Nakajima Makoto, Kimura Kazumi, Shimode Atsuko, Miyashita Fumio, Uchino Makoto, Naritomi Hiroaki, Minematsu Kazuo
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Cerebrovasc Dis. 2007;23(4):282-8. doi: 10.1159/000098328. Epub 2006 Dec 29.
The clinical relevance of the microembolic signals (MES) detected by transcranial Doppler sonography (TCD) in acute stroke remains unclear. In a prospective study the authors analyzed the relationship between MES and the findings on diffusion-weighted magnetic resonance imaging (DWI) in acute stroke patients.
We performed TCD for a period of 30 min to detect MES in patients within 24 h of stroke onset, and DWI was done within the initial 7 days. MES were assessed from Doppler waves obtained from the middle cerebral artery contralateral to the side of the neurological deficits. The acute ischemic lesions observed on DWI were classified by their diameter (small, medium or large) and by their site (cortical, superficial perforator territory, internal borderzone or deep perforator territory).
We obtained Doppler waves from 39 vessels in 37 patients; 2 patients had bilateral deficits. MES were detected in 12 vessels (MES-positive group) and not detected in 27 vessels (MES-negative group). No significant differences in clinical features were observed between the 2 groups. The number of small lesions was significantly higher in the MES-positive group than in the MES-negative group (p = 0.02). The numbers of cortical and superficial perforator infarcts were significantly higher in the MES-positive group than in the MES-negative group (p = 0.002 and 0.02, respectively).
In acute ischemic stroke, MES detected by TCD in the acute phase may produce small cortical and subcortical lesions found on DWI.
经颅多普勒超声（TCD）检测到的微栓子信号（MES）在急性卒中中的临床相关性仍不明确。在一项前瞻性研究中，作者分析了急性卒中患者中MES与弥散加权磁共振成像（DWI）结果之间的关系。
我们对卒中发作24小时内的患者进行了30分钟的TCD检查以检测MES，并在最初7天内进行了DWI检查。从与神经功能缺损侧对侧的大脑中动脉获取的多普勒波评估MES。DWI上观察到的急性缺血性病变按其直径（小、中或大）和部位（皮质、浅表穿支区域、内边界区或深部穿支区域）进行分类。
我们从37例患者的39条血管中获取了多普勒波；2例患者有双侧缺损。12条血管检测到MES（MES阳性组），27条血管未检测到（MES阴性组）。两组之间在临床特征上未观察到显著差异。MES阳性组的小病变数量显著高于MES阴性组（p = 0.02）。MES阳性组的皮质和浅表穿支梗死数量显著高于MES阴性组（分别为p = 0.002和0.02）。
在急性缺血性卒中中，急性期TCD检测到的MES可能会导致DWI上发现的小皮质和皮质下病变。
