Kostuk W J, Boughner D R, Barnett H J, Silver M D
Lancet. 1977 Aug 13;2(8033):313-6. doi: 10.1016/s0140-6736(77)91482-9.
During a prospective trial of platelet-inhibiting drugs in patients with transient ischaemic attacks (T.I.A.s), 14 patients had serious neurological dysfunction and normal cerebral angiograms. The patients (mean age 37 years) had neurological episodes over a period of 1-4 years consisting of acute non-progressive strokes with residual symptoms. In 3 patients, the two cerebral hemispheres were involved on different occasions. Cerebral angiograms showed no significant atheromatous disease in the intracranial or extracranial vessels. 3 patients had mid-systolic clicks, 5 had systolic murmurs, and 2 patients had both a click and a murmur. Holter electrocardiographic monitoring revealed atrial, junctional, or ventricular extrasystoles (5 patients), paroxysmal atrial fibrillation (3), and paroxysmal ventricular tachycardia (1). Left ventricular angiography confirmed mitral-leaflet prolapse in all the patients. The focal nature of the T.I.A.s suggests an embolic event, the embolus arising from the abnormal mitral valve. In a patient not included in this series, a small antemortem left atrial thrombus was found at necropsy.
在一项针对短暂性脑缺血发作（TIA）患者的血小板抑制药物前瞻性试验中，14名患者出现严重神经功能障碍但脑血管造影正常。这些患者（平均年龄37岁）在1至4年期间出现神经发作，包括急性非进行性中风并伴有残留症状。3名患者在不同时间双侧大脑半球均受累。脑血管造影显示颅内或颅外血管无明显动脉粥样硬化病变。3名患者有收缩中期喀喇音，5名有收缩期杂音，2名患者既有喀喇音又有杂音。动态心电图监测显示房性、交界性或室性早搏（5名患者）、阵发性心房颤动（3名）和阵发性室性心动过速（1名）。左心室造影证实所有患者均有二尖瓣脱垂。TIA的局灶性提示为栓塞事件，栓子源于异常的二尖瓣。在该系列未纳入的一名患者尸检时发现生前左心房有一小血栓。
