Department of Neurology, Toho University Omori Medical Center, 6-11-1, Omorinishi, Otaku, Tokyo, 143-8541, Japan.
J Neurol Sci. 2010 Nov 15;298(1-2):42-5. doi: 10.1016/j.jns.2010.08.069.
Cerebral aneurysms (CA) are incidentally detected by magnetic resonance angiography (MRA) in acute stroke patients or asymptomatic volunteers. We investigated whether incidental CA influences stroke subtypes and clinical outcome of patients with acute brain infarction (BI) and hemorrhage (BH). Moreover, frequency and neuroradiological profile of incidental CA were compared between acute stroke patients and asymptomatic healthy controls. We included consecutive BI and BH patients who underwent magnetic resonance imaging and MRA within 7 days from clinical onset. CA diagnosis was performed by 3-dimensional time-of-flight MRA. Demographics, risk factors, stroke subtypes, and modified Rankin scale (mRS) at 3 months after stroke were assessed. Incidental CA was detected in 18 (3.7%) of 481 stroke patients, 13 (3.5%) of 374 BI patients, 5 (4.7%) of 107 BH patients, and 146 (2.0%) of 7345 controls. Multivariate analysis showed no significant differences in CA frequency between BI, BH, and control groups. Female sex was associated independently with incidental CA in the stroke (P<0.01), BI (P<0.05), BH (P<0.05), and healthy control groups (P<0.01). No statistical differences in CA size and location between the 4 groups were found. BI subtypes and BH sites were not correlated with incidental CA. CA rupture or subarachnoid hemorrhage did not occur until 3 months after stroke. The 3-month mRS score did not differ between stroke patients with and without CA. Prevalence of incidental CA did not differ statistically among stroke, BI, BH patients and healthy asymptomatic subjects. The 3-month mRS score was not affected by incidental CA. Female sex was only an independent factor for incidental CA. Thus, we should pay more attention to incidental CA in female BI patients treated with tissue plasminogen activator.
颅内动脉瘤（CA）在急性脑卒中患者或无症状志愿者中通过磁共振血管造影（MRA）偶然发现。我们研究了偶然发现的 CA 是否影响急性脑梗死（BI）和脑出血（BH）患者的脑卒中亚型和临床结局。此外，还比较了急性脑卒中患者和无症状健康对照者偶然 CA 的频率和神经影像学特征。我们纳入了发病后 7 天内接受磁共振成像和 MRA 的连续 BI 和 BH 患者。通过三维时间飞越 MRA 进行 CA 诊断。评估了人口统计学、危险因素、脑卒中亚型和脑卒中后 3 个月的改良 Rankin 量表（mRS）评分。在 481 例脑卒中患者中发现 18 例（3.7%），374 例 BI 患者中发现 13 例（3.5%），107 例 BH 患者中发现 5 例（4.7%），7345 例对照组中发现 146 例（2.0%）。多变量分析显示，BI、BH 和对照组之间 CA 的频率无显著差异。女性与脑卒中（P<0.01）、BI（P<0.05）、BH（P<0.05）和健康对照组（P<0.01）中的偶然 CA 独立相关。4 组之间 CA 大小和位置无统计学差异。BI 亚型和 BH 部位与偶然 CA 无关。CA 破裂或蛛网膜下腔出血直到脑卒中后 3 个月才发生。有和无 CA 的脑卒中患者 3 个月 mRS 评分无差异。脑卒中、BI、BH 患者和健康无症状者偶然 CA 的发生率无统计学差异。偶然 CA 不影响 3 个月 mRS 评分。女性是偶然 CA 的唯一独立因素。因此，我们应该更加关注接受组织型纤溶酶原激活剂治疗的 BI 女性患者中的偶然 CA。
