De Schryver E L L M, Algra A, Donders R C J M, van Gijn J, Kappelle L J
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, H.02.128, PO Box 85500, 3508 GA Utrecht, The Netherlands.
J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):734-8. doi: 10.1136/jnnp.2005.085613. Epub 2006 Feb 24.
Retinal infarction and transient monocular blindness (TMB) are associated with an increased risk of future ischaemic stroke. Little information is available on the type of subsequent ischaemic strokes that may occur (anterior or posterior circulation and small vessel or large vessel).
To analyse the type of stroke after TMB.
Patients with transient or permanent retinal ischaemia were selected from three prospective studies: the Dutch TIA Trial, the Dutch Amaurosis Fugax Study and the European/Australian Stroke Prevention in Reversible Ischaemia Trial. On follow-up the type of stroke was classified according to the supply territory and the type of vessel involved.
654 patients were included. During a mean follow-up of 5.2 years, 42 patients were found to have had a cerebral or retinal infarct, of which 27 occurred in the carotid territory ipsilateral to the symptomatic eye, 9 in the territory of the contralateral carotid artery and 6 were infratentorial strokes. Thirty patients had a large-vessel infarct, four had a small-vessel infarct and eight had a retinal infarct. Characteristics associated with a notable increased risk for subsequent stroke or retinal infarction were age > or = 65 years, a history of stroke, a history of intermittent claudication, diabetes mellitus, Rankin score > or = 3, more than three attacks of retinal ischaemia and any degree of ipsilateral carotid stenosis on duplex ultrasonography observation.
Ischaemic strokes after TMB or retinal infarction were found to be mainly large-vessel infarcts in the territory of the ipsilateral carotid artery. TMB and retinal infarction are probably manifestations of large-vessel disease.
视网膜梗死和短暂性单眼盲(TMB)与未来缺血性卒中风险增加相关。关于可能发生的后续缺血性卒中类型(前循环或后循环以及小血管或大血管)的信息较少。
分析TMB后的卒中类型。
从三项前瞻性研究中选取患有短暂性或永久性视网膜缺血的患者:荷兰短暂性脑缺血发作试验、荷兰一过性黑矇研究以及欧洲/澳大利亚可逆性缺血性卒中预防试验。在随访期间,根据供血区域和受累血管类型对卒中类型进行分类。
纳入654例患者。在平均5.2年的随访期间,发现42例患者发生了脑梗死或视网膜梗死,其中27例发生在有症状眼同侧的颈动脉供血区域,9例发生在对侧颈动脉供血区域,6例为幕下卒中。30例患者发生大血管梗死,4例发生小血管梗死,8例发生视网膜梗死。与后续卒中或视网膜梗死风险显著增加相关的特征为年龄≥65岁、卒中病史、间歇性跛行病史、糖尿病、Rankin评分≥3、视网膜缺血发作超过3次以及双功超声检查发现任何程度的同侧颈动脉狭窄。
发现TMB或视网膜梗死后的缺血性卒中主要是同侧颈动脉供血区域的大血管梗死。TMB和视网膜梗死可能是大血管疾病的表现。