青年缺血性脑卒中并发卵圆孔未闭1例

1病例介绍患者,男性,28岁,主因"言语不利1个月"以"脑梗死"收入院。查体:血压120/80mmHg(1mmHg=0.133kPa),神清,言语不利,唇无紫绀,咽无充血。颈软,气管居中,颈静脉无发怒张。胸廓对称,呼吸平,双肺呼吸音清,未闻及干、湿性啰音。心界不大,心尖搏动位于胸骨左缘第五肋间左锁骨中线内     

脑卒中合并卵圆孔未闭临床及文献分析

目的:探讨脑卒中合并卵圆孔未闭(PFO)患者的临床特征。方法:回顾性分析2002年1月²012年11月我院收治的及万方数据库和中国医知网报道的脑卒中合并PFO患者41例的临床资料。结果:本组患者年龄<55岁35例(85.4%),有少量吸烟史9例,高血压5例,高血脂1例,糖尿病2例;左侧大隐静脉瓣膜功能不全1例,下肢深静脉血栓6例,髋关节置换术后2例;卵圆孔缺损直径≥2 mm者26例(86.7%);头颅MRI示皮质下白质额叶区、顶叶区梗死各12例。结论:脑卒中合并PFO患者发病年龄偏小,多无常规脑血管病危险因素,卵圆孔缺损直径≥2 mm易发病,确诊需经食管超声心动图、经颅多普勒超声造影等辅助检查。     

卵圆孔未闭与偏头痛发病相关性的Meta分析

目的:采用Meta分析探讨卵圆孔未闭(PFO)与偏头痛发病的相关性。方法:计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、VIP、WanFang Data及CBM数据库,收集观察PFO与偏头痛发病相关性的病例对照研究或横断面研究或队列研究,检索时限从建库至2018年8月1日。由两名评价者按照纳入与排除标准筛选文献、提取资料,并进行NOS文献质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入30篇文献,样本量为9 177例。Meta分析结果显示偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.19,95%CI为2.20～4.63,P0.01),先兆偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.71,95%CI为2.13～6.46,P0.01),无先兆偏头痛组PFO发生率高于健康对照组(OR=1.48,95%CI为1.09～2.00,P=0.01),先兆性偏头痛组PFO发生率高于无先兆性偏头痛组(OR=2.32,95%CI为1.96～2.76,P0.01)。PFO组的偏头痛率高于健康对照组(OR=2.58,95%CI为1.57～4.25,P0.01)。结论:PFO与偏头痛存在明显相关性。     

伴有卵圆孔未闭的隐源性缺血性脑血管病危险因素分析

目的分析并发卵圆孔未闭(PFO)的隐源性缺血性脑血管病(CICVD)患者伴随危险因素情况,探讨常见危险因素与PFO在脑缺血发生过程中的相关性。方法连续选取2008年1月~2011年7月于首都医科大学宣武医院神经内科住院的15~70岁CICVD患者,将其中完成经食管超声心动图检查的患者分为PFO组和非PFO组,比较两组患者的常见缺血性脑血管病危险因素,分析其与PFO的相关性。结果两组患者共102例,其中PFO组61例(59.80%),非PFO组41例(40.20%)。PFO组患者缺血性脑血管病家族史阳性者所占比例(31.1%)高于非PFO组(9.8%)(P=0.011)。两组其他观察指标无显著性差异(P>0.05)。缺血性脑血管病阳性家族史与CICVD患者伴有PFO具有相关性(r=0.251,P=0.011)。结论 CICVD并发PFO比例较高,PFO的存在与缺血性脑血管病家族史具有相关性。     

Diagnostic Value of Transthoracic Echocardiography for Patent Foramen Ovale: A Meta-analysis

As a non-invasive and convenient modality, transthoracic echocardiography (TTE) has been widely recommended for the diagnosis of patent foramen ovale (PFO). In this study our aim was to systematically review the diagnostic accuracy of TTE in detection of PFO. We conducted comprehensive searches in PubMed, Embase and the Cochrane Library to the end of September 1, 2012. Sixteen studies comprising 1831 patients were included in the meta-analysis. The quality of reported studies was modest. The summary sensitivity and specificity of TTE in diagnosis of PFO were 88% (95% confidence interval [CI], 79–94) and 97% (95% CI, 92–99), respectively. The positive likelihood ratio was 27.1 (95% CI, 11.2–65.1), and the negative likelihood ratio was 0.12 (95% CI, 0.07–0.22). The summary diagnostic odds ratio was 221 (95% CI, 95–518). Subgroup analyses suggested that age and initial disease may affect the accuracy of TTE in detection of PFO. The meta-analysis suggested that TTE is a test with high sensitivity and specificity in detection of PFO, but it may not be appropriate for screening for PFO in all patients, especially patients with a small right-left shunt.     

