Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brazil.
Universidade Estadual Paulista "Júlio de Mesquita Filho", Departamento de Neurologia, Botucatu SP, Brazil.
Arq Neuropsiquiatr. 2021 Oct;79(10):859-863. doi: 10.1590/0004-282X-ANP-2020-0430.
Patent foramen ovale (PFO) has been considered a potential mechanism of embolic stroke of undetermined origin.
The aim of the present study was to identify the features of the right-to-left shunt (RLS) in patients with undetermined embolic ischemic stroke and compare them with those of patients with non-cardioembolic ischemic stroke.
A retrospective study was conducted with 168 patients with stroke and RLS separated into the following two groups: the undetermined embolic stroke group (UES group) and non-cardioembolic stroke group (NCES group). All patients were assessed by transcranial Doppler to evaluate the presence and quantification of microembolic signals (MES) at rest and under Valsalva maneuver.
Of all patients evaluated in the current study, 96 were included in the UES group and 72 in the NCES group. In the UES group, 65 patients had RLS with ≥10 MES (67.7%), which was higher than that observed in the NCES group (51.4%, p=0.038). According to the moment of the cardiac cycle, 75 patients (78.1%) in the UES group had a positive test at rest compared to 42 (58.3%) in the NCES group (p=0.007).
The current study demonstrated that almost 70% of patients with undetermined embolic stroke and PFO presented a large RLS and more than 75% had RLS at rest. These findings suggest that the size of the shunt should be taken into account when evaluating whether PFO could be a possible mechanism underlying cryptogenic stroke.
卵圆孔未闭（PFO）被认为是不明来源栓塞性卒中的潜在机制。
本研究旨在确定不明来源栓塞性缺血性卒中患者的右向左分流（RLS）特征，并将其与非心源性缺血性卒中患者进行比较。
回顾性研究纳入了 168 例卒中合并 RLS 的患者，分为不明来源栓塞性卒中组（UES 组）和非心源性缺血性卒中组（NCES 组）。所有患者均接受经颅多普勒超声检查，评估微栓子信号（MES）在静息和valsalva 动作下的存在和定量。
在本研究评估的所有患者中，96 例纳入 UES 组，72 例纳入 NCES 组。UES 组中，65 例存在≥10 个 MES 的 RLS（67.7%），高于 NCES 组（51.4%，p=0.038）。根据心动周期的瞬间，UES 组有 75 例（78.1%）在静息时检测为阳性，而 NCES 组有 42 例（58.3%）（p=0.007）。
本研究表明，近 70%的不明来源栓塞性卒中合并 PFO 患者存在较大的 RLS，且>75%的患者在静息时存在 RLS。这些发现提示在评估 PFO 是否可能是隐源性卒中的潜在机制时，应考虑分流的大小。
