，6例（7%）存在瓣膜条索，10例（11%）存在复杂主动脉斑块，17例（19%）卵圆孔未闭，9例（11%）房间隔瘤，9例（11%）二尖瓣营养不良和钙化。在另外18例患者中，TEE未发现任何异常。在所有病变中，14%确定为明确的卒中来源（血栓和肿瘤）；然而，大多数（86%）为潜在来源。两种超声心动图技术的比较显示TEE具有更高的敏感性和特异性。虽然TEE在识别和评估潜在栓塞来源方面优于TTE，但我们发现两种方法都很有用，并建议在TEE之前先进行TTE。虽然TTE无法识别大多数异常情况，但它确实能提供有用信息以指导后续的经食管检查。
