Allder S J, Moody A R, Martel A L, Morgan P S, Delay G S, Gladman J R, Lennox G G
University Department of Clinical Neurology, Queen's Medical Centre, Nottingham, UK.
J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):886-8. doi: 10.1136/jnnp.74.7.886.
Despite its importance for acute stroke management, little is known about the underlying pathophysiology when patients with acute stroke are classified using clinical methods.
To examine the relation between the magnetic resonance defined stroke subtype and clinical stroke classifications using diffusion weighted imaging (DWI), perfusion weighted imaging (PWI), and angiographic magnetic resonance techniques.
Consecutive patients with clinical syndromes consistent with acute anterior circulation stroke were assessed clinically within six hours of onset and scanned as soon as possible using multimodal magnetic resonance imaging (MRI). Patients were classified clinically into total or partial anterior circulation syndromes using the Oxford classification, or according the severity of the National Institutes of Health stroke scale (NIHSS) (severe > 15; mild/moderate <or= 15). At day seven, patients were classified by combining clinical course and MRI data as misdiagnosed, misclassified, suffering transient ischaemic attack, infarct with recanalisation, or infarction with persisting occlusion. Patients with occlusion were further divided on the basis of a large diffusion-perfusion mismatch.
84 patients with clinical anterior circulation syndromes were studied. Using the NIHSS, 42 were mild to moderate (0-15) and 42 were severe (> 15). There were 42 with partial anterior circulation syndromes (PACS) and 42 with total anterior circulation syndromes (TACS). Patients with TACS or severe stroke were more likely to have actually suffered a stroke (Fischer's exact test, p = 0.01), to have a correctly classified stroke (chi(2) 28.2, p < 0.01), to have persisting occlusion (chi(2) 30.6, p < 0.01), and to have a large DWI-PWI mismatch (chi(2) 17.1, p < 0.01).
There is more inaccuracy in patients presenting with acute PACS or clinically mild to moderate anterior circulation stroke than in those with TACS or severe acute stroke syndromes. The latter appear more likely to be the targets for acute stroke interventions, as they include a significantly higher proportion of patients with persisting occlusion and diffusion/perfusion mismatch.
尽管其对急性卒中管理很重要，但对于使用临床方法对急性卒中患者进行分类时的潜在病理生理学知之甚少。
使用扩散加权成像（DWI）、灌注加权成像（PWI）和血管造影磁共振技术，研究磁共振定义的卒中亚型与临床卒中分类之间的关系。
对符合急性前循环卒中临床综合征的连续患者在发病6小时内进行临床评估，并尽快使用多模态磁共振成像（MRI）进行扫描。使用牛津分类法或根据美国国立卫生研究院卒中量表（NIHSS）的严重程度（重度>15；轻度/中度≤15）将患者临床分类为完全或部分前循环综合征。在第7天，结合临床病程和MRI数据将患者分类为误诊、分类错误、短暂性脑缺血发作、再通梗死或持续闭塞性梗死。闭塞患者根据大的扩散-灌注不匹配进一步划分。
研究了84例具有临床前循环综合征的患者。使用NIHSS，42例为轻度至中度（0-15），42例为重度（>15）。有42例部分前循环综合征（PACS）和42例完全前循环综合征（TACS）。TACS或重度卒中患者更有可能实际发生了卒中（费舍尔精确检验，p = 0.01），卒中分类正确（χ² 28.2，p < 0.01），存在持续闭塞（χ² 30.6，p < 0.01），并且存在大的DWI-PWI不匹配（χ² 17.1，p < 0.01）。
与TACS或重度急性卒中综合征患者相比，急性PACS或临床轻度至中度前循环卒中患者的误诊更多。后者似乎更有可能成为急性卒中干预的目标，因为他们中存在持续闭塞和扩散/灌注不匹配的患者比例明显更高。
