Itoh T, Matsumoto M, Handa N, Maeda H, Hougaku H, Tsukamoto Y, Kondo H, Tanouchi J, Kamada T
First Department of Internal Medicine, Osaka University Medical School, Japan.
Stroke. 1994 Apr;25(4):771-5. doi: 10.1161/01.str.25.4.771.
This study was designed to test the hypothesis that paradoxical embolization would be a cause of embolic strokes and transient ischemic attacks in patients with stroke of uncertain etiology in all age groups.
Thirty patients who had stroke of uncertain etiology were studied. They were divided into the following three groups: 13 patients with sudden onset (group A), 11 patients with subacute onset (group B), and 6 asymptomatic stroke patients (group C). Eleven patients with stroke of obvious etiology (group D) and 11 normal healthy volunteers (group E) were also studied as controls. In all patients transcranial Doppler sonography and contrast echocardiography were recorded simultaneously after intravenous injection of the contrast medium. Findings of positive patient foramen ovale in contrast echocardiography or "chirp" sounds in transcranial Doppler sonography were defined as positive for paradoxical contrast embolization. Radioisotope phlebography of the lower extremities and pulmonary scintigraphy, using technetium-99 macroaggregated albumin, were performed in all 17 patients who had positive findings of paradoxical contrast embolization and in 12 patients whose findings were negative.
Positive findings of paradoxical contrast embolization were found in 17 subjects by transcranial Doppler sonography but in only 8 on contrast echocardiography. These positive findings were detected more frequently in group A (77%) than in groups B, D, and E (9%, 18%, and 9%, respectively) (P < .05). In group C, 4 of 6 patients (67%) had positive findings. There were positive findings on both phlebography and pulmonary scintigraphy only in 6 group A patients, with positive findings of paradoxical contrast embolization.
Transcranial Doppler sonography is a sensitive detector of right-to-left shunts. Paradoxical cerebral embolization might be frequent in patients with stroke of unknown etiology, especially when the stroke is of sudden onset.
本研究旨在验证以下假设，即反常栓塞是各年龄组病因不明性卒中患者发生栓塞性卒中和短暂性脑缺血发作的一个原因。
对30例病因不明性卒中患者进行研究。他们被分为以下三组：13例急性起病患者（A组），11例亚急性起病患者（B组），以及6例无症状性卒中患者（C组）。还研究了11例病因明确的卒中患者（D组）和11名正常健康志愿者（E组）作为对照。所有患者在静脉注射造影剂后同时记录经颅多普勒超声检查和对比超声心动图检查结果。对比超声心动图检查发现卵圆孔未闭阳性或经颅多普勒超声检查出现“啁啾”声被定义为反常对比剂栓塞阳性。对17例反常对比剂栓塞检查结果阳性的患者和12例检查结果阴性的患者进行了下肢放射性核素静脉造影和使用锝-99大聚合白蛋白的肺闪烁扫描。
经颅多普勒超声检查发现17例患者存在反常对比剂栓塞阳性结果，但对比超声心动图检查仅发现8例。这些阳性结果在A组（77%）中比在B组、D组和E组（分别为9%、18%和9%）中更频繁地被检测到（P < 0.05）。在C组中，6例患者中有4例（67%）有阳性结果。仅6例A组患者在静脉造影和肺闪烁扫描中均有阳性结果，这些患者存在反常对比剂栓塞阳性结果。
经颅多普勒超声检查是检测右向左分流的敏感方法。反常性脑栓塞在病因不明性卒中患者中可能很常见，尤其是当卒中为急性起病时。
