Ito Hirono, Kano Osamu, Ikeda Ken
Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2008 Jan-Feb;17(1):35-8. doi: 10.1016/j.jstrokecerebrovasdis.2007.11.002.
We studied whether some variables differ between patients with right and left hemispheric ischemic stroke. A total of 383 cases were obtained from our department-based records between April 2003 and March 2006. Age distribution, sex, intracranial localization of anterior (carotid artery distribution) or posterior (vertebrobasilar artery distribution) circulation, mechanism subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, cerebrovascular risk factors, and time from clinical onset to admission were analyzed between the right and the left hemispheric ischemic stroke groups. In all, 200 patients had left hemispheric stroke and 183 patients had right hemispheric stroke. Age, sex, vascular risk profile, stroke subtypes, and mechanism subtypes were not statistically different between patients with right- and left-sided ischemic stroke. Time interval from neurologic onset to admission within 6 hours was significantly associated with left hemispheric cerebral infarction. Furthermore, patients with left-sided small-vessel occlusion visited our hospital earlier, up to 6 hours as compared with patients with right-sided small-vessel occlusion (P < .05). We suppose that patients with right-sided small-vessel occlusion may take time to be aware of neurologic deficits because of nondominant language or hand function. Our data indicate that different medical attention exists between patients with right and left hemispheric ischemic stroke. We should pay more attention to the difficulty in recognizing the neurologic deficits in patients with right hemisphere ischemic stroke, so that those patients delay hospital visit.
我们研究了右半球和左半球缺血性卒中患者之间某些变量是否存在差异。2003年4月至2006年3月期间,我们从科室记录中获取了总共383例病例。对右半球和左半球缺血性卒中组的年龄分布、性别、前循环(颈动脉分布)或后循环(椎基底动脉分布)的颅内定位、根据急性卒中治疗中Org 10172试验(TOAST)标准的机制亚型、脑血管危险因素以及从临床发病到入院的时间进行了分析。其中,200例患者为左半球卒中,183例患者为右半球卒中。右侧和左侧缺血性卒中患者在年龄、性别、血管风险状况、卒中亚型和机制亚型方面无统计学差异。神经症状发作后6小时内入院的时间间隔与左半球脑梗死显著相关。此外,左侧小血管闭塞的患者比右侧小血管闭塞的患者更早来我院就诊,相差可达6小时(P <.05)。我们推测,右侧小血管闭塞的患者可能由于非优势语言或手部功能而需要时间来意识到神经功能缺损。我们的数据表明,右半球和左半球缺血性卒中患者之间存在不同的医疗关注情况。我们应更加关注右半球缺血性卒中患者在识别神经功能缺损方面的困难,因为这些患者会延迟就诊。