深部脑白质高信号评分对轻型缺血性脑卒中的诊断效能
摘要
目的探讨深部脑白质高信号(DWMHs)对轻型缺血性脑卒中(IS)的诊断效能,同时观察假性脑卒中(SM)的特点。方法连续收集2018年1-3月在青岛西海岸新区人民医院神经内科住院的患者110例,分为SM组(43例)和轻型IS组(67例)。绘制受试者操作特征(ROC)曲线,计算曲线下面积,比较DWMHs对2组疾病的诊断效能。结果 SM组中,DWMHs评分2～3分患者5例,其中1例为代谢性脑病,4例为癫痫发作后的Todd′s麻痹。轻型IS组中,DWMHs评分2～3分患者60例。ROC曲线下面积为0.918(95%可信区间:0.860～0.976),标准误为0.030,差异有统计学意义(P<0.01)。结论 DWMHs评分针对轻型IS有较高的诊断效能,SM最常见的病因包括中毒或代谢性脑病、癫痫发作后的Todd′s麻痹及偏头痛或周围性眩晕等。
引文
[1]AMARENCO P,LAVALLEE PC,MONTEIRO TAVARES L,et al.Five-year risk of stroke after TIA or minor ischemic stroke[J].N Engl J Med,2018,378(23):2182-2190.
[2]张艳华,李许涛.老年人认知功能障碍与缺血性脑白质病变的相关性研究[J].现代医药卫生,2018,34(2):200-203.
[3]SIMONSEN CZ,MADSEN MH,SCHMITZ ML,et al.Sensitivity of diffusion-and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%[J].Stroke,2015,46(1):98-101.
[4]ONTEDDU SR,GODDEAU J,MINAEIAN A,et al.Clinical impact of leukoaraiosis burden and chronological age on neurological deficit recovery and 90-day outcome after minor ischemic stroke[J].J Neurol Sci,2015,359(1/2):418-423.
[5]HAND PJ,KWAN J,LINDLEY RI,et al.Distinguishing between stroke and mimic at the bedside:the brain attack study[J].Stroke,2006,37(3):769-775.
[6]FAZEKAS F,SCHMIDT R,SCHELTENS P.Pathophysiologic mechanisms in the development of age-related white matter changes of the brain[J].Dement Geriatr Cogn Disord,1998,9(Suppl 1):2-5.
[7]王伊龙,赵性泉,刘新峰,等.高危非致残性缺血性脑血管事件诊疗指南[J].中国卒中杂志,2016,11(6):481-491.
[8]LUENGO-FERNANDEZ R,GRAY AM,ROTHWELL PM.Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs(Express study):aprospective populationbased sequential comparison[J].The Lancet Neurology,2009,8(3):235-243.
[9]EASTWOOD JD,ENGELTER ST,MACFALL JF,et al.Quantitative assessment of the time course of infarct signal intensity on diffusion-weighted images[J].AJNR Am J Neuroradiol,2003,24(4):680-687.
[10]MAKIN SD,DOUBAL FN,DENNIS MS,et al.Clinically confirmed stroke with negative diffusion-weighted imaging magnetic resonance imaging:longitudinal study of clinical outcomes,stroke recurrence,and systematic review[J].Stroke,2015,46(11):3142-3148.
[11]DAWSON A,CLOUD GC,PEREIRA AC,et al.Stroke mimic diagnoses presenting to a hyperacute stroke unit[J].Clin Med,2016,16(5):423-426.
[12]NATTERU P,MOHEBBI MR,GEORGE P,et al.Variables that best differentiate in-patient acute stroke from stroke-mimics with acute neurological deficits[J].Stroke Res Treat,2016,2016:4393127.
[13]GARGALAS S,WEEKS R,KHAN-BOURNE N,et al.Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit[J].J Neurol Neurosurg Psychiatry,2017,88(1):2-6.
