Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Neurol Sci. 2012 Jan 15;312(1-2):127-30. doi: 10.1016/j.jns.2011.08.004. Epub 2011 Aug 26.
The etiologic diagnosis of intracranial arterial occlusion is sometimes challenging because of the dynamic nature of acute stroke. We investigated whether short-term follow-up vascular imaging adds additional information to the differential diagnosis between intracranial atherosclerotic and embolic occlusion.
Acute ischemic stroke patients with symptomatic middle cerebral artery (MCA) occlusion on MR angiography (MRA) within 24h of symptom onset were included. Follow-up MRA was performed 5-7days after stroke onset. Stroke subtypes were independently determined at baseline and follow-up MRAs based on clinical, laboratory and imaging findings.
In the 108 included patients, the most common etiologic subtype of initial stroke was intracranial large artery atherosclerosis (ICLAA) in 70 patients, followed by cardioembolism in 29 and other causes in 9. On follow-up MRA, 32 (29.6%) patients showed either significant or complete recanalization. Of these, 10 had been originally diagnosed with ICLAA, but were reclassified as a cryptogenic mechanism after follow-up MRA. Multiple logistic regression analysis showed that the presence of coexisting arterial atherosclerosis (odds ratio [OR], 6.91; 95% confidence interval [CI], 2.67-17.91; p<0.001); the absence of large territorial infarction (OR, 4.06; 95% CI, 1.39-11.85; p=0.010); and smoking (OR, 2.54; 95% CI, 1.028-6.29; p=0.043) were significantly associated with a final diagnosis of ICLAA.
In the absence of follow-up vascular imaging, a substantial proportion of patients with intracranial middle cerebral arterial occlusion may be misdiagnosed as ICLAA. Evaluation of early dynamic changes in intracranial middle cerebral arterial occlusion may provide useful information for the differential diagnosis of intrinsic atherosclerosis and embolic occlusion.
由于急性脑卒中的动态性质，颅内动脉闭塞的病因诊断有时具有挑战性。我们研究了短期随访血管成像是否为颅内动脉粥样硬化性和栓塞性闭塞的鉴别诊断提供了额外的信息。
纳入发病 24 小时内磁共振血管造影（MRA）显示症状性大脑中动脉（MCA）闭塞的急性缺血性脑卒中患者。在卒中发病后 5-7 天进行随访 MRA。根据临床、实验室和影像学表现，在基线和随访 MRA 上独立确定卒中亚型。
在 108 例纳入患者中，初始卒中最常见的病因亚型是颅内大动脉粥样硬化（ICLAA），共 70 例，其次是心源性栓塞（29 例）和其他原因（9 例）。在随访 MRA 中，32 例（29.6%）患者显示明显或完全再通。其中，10 例最初被诊断为 ICLAA，但在随访 MRA 后被重新分类为隐匿性机制。多因素逻辑回归分析显示，共存动脉粥样硬化（比值比[OR]，6.91；95%置信区间[CI]，2.67-17.91；p<0.001）、无大面积区域性梗死（OR，4.06；95%CI，1.39-11.85；p=0.010）和吸烟（OR，2.54；95%CI，1.028-6.29；p=0.043）与最终诊断为 ICLAA 显著相关。
如果没有随访血管成像，颅内大脑中动脉闭塞的患者中有相当一部分可能被误诊为 ICLAA。评估颅内大脑中动脉闭塞的早期动态变化可能为内在动脉粥样硬化和栓塞闭塞的鉴别诊断提供有用信息。
