Kappelle L J, van Latum J C, Koudstaal P J, van Gijn J
University Department of Neurology, Utrecht, Netherlands.
Lancet. 1991 Feb 9;337(8737):339-41. doi: 10.1016/0140-6736(91)90955-o.
Histories and computed tomograms of 606 patients with transient cerebral ischaemia were studied. All symptoms and signs had completely resolved within 24 hours, and any episodes suggestive of posterior fossa ischaemia were excluded. Computed tomography, done after the clinical features had resolved, showed 79 relevant infarcts: 46 were small, deep, lacunar infarcts (58%, 95% confidence interval [CI] 47-69%), and 33 were larger cortical infarcts. The histories and the type of infarct in these 79 patients were compared to see whether lacunar infarcts were preceded by a history of unilateral motor or sensory symptoms without features usually attributed to the cerebral cortex. The positive predictive value of such lacunar symptoms was 0.74, with a negative predictive value of 0.61. 11 patients had a cortical infarct despite a history of lacunar TIAs, but only one occurred in the left hemisphere and speech was not affected. Of 527 patients with transient ischaemic attacks without a relevant infarct visible on computed tomography, 335 (64%) had a history suggestive of lacunar ischaemia, whereas in several other studies 20-25% of patients with ischaemic stroke have evidence of lacunar infarcts. Lacunar TIAs may therefore have a better prognosis than cortical TIAs or may often precede cortical infarcts; alternatively, many cortical infarcts may occur without warning.
对606例短暂性脑缺血患者的病史和计算机断层扫描结果进行了研究。所有症状和体征在24小时内完全消失，任何提示后颅窝缺血的发作均被排除。在临床症状消失后进行的计算机断层扫描显示有79处相关梗死灶：46处为小的、深部的腔隙性梗死（58%，95%置信区间[CI]47 - 69%），33处为较大的皮质梗死。对这79例患者的病史和梗死类型进行比较，以观察腔隙性梗死之前是否有单侧运动或感觉症状的病史，而无通常归因于大脑皮质的特征。此类腔隙性症状的阳性预测值为0.74，阴性预测值为0.61。11例患者尽管有腔隙性短暂性脑缺血发作史，但仍发生了皮质梗死，但仅1例发生在左半球且未影响言语。在527例计算机断层扫描未见相关梗死灶的短暂性脑缺血发作患者中，335例（64%）有提示腔隙性缺血的病史，而在其他几项研究中，20 - 25%的缺血性卒中患者有腔隙性梗死的证据。因此，腔隙性短暂性脑缺血发作的预后可能比皮质性短暂性脑缺血发作更好，或者可能经常先于皮质梗死出现；或者，许多皮质梗死可能毫无征兆地发生。
