Lindgren A, Roijer A, Norrving B, Wallin L, Eskilsson J, Johansson B B
Department of Neurology, University Hospital, Lund, Sweden.
Stroke. 1994 Dec;25(12):2356-62. doi: 10.1161/01.str.25.12.2356.
The aim of the study was to determine the prevalences of carotid artery disease and major and minor potential cardioembolic sources (1) in patients with cerebral infarction and age-matched control subjects and (2) in different clinical subtypes of cerebral infarction.
A series of 166 consecutive patients with cerebral infarction and 59 control subjects was examined. The study protocol included clinical subtyping of the cerebral infarctions, ultrasonography of the carotid arteries, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG, and examination of the brain with computed tomography, magnetic resonance imaging, or autopsy.
Carotid artery stenosis > or = 80% or occlusion was present in 35 (21%) patients but in no control subjects (P < .001; chi 2 test). A major potential cardioembolic source was detected in 65 (39%) patients and 3 (5%) control subjects. Atrial fibrillation was present in 35 (21%) patients and 3 (5%) control subjects at initial ECG (P < .01) and in 47 (28%) patients at repeat examination; 17 patients had paroxysmal atrial fibrillation. Sinus rhythm and a major potential cardioembolic source were detected in 18 (11%) patients but in no control subjects (P < .01) at TTE (all patients and control subjects examined) or TEE (118 patients and 52 control subjects examined). The frequency of a minor potential cardioembolic source detectable at TTE or TEE was similar in the patient and control groups (51% and 53%, respectively [NS]) and increased significantly with age. A finding of carotid artery stenosis > or = 80% or occlusion, atrial fibrillation, or a major cardioembolic source detected at TTE or TEE was more frequent among patients with cortical symptoms from anterior or middle cerebral artery territories than among those with lacunar syndromes (66% versus 22%, respectively). The probable source of cerebral infarction was identified in most of the 166 patients: cardiac embolism in 28% of cases (n = 46), carotid artery disease in 8% (n = 14), both cardiac embolism and carotid artery disease in 7% (n = 11), and lacunar infarction in 23% (n = 38). In 57 (34%) of the patients no unequivocal cause of the cerebral infarction was found.
The prevalences of carotid artery and heart disease differ significantly between clinical subtypes of cerebral infarction. The cause of cerebral infarction remains uncertain in one third of patients. Because a minor potential cardioembolic source occurs in about 50% of both patients and control subjects, this finding is of questionable value as a risk factor for stroke in the elderly.
本研究旨在确定（1）脑梗死患者及年龄匹配的对照者中颈动脉疾病以及主要和次要潜在心源性栓子来源的患病率，以及（2）不同临床亚型脑梗死患者中上述情况的患病率。
对166例连续的脑梗死患者和59例对照者进行了检查。研究方案包括脑梗死的临床分型、颈动脉超声检查、经胸超声心动图（TTE）、经食管超声心动图（TEE）、心电图检查以及头颅计算机断层扫描、磁共振成像或尸检。
35例（21%）患者存在颈动脉狭窄≥80%或闭塞，而对照者中无此情况（P<.001；卡方检验）。65例（39%）患者和3例（5%）对照者检测到主要潜在心源性栓子来源。初始心电图检查时，35例（21%）患者和3例（5%）对照者存在房颤（P<.01），复查时47例（28%）患者存在房颤；17例患者为阵发性房颤。在所有接受检查的患者和对照者的TTE检查中（或接受检查的118例患者和52例对照者的TEE检查中），18例（11%）患者检测到窦性心律和主要潜在心源性栓子来源，而对照者中无此情况（P<.01）。在TTE或TEE检查中可检测到的次要潜在心源性栓子来源在患者组和对照组中的频率相似（分别为51%和53%[无显著性差异]），且随年龄显著增加。在前循环或中循环皮质症状的患者中检测到颈动脉狭窄≥80%或闭塞、房颤或TTE或TEE检查中发现的主要心源性栓子来源的频率高于腔隙综合征患者（分别为66%和22%）。在166例患者中的大多数患者中确定了脑梗死的可能病因：28%（n = 46）为心源性栓塞，8%（n = 14）为颈动脉疾病，7%（n = 11）为心源性栓塞和颈动脉疾病两者，23%（n = 38）为腔隙性梗死。57例（34%）患者未发现明确的脑梗死病因。
脑梗死不同临床亚型之间颈动脉和心脏病的患病率存在显著差异。三分之一的患者脑梗死病因仍不确定。由于次要潜在心源性栓子来源在患者和对照者中约50%的人中出现，因此这一发现作为老年人中风的危险因素其价值存疑。
