Simaan Naaem, Jubeh Tamer, Shalabi Fatma, Jubran Hamza, Metanis Issa, Parag Yoav, Schwartzman Yoel, Magadlla Jad, Gomori John M, Beiruti Karine Wiegler, Cohen Jose E, Leker Ronen
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel.
J Clin Med. 2023 Dec 29;13(1):189. doi: 10.3390/jcm13010189.
(1) Background: The mechanism responsible for stroke in patients younger than 50 often remains unknown. This study was designed to assess whether high-resolution intracranial vessel wall MR imaging (icVWI) may be instrumental in determining stroke cause. (2) Methods: Young stroke patients with and without an identified cause of stroke despite an exhaustive investigation were prospectively included. Patients who underwent icVWI were compared to those who did not. We next compared patients with and without intracranial vulnerable plaques on icVWI. (3) Results: Overall, 47 young stroke patients were identified over the span of 2 years and included in this study. Of those, 20 (42%) underwent intracranial icVWI. Cancer prevalence was higher among patients who did not have an icVWI study (19% vs. 0% = 0.042) but there were no other significant differences between patients who had an icVWI study and those who did not have an icVWI. Among patients who had an icVWI, 11 (55%) had vulnerable plaques and the remaining nine studies were negative. Patients with positive icVWI scans had significantly higher stroke severity at admission (mean ± SD NIHSS score 5.5 ± 3.5 vs. 1.7 ± 2.3, = 0.012). Patients with positive icVWI scans were more often treated with antiplatelets upon discharge (100% vs. 67%, = 0.038). (4) Conclusions: icVWI can add significant information relevant to stroke pathogenesis and secondary prevention among young stroke patients with a negative exhaustive diagnostic workup.
（1）背景：50岁以下患者中风的发病机制通常仍不明晰。本研究旨在评估高分辨率颅内血管壁磁共振成像（icVWI）是否有助于确定中风病因。（2）方法：前瞻性纳入尽管经过详尽检查但仍有或无明确中风病因的年轻中风患者。对接受icVWI检查的患者与未接受该检查的患者进行比较。接下来，我们比较了icVWI检查中有和无颅内易损斑块的患者。（3）结果：总体而言，在2年的时间跨度内共确定了47例年轻中风患者并纳入本研究。其中，20例（42%）接受了颅内icVWI检查。未进行icVWI检查的患者中癌症患病率更高（19%对0%，P = 0.042），但接受icVWI检查的患者与未接受icVWI检查的患者之间没有其他显著差异。在接受icVWI检查的患者中，11例（55%）有易损斑块，其余9例检查结果为阴性。icVWI扫描阳性的患者入院时中风严重程度显著更高（平均±标准差美国国立卫生研究院卒中量表（NIHSS）评分5.5±3.5对1.7±2.3，P = 0.012）。icVWI扫描阳性的患者出院时更常接受抗血小板治疗（100%对67%，P = 0.038）。（4）结论：对于经过详尽诊断检查仍为阴性的年轻中风患者，icVWI可为中风发病机制及二级预防提供重要信息。
