短暂症状性脑梗死临床特征及发病机制的研究进展
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摘要
短暂症状性脑梗死(TSI)是近年新出现的组织学定义,指临床症状与短暂性脑缺血发作(TIA)相同,采用弥散加权成像(DWI)可发现病变的一类疾病。TSI、缺血性脑卒中(IS)和TIA的临床、血液化验和影像学的特征具有相似性和差异性,但也有其独特性。TSI作为独立疾病,其复发率远高于IS和TIA。DWI显示相似梗死改变患者的临床表现和预后存在差异,但具体机制尚不清楚。TSI可能与微栓子、脑白质病变、脑储备等有关,TSI阳性的相关因素可能与血尿素氮/肌酐比值、血糖、血浆D-二聚体、神经功能缺损症状持续时间、DWI检查时间等有关。
Transient symptoms associated with infarction( TSI) is a newly emerging histological definition in recent years. It refers to a kind of disease whose clinical symptoms are the same as that of transient ischemic attack( TIA). Diffusion weighted imaging( DWI) can detect this type of lesions. The clinical,blood test and imaging features of TSI,ischemic stroke( IS) and TIA have both similarities and differences,but they also have their own characteristics. As an independent disease,the recurrence rate of TSI is much higher than that of IS and TIA. DWI shows that the clinical manifestations and prognosis of patients with similar infarction changes are different,but the specific mechanism is not clear. TSI may be related to microembolism,white matter lesion,brain reserve,etc. The related factors of TSI positive may be blood urea nitrogen/creatinine ratio,blood sugar,plasma D-dimer,duration of neurological deficit symptoms,time of DWI examination,etc.
Transient symptoms associated with infarction( TSI) is a newly emerging histological definition in recent years. It refers to a kind of disease whose clinical symptoms are the same as that of transient ischemic attack( TIA). Diffusion weighted imaging( DWI) can detect this type of lesions. The clinical,blood test and imaging features of TSI,ischemic stroke( IS) and TIA have both similarities and differences,but they also have their own characteristics. As an independent disease,the recurrence rate of TSI is much higher than that of IS and TIA. DWI shows that the clinical manifestations and prognosis of patients with similar infarction changes are different,but the specific mechanism is not clear. TSI may be related to microembolism,white matter lesion,brain reserve,etc. The related factors of TSI positive may be blood urea nitrogen/creatinine ratio,blood sugar,plasma D-dimer,duration of neurological deficit symptoms,time of DWI examination,etc.
引文
[1] Pavlovic AM,Barras CD,Hand PJ,et al. Brain imaging in transient ischemic attack-redefining TIA[J]. J Clin Neurosci,2010,17(9):1105-1110.
[2] Easton JD,Saver JL,Albers GW,et al. Definition and evaluation of transient ischemic attack:A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists[J]. Stroke,2009,40(6):2276-2293.
[3] Ay H,Koroshetz WJ,Benner T,et al. Transient ischemic attack with infarction:A unique syndrome?[J]. Ann Neurol,2005,57(5):679-686.
[4] Brazzelli M,Chappell FM,Miranda H,et al. Diffusion-weighted imaging and diagnosis of transient ischemic attack[J]. Ann Neurol,2014,75(1):67-76.
[5] Kvistad CE,Thomassen L,Waje-Andreassen U,et al. Clinical implications of increased use of MRI in TIA[J]. Acta Neurol Scand,2013,128(1):32-38.
[6] Kono Y,Shimoyama T,Sengoku R,et al. Clinical characteristics associated with abnormal diffusion-weighted images in patients with transient cerebral ischemic attack[J]. J Stroke Cerebrovasc Dis,2014,23(5):1051-1055.
[7]韦世文.联合用药治疗短暂性脑缺血发作伴脑梗死77例分析[J].中国中医药现代远程教育,2011,9(11):45-46.
[8]李江坤,张津华,付志新,等.以短暂性脑缺血发作为表现的患者ABCD2评分与脑磁共振DWI高信号的关系[J].中国实用神经疾病杂志,2017,20(5):78-79.
[9] Molad J,Ben-Assayag E,Korczyn AD,et al. Clinical and radiological determinants of transient symptoms associated with infarction(TSI)[J]. J Neurol Sci,2018,390:195-199.
[10] Kasner SE. Clinical interpretation and use of stroke scales[J].Lancet Neurol,2006,5(7):603-612.
[11] Schulz UG,Briley D,Meagher T,et al. Diffusion-weighted MRI in300 patients presenting late with subacute transient ischemic attack or minor stroke[J]. Stroke,2004,35(11):2459-2465.
[12] Asplund K,Karvanen J,Giampaoli S,et al. Relative risks for stroke by age,sex,and population based on follow-up of 18European populations in the MORGAM Project[J]. Stroke,2009,40(7):2319-2326.
