Friedlander A H, Manesh F, Wasterlain C G
Veterans Affairs Medical Center, Sepulveda, Calif.
Oral Surg Oral Med Oral Pathol. 1994 Jun;77(6):669-73. doi: 10.1016/0030-4220(94)90332-8.
Cerebrovascular accidents are responsible for killing or disabling half a million Americans every year and are the third leading cause of death in this country. Finding cost-effective means of decreasing stroke mortality and morbidity is of great humanitarian and economic importance. Panoramic dental radiography was done on 19 white men who had a recent cerebrovascular accident and who were hospitalized at a Department of Veteran Affairs medical center. Inclusion criteria included clinical suspicion or imaging study evidence that the stroke arose from atheroembolic disease of the carotid artery bifurcation. Women were omitted from the study because of their paucity in the patient pool, and African-Americans and Asian-Americans were omitted because strokes in those groups usually develop as a result of disease of intracranial vessels. Carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below intervertebral space C3-4 were noted in seven persons (37%). These patients had an average age of 65 years and demonstrated multiple risk factors (prior transient ischemic attacks, prior stroke, hypertension, obesity, tobacco and alcohol abuse, hyperlipidemia) associated with occurrence of a stroke. We concluded that some white men at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph and medical history. The presence of carotid artery calcifications demands an expeditious referral to an appropriate practitioner who can assist in the control of risk factors and arrange prophylactic surgical removal of the carotid arterial plaque, which are both safe and reliable methods of reducing the incidence of stroke.
脑血管意外每年导致50万美国人死亡或致残，是该国第三大死因。找到具有成本效益的降低中风死亡率和发病率的方法具有重大的人道主义和经济意义。对19名近期发生脑血管意外且在退伍军人事务部医疗中心住院的白人男性进行了全景牙科X光检查。纳入标准包括临床怀疑或影像学研究证据表明中风由颈动脉分叉处的动脉粥样硬化栓塞性疾病引起。由于患者群体中女性数量稀少，因此将女性排除在研究之外；由于非裔美国人和亚裔美国人的中风通常是由颅内血管疾病引起的，因此也将他们排除在外。在7人（37%）中发现颈动脉钙化表现为在C3-4椎间隙或以下与颈椎相邻的不透射线的结节状肿块。这些患者的平均年龄为65岁，表现出与中风发生相关的多种风险因素（既往短暂性脑缺血发作、既往中风、高血压、肥胖、吸烟和酗酒、高脂血症）。我们得出结论，通过对全景牙科X光片和病史进行适当检查，在牙医办公室可能识别出一些有脑血管意外风险的白人男性。颈动脉钙化的存在需要迅速转诊给合适的医生，该医生可以协助控制风险因素并安排预防性手术切除颈动脉斑块，这两种方法都是降低中风发病率的安全可靠方法。
