Böjti Péter, Bartha Noémi Eszter, May Zsolt, Bereczki Dániel, Fülöp Szilvia, Szakács Zoltán, Szilágyi Géza
Magyar Honvédség Egészségügyi Központ, Neurológiai Osztály, Budapest, Magyarország.
Semmelweis Egyetem, Szentágothai János Idegtudományi Doktori Iskola, Budapest, Magyarország.
Ideggyogy Sz. 2018 May 30;71(5-06):169-177. doi: 10.18071/isz.71.0169.
After routine workup, 23-25% of ischemic strokes etiology remains unknown, i.e. cryptogenic. However, according to international results pathogenic patent foramen ovale (PFO) reveals in 25% of these cases. Aim of our retrospective study to prove the substantial etiological role of PFO-related stroke (PFO-RS) in cryptogenic strokes (CS), and to identify age related differences in stroke etiology.
All new ischemic strokes of 2014-2015 were classified by ASCOD (Atherosclerosis, Small-vessel disease, Cardiac pathology, Other, Dissection) phenotyping. CS was defined when the etiology was unknown. With the help of special ultrasound techniques and RoPE (Risk of Paradoxical Embolism) score the portion of PFO-RS were determined in the examined CS population. Moreover, etiological distribution and differences between age groups (<40, 40-60, >60 years) were described.
During the examined period, 8.12% of 985 new ischemic strokes were categorized as CS. 41.38% of examined CS were found to be PFO-related. PFO-RS were considerably more frequent in the younger age groups than in the older age groups. The probability of appearance of PFO-RS were significantly higher in younger age than in case of age independency. Our results verify the substantial etiological role of PFO-RS in CS, and confirm the essential role of contrast enhanced functional transcranial Doppler in the routine diagnostic workup. Age related differences in stroke etiology were found to be statistically significant (p=0.000, df=14), in which small-vessel disease, cardiac pathology, dissection, other pathologies, CS and PFO-RS were contributed significantly.
Based on our results, till in young age rare etiologies are typical, while in older age classical etiologies are mainly characteristic.
经过常规检查后，23% - 25%的缺血性中风病因仍不明，即隐源性。然而，根据国际研究结果，在这些病例中25%发现有致病性卵圆孔未闭（PFO）。我们这项回顾性研究的目的是证明PFO相关中风（PFO - RS）在隐源性中风（CS）中具有重要的病因学作用，并确定中风病因与年龄的相关性差异。
对2014 - 2015年所有新发缺血性中风病例按ASCOD（动脉粥样硬化、小血管病、心脏病变、其他、夹层）表型进行分类。当病因不明时定义为CS。借助特殊超声技术和矛盾栓塞风险（RoPE）评分，在接受检查的CS人群中确定PFO - RS的比例。此外，还描述了病因分布以及不同年龄组（<40岁、40 - 60岁、>60岁）之间的差异。
在检查期间，985例新发缺血性中风中有8.12%被归类为CS。在接受检查的CS病例中，41.38%被发现与PFO相关。PFO - RS在较年轻年龄组中比在较年长年龄组中更为常见。较年轻年龄组中PFO - RS出现的概率明显高于与年龄无关的情况。我们的结果证实了PFO - RS在CS中的重要病因学作用，并确认了对比增强功能经颅多普勒在常规诊断检查中的重要作用。发现中风病因与年龄的相关性差异具有统计学意义（p = 0.000，自由度 = 14），其中小血管病、心脏病变、夹层、其他病变、CS和PFO - RS的贡献显著。
基于我们的结果，在年轻人群中罕见病因较为典型，而在老年人群中主要以经典病因为特征。
