From the Department of Neurology (M.C.M., S.C.), Cork University Hospital, Ireland.
Department of Neurointerventional Radiology (N.F.), Cork University Hospital, Ireland.
Stroke. 2020 May;51(5):1596-1599. doi: 10.1161/STROKEAHA.119.028343. Epub 2020 Mar 26.
Background and Purpose- Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods- We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results- There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32-55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions- Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.
背景与目的-局灶性脑动脉病是颈内动脉远端或大脑中动脉近端节段的单相炎症性狭窄。它是小儿急性动脉缺血性脑卒中最常见的原因之一，但对于成人神经科医生来说，这是一种不太熟悉的疾病。方法-我们回顾性分析了 2013 年 1 月至 2014 年 12 月在一家三级转诊中心的脑卒中服务放射学记录。局灶性脑动脉病定义为非进行性单发、单侧颈内动脉远端或其近端分支狭窄/不规则。仅纳入年龄 16 至 55 岁的脑卒中患者。结果-共有 5 例局灶性脑动脉病：2 例男性，3 例女性。3 例来自 123 例年轻脑卒中急性发作的队列，2 例为门诊转介。平均年龄（范围）为 43（32-55）岁。大多数患者在数天至数周内出现单一血管区域的复发性短暂性脑缺血发作/小中风。所有病例均具有特征性的影像学特征。间隔影像学检查显示 1 例缓解，3 例改善。出院时改良 Rankin 量表评分为 0-1 分，功能预后良好。1 例复发。结论-局灶性脑动脉病是年轻成年人动脉缺血性脑卒中的罕见原因。需要进行颅内随访影像学检查以与进行性动脉病相鉴别。需要进一步研究基于证据的治疗方法。预后良好。