[13] Liebeskind DS. Collateral circulation[J]. Stroke,2003,34(9):2279-2284.
[14] Go AS,Mozaffarian D,Roger VL,et al. Heart disease and stroke statistics-2013 update:A report from the American Heart Association[J]. Circulation,2013,127(1):e6-245.
[15] Inatomi Y,Kimura K,Yonehara T,et al. DWI abnormalities and clinical characteristics in TIA patients[J]. Neurology,2004,62(3):376-380.
[16] Redgrave JN,Coutts SB,Schulz UG,et al. Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack[J]. Stroke,2007,38(5):1482-1488.
[17] Tanislav C,Grittner U,Fazekas F,et al. Frequency and predictors of acute ischaemic lesions on brain magnetic resonance imaging in young patients with a clinical diagnosis of transient ischaemic attack[J]. Eur J Neurol,2016,23(7):1174-1182.
[18] Kvistad CE,Logallo N,Thomassen L,et al. Diffusion-weighted lesions in stroke patients with transient symptoms-where are they located?[J]. Cerebrovasc Dis,2014,38(3):219-225.
[19] Schaechter JD,Fricker ZP,Perdue KL,et al. Microstructural status of ipsilesional and contralesional corticospinal tract correlates with motor skill in chronic stroke patients[J]. Hum Brain Mapp,2010,30(11):3461-3474.
[20] Kashima S,Shimizu T,Akiyama H,et al. Magnetic Resonance Imaging White Matter Hyperintensity as a Predictor of Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source[J]. J Stroke Cerebrovasc Dis,2018,27(12):3613-3620.
[21] Menezes NM,Ay H,Wang Zhu M,et al. The real estate factor:Quantifying the impact of infarct location on stroke severity[J].Stroke,2007,38(1):194-197.
[22] Fang H,Zhao L,Pei L,et al. Severity of White Matter Lesions Correlates with Subcortical Diffusion-Weighted Imaging Abnormalities and Predicts Stroke Risk[J]. J Stroke Cerebrovasc Dis,2017,26(12):2964-2970.
[23] Perkins JM,Subramanian SV,Davey Smith G,et al. Adult height,nutrition,and population health[J]. Nutr Rev,2016,74(3):149-165.
[24] Goldbourt U,Tanne D. Body height is associated with decreased long-term stroke but not coronary heart disease mortality?[J].Stroke,2002,33(3):743-748.
[25] Kang Y,Zhang Y,Feng Z,et al. Nutritional Deficiency in Early Life Facilitates Aging-Associated Cognitive Decline[J]. Curr Alzheimer Res,2017,14(8):841-849.
[26] Pinter D,Enzinger C,Fazekas F. Cerebral small vessel disease,cognitive reserve and cognitive dysfunction[J]. J Neurol,2015,262(11):2411-2419.
[27] Valenzuela MJ. Brain reserve and the prevention of dementia[J].Curr Opin Psychiatry,2008,21(3):296-302.
[28] Guo LH,Alexopoulos P,Wagenpfeil S,et al. Brain size and the compensation of Alzheimer's disease symptoms:A longitudinal cohort study[J]. Alzheimers Dement,2013,9(5):580-586.
[29] Nunnari D,Bramanti P,Marino S. Cognitive reserve in stroke and traumatic brain injury patients[J]. Neurol Sci,2014,35(10):1513-1518.
[30] Whalley LJ,Staff RT,Fox HC,et al. Cerebral correlates of cognitive reserve[J]. Psychiatry Res Neuroimaging,2016,247:65-70.
[31] D'Aniello GE,Castelnuovo G,Scarpina F. Could cognitive estimation ability be a measure of cognitive reserve?[J]. Front Psychol,2015,6:608.
[32] Weisenbach SL,Kumar A. Current understanding of the neurobiology and longitudinal course of geriatric depression[J]. Curr Psychiatry Rep,2014,16(9):463.
[33] Rodriguez GJ,Cordina SM,Vazquez G,et al. The hydration influence on the risk of stroke(THIRST)study[J]. Neurocrit Care,2009,10(2):187-194.
[34] Akimoto T,Ito C,Kato M,et al. Reduced hydration status characterized by disproportionate elevation of blood urea nitrogen to serum creatinine among the patients with cerebral infarction[J].Med Hypotheses,2011,77(4):601-604.
[35] Bosarge PL,Shoultz TH,Griffin RL,et al. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J]. J Trauma Acute Care Surg,2015,79(2):289-294.
[36] Rau CS,Wu SC,Chen YC,et al. Stress-Induced Hyperglycemia,but Not Diabetic Hyperglycemia,Is Associated with Higher Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury:Analysis of a Propensity Score-Matched Population[J]. Int J Environ Res Public Health,2017,14(11).pii:E1340.
