在日本，右向左分流可能是短暂性脑缺血发作（TIA）并不少见的病因。

Right-to-left shunts may be not uncommon cause of TIA in Japan.

作者信息

Tateishi Yohei, Iguchi Yasuyuki, Kimura Kazumi, Kobayashi Kazuto, Shibazaki Kensaku, Eguchi Katsumi

机构信息

Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan.

出版信息

J Neurol Sci. 2009 Feb 15;277(1-2):13-6. doi: 10.1016/j.jns.2008.09.035. Epub 2008 Nov 5.

DOI:10.1016/j.jns.2008.09.035

PMID:18990412

Abstract

BACKGROUND AND PURPOSE

Although 30% to 60% of transient ischemic attacks (TIAs) have embolic sources, the etiology of the remaining TIAs is unknown. Right-to-left shunt (RLS) is one of the most important etiologies of cryptogenic stroke. The aim of this study was to determine whether RLS is related to transient ischemic attack (TIA) of unknown etiology.

METHODS

We performed transesophageal echocardiography (TEE) and/or transcranial Doppler (TCD) studies for consecutive TIA patients in order to detect RLS from April 2004 to December 2006. TIA patients were divided into three groups, as follows: 1) Cardioembolic TIA, with a patent cardioembolic source, 2) thrombotic TIA, with an atherothrombotic and/or lacunar mechanism, and 3) undetermined TIA, without identified cause of TIA. We compared the characteristics and presence of RLS among these three groups.

RESULTS

We enrolled 124 TIA patients (age: 67+/-13 years old, 80 men). There were 13 patients with Cardioembolic TIA, 25 with Thrombotic TIA, and 86 with Undetermined TIA. TEE and/or TCD were able to detect RLS in 61 of the 124 (49%) patients. RLS was frequent in patients with Undetermined TIA compared with those in the other TIA groups (60% in the Undetermined TIA group, 28% in the Thrombotic TIA group, and 15% in the Cardioembolic TIA group; p<0.001). Smoking and previous history of TIA were frequent in the Thrombotic TIA group (p=0.030 and p=0.016, respectively).

CONCLUSION

RLS may play an important role in the etiology of TIA of undetermined cause.

摘要

背景与目的

尽管30%至60%的短暂性脑缺血发作（TIA）有栓子来源，但其余TIA的病因尚不清楚。右向左分流（RLS）是隐源性卒中的最重要病因之一。本研究的目的是确定RLS是否与病因不明的短暂性脑缺血发作（TIA）有关。

方法

从2004年4月至2006年12月，我们对连续的TIA患者进行经食管超声心动图（TEE）和/或经颅多普勒（TCD）检查，以检测RLS。TIA患者分为三组，如下：1）心源性TIA，有明确的心源性栓子来源；2）血栓性TIA，有动脉粥样硬化血栓形成和/或腔隙性机制；3）不明原因TIA，未明确TIA病因。我们比较了这三组患者的特征及RLS的存在情况。

结果

我们纳入了124例TIA患者（年龄：67±13岁，男性80例）。其中13例为心源性TIA，25例为血栓性TIA，86例为不明原因TIA。124例患者中有61例（49%）通过TEE和/或TCD检测到RLS。与其他TIA组相比，不明原因TIA组患者中RLS更为常见（不明原因TIA组为60%，血栓性TIA组为28%，心源性TIA组为15%；p<0.001）。血栓性TIA组患者吸烟和既往TIA病史更为常见（分别为p=0.030和p=0.016）。