[14]LONG B,KOYFMAN A.Clinical mimics:an emergency medicinefocused review of stroke mimics[J].J Emerg Med,2017,52(2):176-183.
[15]AVELLANEDA-GOMEZ C,RODRIGUEZ CAMPELLO A,GI-RALT STEINHAUER E,et al.Description of stroke mimics after complete neurovascular assessment[J].Neurologia,2017(16):30221-30223.
[16]GIOIA LC,ZEWUDE RT,KATE MP,et al.Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics[J].Neurology,2016,86(23):2146-2153.
[17]王祥翔,柴湘婷,谭兰.脑白质改变发病机制的研究进展[J].实用临床医学,2016,17(8):97-100.
[2]张艳华,李许涛.老年人认知功能障碍与缺血性脑白质病变的相关性研究[J].现代医药卫生,2018,34(2):200-203.
[3]SIMONSEN CZ,MADSEN MH,SCHMITZ ML,et al.Sensitivity of diffusion-and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%[J].Stroke,2015,46(1):98-101.
[4]ONTEDDU SR,GODDEAU J,MINAEIAN A,et al.Clinical impact of leukoaraiosis burden and chronological age on neurological deficit recovery and 90-day outcome after minor ischemic stroke[J].J Neurol Sci,2015,359(1/2):418-423.
[5]HAND PJ,KWAN J,LINDLEY RI,et al.Distinguishing between stroke and mimic at the bedside:the brain attack study[J].Stroke,2006,37(3):769-775.
[6]FAZEKAS F,SCHMIDT R,SCHELTENS P.Pathophysiologic mechanisms in the development of age-related white matter changes of the brain[J].Dement Geriatr Cogn Disord,1998,9(Suppl 1):2-5.
[7]王伊龙,赵性泉,刘新峰,等.高危非致残性缺血性脑血管事件诊疗指南[J].中国卒中杂志,2016,11(6):481-491.
[8]LUENGO-FERNANDEZ R,GRAY AM,ROTHWELL PM.Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs(Express study):aprospective populationbased sequential comparison[J].The Lancet Neurology,2009,8(3):235-243.
[9]EASTWOOD JD,ENGELTER ST,MACFALL JF,et al.Quantitative assessment of the time course of infarct signal intensity on diffusion-weighted images[J].AJNR Am J Neuroradiol,2003,24(4):680-687.
[10]MAKIN SD,DOUBAL FN,DENNIS MS,et al.Clinically confirmed stroke with negative diffusion-weighted imaging magnetic resonance imaging:longitudinal study of clinical outcomes,stroke recurrence,and systematic review[J].Stroke,2015,46(11):3142-3148.
[11]DAWSON A,CLOUD GC,PEREIRA AC,et al.Stroke mimic diagnoses presenting to a hyperacute stroke unit[J].Clin Med,2016,16(5):423-426.
[12]NATTERU P,MOHEBBI MR,GEORGE P,et al.Variables that best differentiate in-patient acute stroke from stroke-mimics with acute neurological deficits[J].Stroke Res Treat,2016,2016:4393127.
[13]GARGALAS S,WEEKS R,KHAN-BOURNE N,et al.Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit[J].J Neurol Neurosurg Psychiatry,2017,88(1):2-6.
[14]LONG B,KOYFMAN A.Clinical mimics:an emergency medicinefocused review of stroke mimics[J].J Emerg Med,2017,52(2):176-183.
[15]AVELLANEDA-GOMEZ C,RODRIGUEZ CAMPELLO A,GI-RALT STEINHAUER E,et al.Description of stroke mimics after complete neurovascular assessment[J].Neurologia,2017(16):30221-30223.
[16]GIOIA LC,ZEWUDE RT,KATE MP,et al.Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics[J].Neurology,2016,86(23):2146-2153.
[17]王祥翔,柴湘婷,谭兰.脑白质改变发病机制的研究进展[J].实用临床医学,2016,17(8):97-100.