Takano K, Yamaguchi T, Minematsu K, Sawada T, Omae T
Department of Medicine, National Cardiovascular Center, Osaka.
Intern Med. 1998 Feb;37(2):141-8. doi: 10.2169/internalmedicine.37.141.
A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia.
基于推测的卒中发病机制进行诊断，对急性缺血性卒中的管理策略很有用。仅依据严格的脑血管造影标准，诊断出92例栓塞性（心源性或动脉到动脉）卒中和107例非栓塞性（血栓形成性或血流动力学性）卒中患者。为了清晰区分这两组，随后比较了神经学和计算机断层扫描（CT）结果。发病速度、呕吐、尿失禁、意识水平、颈部杂音、瞳孔不等大、舌偏斜、感觉障碍以及CT结果（低密度区位置、脑水肿和出血性转化结果）是两组之间的鉴别因素（p<0.01）。根据这11项内容，我们编制了一个用于定量鉴别诊断的数值表。内部验证中栓塞性卒中和非栓塞性卒中的诊断准确率分别为98.9%和87.9%，外部验证中分别为90.0%和82.9%。栓塞性卒中和非栓塞性卒中在临床特征和CT结果上的差异，可能反映了脑动脉闭塞过程的病理生理机制以及缺血的范围和严重程度。
