Mead Gillian E, Lewis Stephanie C, Wardlaw Joanna M, Dennis Martin S
Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland.
Stroke. 2002 Oct;33(10):2383-90. doi: 10.1161/01.str.0000029827.93497.97.
Patients with ischemic stroke, cerebral transient ischemic attacks (TIAs), retinal artery occlusion (RAO), and amaurosis fugax are thought to have similar risk factors and underlying vascular disease. However, if risk factors are different in patients with eye compared with brain symptoms and in those whose symptoms last <24 hours (transient) compared with those lasting >24 hours (prolonged), more focused prevention strategies are possible in the future.
All patients with ischemic stroke, cerebral TIA, RAO, and amaurosis fugax presenting to our hospital from 1994 to 1999 were examined by a stroke physician. Risk factors were documented, and patients underwent carotid Doppler ultrasound.
We registered 1491 patients with ischemic stroke, 580 with cerebral TIA, 79 with RAO, and 138 with amaurosis fugax. Atrial fibrillation was more common in brain than eye events, whether prolonged [ischemic stroke versus RAO: odds ratio (OR), 3.6; 95% confidence interval (CI), 1.1 to 12] or transient (cerebral TIA versus amaurosis fugax: OR, 2.9; 95% CI, 0.7 to 13), and more common in prolonged than transient events, whether brain (stroke versus cerebral TIA: OR, 3.3; 95% CI, 2.1 to 5.1) or eye (RAO versus amaurosis fugax: OR, 2.7; 95% CI, 0.4 to 16). Severe ipsilateral carotid disease was less common in brain than eye events, whether prolonged (ischemic stroke versus RAO: OR, 0.6; 95% CI, 0.3 to 1.0) or transient (cerebral TIA versus amaurosis fugax: OR, 0.4; 95% CI, 0.2 to 0.6).
These data suggest that there are pathogenetic differences between transient and permanent eye and brain ischemic syndromes. Improved understanding of these mechanisms could lead to more effective stroke prevention.
缺血性脑卒中、脑短暂性脑缺血发作（TIA）、视网膜动脉阻塞（RAO）和一过性黑矇患者被认为具有相似的危险因素和潜在血管疾病。然而，如果眼部症状患者与脑部症状患者以及症状持续时间<24小时（短暂性）的患者与症状持续时间>24小时（持续性）的患者的危险因素不同，那么未来有可能制定更具针对性的预防策略。
1994年至1999年期间到我院就诊的所有缺血性脑卒中、脑TIA、RAO和一过性黑矇患者均由一名卒中医生进行检查。记录危险因素，并对患者进行颈动脉多普勒超声检查。
我们登记了1491例缺血性脑卒中患者、580例脑TIA患者、79例RAO患者和138例一过性黑矇患者。心房颤动在脑部事件中比在眼部事件中更常见，无论是持续性的（缺血性脑卒中与RAO：比值比（OR），3.6；95%置信区间（CI），1.1至12）还是短暂性的（脑TIA与一过性黑矇：OR，2.9；95%CI，0.7至13），并且在持续性事件中比在短暂性事件中更常见，无论是脑部的（脑卒中与脑TIA：OR，3.3；95%CI，2.1至5.1）还是眼部的（RAO与一过性黑矇：OR，2.7；95%CI，0.4至16）。严重的同侧颈动脉疾病在脑部事件中比在眼部事件中更少见，无论是持续性的（缺血性脑卒中与RAO：OR，0.6；95%CI，0.3至1.0）还是短暂性的（脑TIA与一过性黑矇：OR，0.4；95%CI，0.2至0.6）。
这些数据表明，短暂性和永久性眼部及脑部缺血综合征之间存在发病机制差异。对这些机制的深入了解可能会导致更有效的卒中预防。
