本文選題：急性腦梗死 + 彌散加權(quán)成像陰性��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討疑似急性腦梗死(Acute cerebral infarction,ACI)而彌散加權(quán)成像(diffusion weighted imaging,DWI)陰性患者的臨床特點(diǎn),包括病因、臨床表現(xiàn)、影像學(xué)表現(xiàn)、預(yù)后等。[方法]收集2011年1月至2016年6月于昆明醫(yī)科大學(xué)第四附屬醫(yī)院神經(jīng)內(nèi)科就診的DWI陰性的疑似急性腦梗死患者信息,匯總資料回顧性分析其人口學(xué)特征、病因、臨床特點(diǎn)等。[結(jié)果]共收集由我院神經(jīng)內(nèi)科醫(yī)生初步診斷為急性腦梗死而DWI陰性的患者73例,其中男性患者與女性患者分別為45例、28例,73例患者中位數(shù)年齡68歲(四分位數(shù)間距60-76)。從發(fā)病到完成DWI檢查的中位數(shù)時(shí)間為420 min(四分位數(shù)間距255-640)。美國國立衛(wèi)生研究院卒中量表(National institutes of Health Stroke Scale,NIHSS)評(píng)分中位數(shù)為3分(四分位數(shù)間距1-4)。73例患者中有48例(65.8%)最終診斷為急性腦梗死,25例(34.2%)最終診斷為其他疾病。最終診斷為急性腦梗死的48例患者中,有13例(27.1%)患者經(jīng)過重新閱片后發(fā)現(xiàn)梗死灶,有1例(2.1%)患者癥狀加重后復(fù)查DWI發(fā)現(xiàn)梗死灶,9例(18.8%)患者癥狀未加重復(fù)查DWI發(fā)現(xiàn)梗死灶,2例(4.2%)患者癥狀加重后復(fù)查DWI仍未發(fā)現(xiàn)梗死灶,但有可以解釋癥狀的頭頸部計(jì)算機(jī)斷層掃描血管造影(Computed Tomography Angiography,CTA)大血管閉塞/狹窄或顱腦計(jì)算機(jī)斷層掃描灌注成像(Computed Tomography Perfusion,CTP)低灌注區(qū),13例(27.1%)患者癥狀未加重且復(fù)查DWI陰性但頭頸部CTA有可以解釋癥狀的大血管閉塞/狹窄或顱腦CTP低灌注區(qū),10例(20.8%)患者復(fù)查DWI陰性且未見大血管異常。診斷為急性腦梗死的48例患者,根據(jù)急性卒中治療低分子肝素試驗(yàn)病因分型法(Trial of Org 10172 in acute stroke treatment,TOAST),23 例(47.9%)為大動(dòng)脈粥樣硬化,25 例(52.1%)為小動(dòng)脈閉塞。診斷為其他疾病的25例患者中,有12例(48%)診斷為短暫性腦缺血發(fā)作(Transient ischemic attack,TIA),4例(16%)診斷為良性發(fā)作性位置性眩暈,診斷為其他疾病者較少見。[結(jié)論]1.DWI陰性的急性腦梗死患者男女比例約2:1,以男性居多,且人群偏向老年人;2.DWI陰性的急性腦梗死患者危險(xiǎn)因素與常見的缺血性卒中危險(xiǎn)因素分布一致。3.根據(jù)TOAST分型,大動(dòng)脈粥樣硬化性閉塞/狹窄和小動(dòng)脈閉塞是DWI陰性急性腦梗死患者主要病因。4.DWI陰性急性腦梗死多為小卒中,癥狀偏輕,引起腦梗死后遺癥如偏癱、失語者較少,出院后絕大多數(shù)可以生活自理。5.當(dāng)疑似急性腦梗死患者DWI為陰性時(shí),不應(yīng)將腦梗死簡單排除在外,需警惕讀片遺漏、顯影延遲的可能和病情加重的風(fēng)險(xiǎn),同時(shí)當(dāng)排除卒中模擬病后,應(yīng)當(dāng)根據(jù)患者臨床表現(xiàn)、體征、病史等綜合分析進(jìn)行腦梗死診斷,而不能僅依賴影像學(xué)檢查。
[Abstract]:[objective] to investigate the clinical features of diffusion-weighted diffusion weighted imaging (DWI) negative patients with suspected acute cerebral infarction (ACI), including etiology, clinical manifestations, imaging manifestations, prognosis and so on. [methods] data of suspected acute cerebral infarction patients with DWI negative were collected from January 2011 to June 2016 in Department of Neurology, fourth affiliated Hospital of Kunming Medical University, and their demographic characteristics, etiology and clinical characteristics were analyzed retrospectively. [results] A total of 73 patients with acute cerebral infarction (DWI negative) diagnosed by neurologist in our hospital were collected. The median age of 73 patients with acute cerebral infarction was 45 male and 28 female, respectively. The median age of 73 patients was 68 years old (4-quartile interval 60-76D). The median time between onset and completion of DWI was 420 mins (quartile spacing 255-640). The median score of the National institutes of Health Stroke scale (NIH) was 3 (48 out of 73 patients with quartile spacing 1-40.73) and 25 patients with acute cerebral infarction were finally diagnosed as other diseases. Of the 48 patients who were eventually diagnosed as acute cerebral infarction, 13 were diagnosed with acute cerebral infarction. There was 1 case with 2. 1) after symptom aggravation, 9 cases with DWI were found to have infarct foci, 9 cases were found infarct focus after symptom aggravation, 2 cases were found infarct focus on DWI) after symptom aggravation, no infarct focus was found after reexamination of DWI. But the symptoms of 13 patients with head and neck computed Tomography angiography (computed Tomography angiographyography), large vessel occlusion / stenosis, or computed Tomography perfusion (CTP) low perfusion area, which can explain the symptoms, were not aggravated and DWI negative was rechecked. There were 10 patients with large vessel occlusion / stenosis or hypoperfusion area of craniocerebral CTP with CTA in the head and neck. DWI was negative and no major vascular abnormalities were found in the patients. According to the etiological classification of low molecular weight heparin test (LMWH) for acute stroke, 23 patients with acute cerebral infarction were treated with trial of Org 10172 in acute stroke (47.9%) as arteriosclerosis and 52.1% as arteriole occlusion. Among the 25 cases diagnosed as other diseases, 12 cases were diagnosed as transient ischemic attack-TIAA (4 cases) were diagnosed as benign paroxysmal positional vertigo, and few cases were diagnosed as other diseases. [conclusion] the male / female ratio of acute cerebral infarction patients with 1.DWI negative is about 2: 1, the male is the majority, and the risk factors of acute cerebral infarction with negative 1.DWI are consistent with the common risk factors of ischemic stroke. According to TOAST classification, arteriosclerotic occlusion / stenosis and arteriole occlusion are the main causes of DWI negative acute cerebral infarction. 4. DWI negative acute cerebral infarction is mostly a small stroke with mild symptoms, resulting in sequelae of cerebral infarction such as hemiplegia and fewer aphasia. Most of them can take care of themselves after discharge. When DWI is negative in suspected patients with acute cerebral infarction, cerebral infarction should not be excluded simply, the possibility of missed reading, delayed development and the risk of aggravation of the disease should be warned. At the same time, when the stroke mimic disease is excluded, it should be based on the patient's clinical manifestation. The diagnosis of cerebral infarction by comprehensive analysis, such as physical signs and history, should not rely on imaging examination alone.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 肖梅;賀聰;;急性腦梗死52例臨床及影像學(xué)診斷對(duì)比分析[J];陜西醫(yī)學(xué)雜志;2013年09期

