Barinagarrementeria F, González-Duarte A, Cantú-Brito C
Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, México D.F., México.
Rev Neurol. 1998 Jan;26(149):85-91.
Hematological disorders per se represent unusual causes of cerebral ischemia, explaining in young people 4% of strokes. Hematological disorders that induce a thrombotic tendency contribute to overall ischemic stroke risk and may directly cause cerebral ischemia in patients without other risk factors. The frequency of cerebral infarctions caused by prothrombotic states is not known.
This review will focus on disorders such as prothrombotic coagulopaties, including resistance to activated protein C and antiphospholipid syndrome as cause of cerebral infarction. Cerebral venous thrombosis and cerebral infarction from arterial origin are the most common form of neurological involvement. Pathophysiological mechanism of stroke in these patients are multiple and can include as in antiphospholipid syndrome embolism from valves abnormalities related to hematological disturbance, as well as thrombosis of extracranial or intracranial vessels.
Is clear, however, that prothrombotic states could explains a high percentage of cases of those so called cryptogenic cerebral infarction in young people.
血液系统疾病本身是导致脑缺血的罕见原因,在年轻人中占中风病例的4%。具有血栓形成倾向的血液系统疾病会增加整体缺血性中风风险,并且可能在没有其他风险因素的患者中直接导致脑缺血。由血栓前状态引起的脑梗死发生率尚不清楚。
本综述将聚焦于血栓前凝血障碍等疾病,包括对活化蛋白C的抵抗和抗磷脂综合征作为脑梗死的病因。脑静脉血栓形成和动脉源性脑梗死是最常见的神经受累形式。这些患者中风的病理生理机制是多方面的,在抗磷脂综合征中可能包括与血液系统紊乱相关的瓣膜异常导致的栓塞,以及颅外或颅内血管的血栓形成。
然而,很明显,血栓前状态可以解释相当比例的年轻人所谓隐源性脑梗死病例。