Kittner S J, Sharkness C M, Sloan M A, Price T R, Dambrosia J M, Tuhrim S, Wolf P A, Mohr J P, Hier D B
Department of Neurology, University of Maryland, Baltimore.
Stroke. 1992 Dec;23(12):1748-51. doi: 10.1161/01.str.23.12.1748.
The lack of valid criteria for the clinical diagnosis of cardiogenic embolism is a major problem in both patient care and research. The aim of this study was to identify features on the initial computed tomogram of the brain that discriminate between patient groups with and without a cardiac source of embolism. To gain insight into the neuroradiological features relevant to the diagnosis of cardiac embolic stroke, we studied the initial computed tomogram of the 1,267 patients with ischemic stroke and such a scan in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Data Bank.
We analyzed the initial computed tomographic data from 1,267 patients with ischemic stroke in the NINDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we defined groups with high (n = 244), medium (n = 165), and low (n = 858) risk for cardiogenic embolism and compared the features on the initial computed tomogram among these three groups.
Patients in the high-risk group were significantly more likely (p < 0.001) to have infarcts involving one half lobe or larger or infarcts involving both superficial and deep structures than patients in the medium- or low-risk groups. In contrast, deep small infarcts had a negative association (p = 0.004) with the presence of a cardiac source of embolism. There was no significant trend across risk groups in the percent with hemorrhagic infarction, regardless of whether patients with anticoagulant use at the time of the stroke were excluded.
Although some features of the initial computed tomogram had highly significant associations with the presence of a cardiac source of embolism, the predictive value of these features for an embolic source was low.
在患者护理和研究中，缺乏用于心源性栓塞临床诊断的有效标准是一个主要问题。本研究的目的是确定脑部初次计算机断层扫描图像上能够区分有无心脏栓塞源患者组的特征。为深入了解与心脏栓塞性卒中诊断相关的神经放射学特征，我们研究了美国国立神经疾病与中风研究所（NINDS）中风数据库中1267例缺血性卒中患者的初次计算机断层扫描图像。
我们分析了NINDS中风数据库中1267例缺血性卒中患者的初次计算机断层扫描数据。仅根据是否存在心脏栓塞源，我们定义了心源性栓塞高风险组（n = 244）、中风险组（n = 165）和低风险组（n = 858），并比较了这三组初次计算机断层扫描图像的特征。
与中风险组或低风险组患者相比，高风险组患者发生累及半个脑叶或更大范围的梗死或累及浅表和深部结构梗死的可能性显著更高（p < 0.001）。相反，深部小梗死与心脏栓塞源的存在呈负相关（p = 0.004）。无论是否排除卒中时使用抗凝剂的患者，各风险组中出血性梗死的百分比均无显著趋势。
尽管初次计算机断层扫描的某些特征与心脏栓塞源的存在有高度显著的相关性，但这些特征对栓塞源的预测价值较低。