卵圆孔未闭患者并发缺血性脑血管病的影响因素

目的观察卵圆孔未闭(PFO)患者并发缺血性脑血管病的影响因素。方法连续选取低于55岁的脑梗死或者短暂性脑缺血发作住院患者,将其中通过经食管超声心动图检查证实存在PFO且行阿司匹林治疗的42例患者按照复发情况分为两组,未复发组36例,复发组6例,比较两组的危险因素和PFO大小及并发房间隔动脉瘤(ASA)情况。结果平均随访时间(523.00±126.20)d。未复发组纤维蛋白原水平为(3.33±1.11)g/L,复发组为(4.40±1.49)g/L(P=0.032)。两组患者PFO直径(P=0.618)及并发ASA情况无显著性差异(P=0.554)。Logistic回归分析显示,纤维蛋白原水平与脑血管病复发无关(OR=2.656,95%CI:0.977～7.219),既往缺血性脑血管病史是复发的危险因素(OR=46.913,95%CI:2.371～928.254)。结论既往存在缺血性脑血管病史的PFO患者再发缺血性脑血管病的危险性较大。还不能确定纤维蛋白原水平在PFO患者发生脑缺血过程中的作用。     

Cardioembolic Stroke in Patients with Patent Foramen Ovale and Implanted Cardiac Leads

Implanted cardiac devices, including pacemakers, defibrillators, and resynchronization devices, are known to develop thrombus on their intravascular leads. Patent foramen ovale (PFO) occurs in approximately one‐quarter of the adult population. It is unclear whether paradoxical cardioembolism and clinically relevant stroke occur in patients with implanted cardiac leads and PFO. We present a case series of four patients with cardioembolic stroke, presumed to arise from intravascular cardiac leads and associated PFO that required device closure of the PFO. (PACE 2013; 36:50–54)     

经颅多普勒发泡试验筛查缺血性卒中合并卵圆孔未闭的应用价值

目的探讨经颅多普勒发泡试验(c-TCD)筛查缺血性卒中合并卵圆孔未闭(PFO)的应用价值。方法收集我院神经内科450例缺血性卒中患者,均给予经食管心脏超声(TEE)、右心声学造影、c-TCD检查。观察c-TCD、TEE联合经右心声学造影检查PFO的阳性率。将TEE联合经右心声学造影检查结果视为PFO诊断的"金标准",计算c-TCD的阳性预测值、阴性预测值、灵敏度、特异度及准确率。结果 TEE联合经右心声学造影检查显示,阳性为72例,阳性率为16.00%,即450例患者中,PFO的发生率为16.00%;c-TCD检查显示,65例清晰可见微栓子信号,阳性率为14.44%,c-TCD与TEE联合经右心声学造影检查阳性率比较差异无统计学意义(P>0.05);c-TCD相对于TEE联合经右心声学造影的阳性预测值为96.92%、阴性预测值为97.66%、灵敏度为87.50%、特异度为99.47%、准确率为97.56%、一致性Kappa值为0.837。结论 c-TCD在筛查诊断缺血性卒中合并PFO中具有灵敏度、特异度、准确率高的特点,且无创、安全,易于患者接受,可考虑将c-TCD作为PFO的无创初筛手段,针对阳性患者再进一步做TEE+经右心声学造影检查确诊,以减轻患者的痛苦。     

经胸和经食管超声心动图诊断卵圆孔未闭的对比研究

目的 对比研究经胸超声心动图TTE和经食管超声心动图TEE对卵圆孔未闭(patent foramen ovale，PFO)的诊断方法和诊断价值，及对卵圆孔未闭的临床意义。方法 运用经胸及经食管超声心动图检查，诊断卵圆孔未闭24例，根据患者有无合并其他心脏疾患及合并的心脏疾患的血流动力学特点将患者分为卵圆孔未闭组及卵圆孔开放组。结果 经胸超声心动图通过CDFI观察房水平的穿隔血流对卵圆孔未闭的诊断准确率为58．3％。经食管超声心动图检查能对所有患者做出正确诊断。卵圆孔未闭组可见卵圆孔瓣上缘与继发隔之间裂缝，CDFI显示源于卵圆孔瓣与继发隔交界边缘处的穿隔血流；卵圆孔开放组可见卵圆孔瓣上缘与继发隔之间出现回声缺失，但卵圆孔瓣尚完整，CDFI于缺口处探及垂直于房间隔的穿隔分流束。结论 经食管超声心动图是目前卵圆孔未闭诊断金标准的首选方法。卵圆孔未闭可导致反常栓塞，应予以积极治疗。     

Migraine With Neurological Features in a Scuba Diver With a Patent Foramen Ovale

Neurologic complications of decompression sickness have been observed for over half of a century. Little is known, however, about the risk of diving in patients that suffer from migraine with aura (MWA). We report the case of a pediatric patient with a history of migraine with aura, who was later found to have a PFO, who developed headache with neurological symptoms during a scuba diving lesson.