Venketasubramanian N, Sacco R L, Di Tullio M, Sherman D, Homma S, Mohr J P
Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY.
Neurology. 1993 Aug;43(8):1533-5. doi: 10.1212/wnl.43.8.1533.
Paradoxical embolism through a patent foramen ovale is a contributory mechanism to stroke and may be diagnosed by contrast echocardiography. The intracranial distribution of these emboli has not been previously reported.
We used transcranial Doppler combined with agitated saline contrast injection to determine whether there was a preferential distribution of the contrast into the anterior or posterior intracranial circulation of patients with an acute stroke or transient ischemic attack.
Forty-nine patients were studied--27 men and 22 women, with a mean age of 62.7 +/- 13.3 years (range, 29 to 85 years). Microcavitations were detected in the proximal right middle cerebral artery in 12 of 49 patients (24%). A patent foramen ovale was confirmed in all cases by simultaneous transesophageal echocardiography. Of the 12 patients, microcavitations were also detected in the proximal basilar artery in nine (75%).
While paradoxical embolism appears to occur more frequently in the anterior circulation, the high rate of detection of microcavitations in the basilar artery suggests that paradoxical embolism to the posterior intracranial circulation may be more frequent than generally believed.
通过卵圆孔未闭发生的反常栓塞是导致中风的一种机制，可通过超声心动图造影进行诊断。此前尚未有关于这些栓子在颅内分布情况的报道。
我们采用经颅多普勒结合注射搅动生理盐水造影剂，以确定急性中风或短暂性脑缺血发作患者的造影剂是否优先分布于颅内前循环或后循环。
共研究了49例患者，其中男性27例，女性22例，平均年龄62.7±13.3岁（范围29至85岁）。49例患者中有12例（24%）在右侧大脑中动脉近端检测到微气泡。所有病例均通过同步经食管超声心动图证实存在卵圆孔未闭。在这12例患者中，有9例（75%）在基底动脉近端也检测到微气泡。
虽然反常栓塞似乎在前循环中更常发生，但基底动脉中微气泡的高检出率表明，反常栓塞至颅内后循环可能比一般认为的更为常见。
