Dennis M, Bamford J, Sandercock P, Molyneux A, Warlow C
University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.
J Neurol. 1990 Jul;237(4):257-61. doi: 10.1007/BF00314630.
In a prospective community-based study, 184 patients with transient ischaemic attacks (TIAs) were identified from a study population of about 105,000 between 1981 and 1986. Computed tomography (CT) was attempted in all those with cerebral ischaemic attacks (n = 152, 83%); patients with amaurosis fugax only (n = 32, 27%) were not scanned routinely. Scans were obtained in 120 (79%) of those with cerebral attacks and 12 (38%) of those with amaurosis fugax. The scans were reported by a neuroradiologist who was blinded to the patients' clinical features. Of 120 (27%:95% confidence interval 19-35) scans in patients with cerebral attacks, 32 showed a focal area of hypodensity or cortical loss, but in only 14 (12%:95% confidence interval 6-18) was this in an area of the brain appropriate to the patients' symptoms. There were no significant differences in the clinical features, the duration of attacks or the prognosis (i.e., risk of death, stroke or myocardial infarction) of patients with and without ischaemic lesions on CT. It is concluded that patients with clinically definite TIAs who have a presumed ischaemic and appropriately sited lesion on CT should not be re-classified as having had a stroke.
在一项基于社区的前瞻性研究中，1981年至1986年间，从约105,000人的研究人群中确定了184例短暂性脑缺血发作（TIA）患者。对所有脑缺血发作患者（n = 152，83%）均尝试进行计算机断层扫描（CT）；仅患有一过性黑矇的患者（n = 32，27%）未进行常规扫描。脑缺血发作患者中有120例（79%）进行了扫描，一过性黑矇患者中有12例（38%）进行了扫描。扫描结果由一位对患者临床特征不知情的神经放射科医生报告。在脑缺血发作患者的120次扫描中（27%：95%置信区间19 - 35），32次显示有局灶性低密度区或皮质缺失，但其中只有14次（12%：95%置信区间6 - 18）位于与患者症状相符的脑区。CT上有或没有缺血性病变的患者在临床特征、发作持续时间或预后（即死亡、中风或心肌梗死风险）方面没有显著差异。得出的结论是，临床确诊为TIA且CT上有假定的缺血性且位置合适的病变的患者不应重新归类为发生过中风。
