Horner S, Ni X S, Weihs W, Harb S, Augustin M, Duft M, Niederkorn K
Department of Neurology, Karl Franzens University of Graz, Austria.
J Neurol Sci. 1997 Sep 1;150(1):49-57. doi: 10.1016/s0022-510x(97)05367-7.
The prevalence of a right-to-left intracardiac shunt, demonstrated by echocardiography and transcranial Doppler sonography has been shown to be higher in stroke patients than in normal controls. The aim of this study was to assess the sensitivity and specificity of contrast transcranial Doppler sonography in comparison to transesophageal echocardiography in the detection and differentiation of intracardiac and intrapulmonary shunts and to correlate the transcranial Doppler findings with clinical outcome and morphological findings. Forty five consecutive stroke patients with suspected paradoxical embolism were entered into the study. In all 25 patients with middle cerebral artery stroke of the left (56%) or right (44%) territory and echocardiographic demonstrated patent foramen ovale (80%) or intrapulmonary shunt (20%), simultaneous bilateral transcranial Doppler sonography of the middle cerebral arteries was performed after contrast medium injection during rest and valsalva straining under standardized and optimized conditions. Overall sensitivity for the detection of a right-to-left shunt by contrast transcranial Doppler sonography was 97% and overall specificity was 70%. Bilateral appearance of microbubbles, microbubble count and time delay of microbubble appearance significantly increased after valsalva straining. In patients with intracardiac shunts, a significantly higher microbubble count (32 vs. 13 in patients with an intrapulmonary shunt) and a shorter time interval of microbubble appearance (11 vs. 14 s in patients with intrapulmonary shunts) was observed. There was no correlation between the side and numerical distribution of microbubble count and the location and severity of the current clinical symptoms, as well as between microbubble count and presence and hemispherical distribution of brain infarcts. Transcranial Doppler sonography is a highly sensitive method for the detection of right-to-left shunts, whether of cardiac or pulmonary location. However. no correlation was found between the side and number of microbubbles counted and the clinical symptomatology.
经超声心动图和经颅多普勒超声检查显示，卒中患者心脏右向左分流的发生率高于正常对照组。本研究的目的是评估对比剂增强经颅多普勒超声与经食管超声心动图在检测和鉴别心内及肺内分流方面的敏感性和特异性，并将经颅多普勒超声检查结果与临床结局及形态学检查结果进行关联。45例连续入选的疑似反常栓塞的卒中患者纳入本研究。所有25例左侧（56%）或右侧（44%）大脑中动脉区域发生卒中且超声心动图显示卵圆孔未闭（80%）或肺内分流（20%）的患者，在标准化和优化条件下，于静息及瓦尔萨尔瓦动作时注射造影剂后，同时对双侧大脑中动脉进行经颅多普勒超声检查。对比剂增强经颅多普勒超声检测右向左分流的总体敏感性为97%，总体特异性为70%。瓦尔萨尔瓦动作后，微气泡的双侧出现、微气泡计数及微气泡出现的时间延迟均显著增加。在心内分流患者中，观察到微气泡计数显著更高（肺内分流患者为13个，心内分流患者为32个），微气泡出现的时间间隔更短（肺内分流患者为14秒，心内分流患者为11秒）。微气泡计数的侧别和数值分布与当前临床症状的部位和严重程度之间，以及微气泡计数与脑梗死的存在及半球分布之间均无相关性。经颅多普勒超声是检测心脏或肺部右向左分流的一种高度敏感的方法。然而，微气泡计数的侧别和数量与临床症状学之间未发现相关性。