2 黃瑞庭;張德佳;黃海松;;大面積腦梗塞的多層螺旋CT診斷價(jià)值[J];中國CT和MRI雜志;2013年02期

3 朱海龍;;腦分水嶺區(qū)腦梗死CT、MRI診斷與臨床表現(xiàn)[J];中外醫(yī)學(xué)研究;2012年32期

4 叢林;;腦血管疾病的發(fā)病與氣溫的關(guān)系[J];中國醫(yī)藥指南;2010年13期

5 劉生榮;李煥吉;鄒志華;;多層螺旋CTA后處理技術(shù)在診斷顱內(nèi)動(dòng)脈瘤的臨床應(yīng)用[J];現(xiàn)代醫(yī)用影像學(xué);2010年02期

6 趙英,戴敏方,袁云;超急性腦梗塞的磁共振診斷[J];醫(yī)學(xué)影像學(xué)雜志;2004年02期

7 張玉欣,張維娜,郭振華;低血糖腦病誤診為缺血性腦血管病而溶栓1例[J];臨床薈萃;2003年05期

8 吳兆蘇,姚崇華,趙冬;我國人群腦卒中發(fā)病率、死亡率的流行病學(xué)研究[J];中華流行病學(xué)雜志;2003年03期

9 李惠民,于紅,肖湘生,陶曉峰,黃承光;顱內(nèi)血管病變CTA綜合評(píng)價(jià)[J];臨床放射學(xué)雜志;2003年02期

10 ;各類腦血管疾病診斷要點(diǎn)[J];中華神經(jīng)科雜志;1996年06期

，

本文編號(hào)：1907419