[37] Iwasaki Y,Kambayashi M,Asai M,et al. High glucose alone,as well as in combination with proinflammatory cytokines,stimulates nuclear factor kappa-B-mediated transcription in hepatocytes in vitro[J]. J Diabetes Complications,2007,21(1):56-62.
[38] Vink H,Constantinescu AA,Spaan JA. Oxidized lipoproteins degrade the endothelial surface layer:Implications for plateletendothelial cell adhesion[J]. Circulation,2000,101(13):1500-1502.
[39] Anderson RE,Tan WK,Martin HS,et al. Effects of glucose and Pa O2modulation on cortical intracellular acidosis,NADH redox state,and infarction in the ischemic penumbra[J]. Stroke,1999,30(1):160-170.
[40] Lowe GD,Rumley A,Whincup PH,et al. Hemostatic and rheological variables and risk of cardiovascular disease[J]. Semin Vasc Med,2002,2(4):429-439.
[41] Park YW,Koh EJ,Choi HY. Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke[J]. J Korean Neurosurg Soc,2011,50(2):89-94.
[42] Zhang J,Song Y,Shan B,et al. Elevated level of D-dimer increases the risk of stroke[J]. Oncotarget,2017,9(2):2208-2219.
[43] Folsom AR,Gottesman RF,Appiah D,et al. Plasma d-Dimer and Incident Ischemic Stroke and Coronary Heart Disease:The Atherosclerosis Risk in Communities Study[J]. Stroke,2016,47(1):18-23.
[44] Dopsaj V,Bogavac-Stanojevic N,Vasic D,et al. Excluding deep venous thrombosis in symptomatic outpatients:Is fibrin monomer aid to D-dimer analysis?[J]. Blood Coagul Fibrinolysis,2009,20(7):546-551.
[45] Al-Khaled M,Eggers J. MRI findings and stroke risk in TIA patients with different symptom durations[J]. Neurology,2013,80(21):1920-1926.
[46] Shono K,Satomi J,Tada Y,et al. Optimal Timing of Diffusion Weighted Imaging to Avoid False-Negative Findings in Patients With Transient Ischemic Attack[J]. Stroke,2017,48(7):1990-1992.
[2] Easton JD,Saver JL,Albers GW,et al. Definition and evaluation of transient ischemic attack:A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists[J]. Stroke,2009,40(6):2276-2293.
[3] Ay H,Koroshetz WJ,Benner T,et al. Transient ischemic attack with infarction:A unique syndrome?[J]. Ann Neurol,2005,57(5):679-686.
[4] Brazzelli M,Chappell FM,Miranda H,et al. Diffusion-weighted imaging and diagnosis of transient ischemic attack[J]. Ann Neurol,2014,75(1):67-76.
[5] Kvistad CE,Thomassen L,Waje-Andreassen U,et al. Clinical implications of increased use of MRI in TIA[J]. Acta Neurol Scand,2013,128(1):32-38.
[6] Kono Y,Shimoyama T,Sengoku R,et al. Clinical characteristics associated with abnormal diffusion-weighted images in patients with transient cerebral ischemic attack[J]. J Stroke Cerebrovasc Dis,2014,23(5):1051-1055.
[7]韦世文.联合用药治疗短暂性脑缺血发作伴脑梗死77例分析[J].中国中医药现代远程教育,2011,9(11):45-46.
[8]李江坤,张津华,付志新,等.以短暂性脑缺血发作为表现的患者ABCD2评分与脑磁共振DWI高信号的关系[J].中国实用神经疾病杂志,2017,20(5):78-79.
[9] Molad J,Ben-Assayag E,Korczyn AD,et al. Clinical and radiological determinants of transient symptoms associated with infarction(TSI)[J]. J Neurol Sci,2018,390:195-199.
[10] Kasner SE. Clinical interpretation and use of stroke scales[J].Lancet Neurol,2006,5(7):603-612.
[11] Schulz UG,Briley D,Meagher T,et al. Diffusion-weighted MRI in300 patients presenting late with subacute transient ischemic attack or minor stroke[J]. Stroke,2004,35(11):2459-2465.
[12] Asplund K,Karvanen J,Giampaoli S,et al. Relative risks for stroke by age,sex,and population based on follow-up of 18European populations in the MORGAM Project[J]. Stroke,2009,40(7):2319-2326.
[13] Liebeskind DS. Collateral circulation[J]. Stroke,2003,34(9):2279-2284.
[14] Go AS,Mozaffarian D,Roger VL,et al. Heart disease and stroke statistics-2013 update:A report from the American Heart Association[J]. Circulation,2013,127(1):e6-245.
[15] Inatomi Y,Kimura K,Yonehara T,et al. DWI abnormalities and clinical characteristics in TIA patients[J]. Neurology,2004,62(3):376-380.
[16] Redgrave JN,Coutts SB,Schulz UG,et al. Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack[J]. Stroke,2007,38(5):1482-1488.
[17] Tanislav C,Grittner U,Fazekas F,et al. Frequency and predictors of acute ischaemic lesions on brain magnetic resonance imaging in young patients with a clinical diagnosis of transient ischaemic attack[J]. Eur J Neurol,2016,23(7):1174-1182.
[18] Kvistad CE,Logallo N,Thomassen L,et al. Diffusion-weighted lesions in stroke patients with transient symptoms-where are they located?[J]. Cerebrovasc Dis,2014,38(3):219-225.
[19] Schaechter JD,Fricker ZP,Perdue KL,et al. Microstructural status of ipsilesional and contralesional corticospinal tract correlates with motor skill in chronic stroke patients[J]. Hum Brain Mapp,2010,30(11):3461-3474.
[20] Kashima S,Shimizu T,Akiyama H,et al. Magnetic Resonance Imaging White Matter Hyperintensity as a Predictor of Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source[J]. J Stroke Cerebrovasc Dis,2018,27(12):3613-3620.
[21] Menezes NM,Ay H,Wang Zhu M,et al. The real estate factor:Quantifying the impact of infarct location on stroke severity[J].Stroke,2007,38(1):194-197.
[22] Fang H,Zhao L,Pei L,et al. Severity of White Matter Lesions Correlates with Subcortical Diffusion-Weighted Imaging Abnormalities and Predicts Stroke Risk[J]. J Stroke Cerebrovasc Dis,2017,26(12):2964-2970.
[23] Perkins JM,Subramanian SV,Davey Smith G,et al. Adult height,nutrition,and population health[J]. Nutr Rev,2016,74(3):149-165.
[24] Goldbourt U,Tanne D. Body height is associated with decreased long-term stroke but not coronary heart disease mortality?[J].Stroke,2002,33(3):743-748.
[25] Kang Y,Zhang Y,Feng Z,et al. Nutritional Deficiency in Early Life Facilitates Aging-Associated Cognitive Decline[J]. Curr Alzheimer Res,2017,14(8):841-849.
[26] Pinter D,Enzinger C,Fazekas F. Cerebral small vessel disease,cognitive reserve and cognitive dysfunction[J]. J Neurol,2015,262(11):2411-2419.
[27] Valenzuela MJ. Brain reserve and the prevention of dementia[J].Curr Opin Psychiatry,2008,21(3):296-302.
[28] Guo LH,Alexopoulos P,Wagenpfeil S,et al. Brain size and the compensation of Alzheimer's disease symptoms:A longitudinal cohort study[J]. Alzheimers Dement,2013,9(5):580-586.
[29] Nunnari D,Bramanti P,Marino S. Cognitive reserve in stroke and traumatic brain injury patients[J]. Neurol Sci,2014,35(10):1513-1518.
[30] Whalley LJ,Staff RT,Fox HC,et al. Cerebral correlates of cognitive reserve[J]. Psychiatry Res Neuroimaging,2016,247:65-70.
[31] D'Aniello GE,Castelnuovo G,Scarpina F. Could cognitive estimation ability be a measure of cognitive reserve?[J]. Front Psychol,2015,6:608.
[32] Weisenbach SL,Kumar A. Current understanding of the neurobiology and longitudinal course of geriatric depression[J]. Curr Psychiatry Rep,2014,16(9):463.
[33] Rodriguez GJ,Cordina SM,Vazquez G,et al. The hydration influence on the risk of stroke(THIRST)study[J]. Neurocrit Care,2009,10(2):187-194.
[34] Akimoto T,Ito C,Kato M,et al. Reduced hydration status characterized by disproportionate elevation of blood urea nitrogen to serum creatinine among the patients with cerebral infarction[J].Med Hypotheses,2011,77(4):601-604.
[35] Bosarge PL,Shoultz TH,Griffin RL,et al. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J]. J Trauma Acute Care Surg,2015,79(2):289-294.
[36] Rau CS,Wu SC,Chen YC,et al. Stress-Induced Hyperglycemia,but Not Diabetic Hyperglycemia,Is Associated with Higher Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury:Analysis of a Propensity Score-Matched Population[J]. Int J Environ Res Public Health,2017,14(11).pii:E1340.
[37] Iwasaki Y,Kambayashi M,Asai M,et al. High glucose alone,as well as in combination with proinflammatory cytokines,stimulates nuclear factor kappa-B-mediated transcription in hepatocytes in vitro[J]. J Diabetes Complications,2007,21(1):56-62.
[38] Vink H,Constantinescu AA,Spaan JA. Oxidized lipoproteins degrade the endothelial surface layer:Implications for plateletendothelial cell adhesion[J]. Circulation,2000,101(13):1500-1502.
[39] Anderson RE,Tan WK,Martin HS,et al. Effects of glucose and Pa O2modulation on cortical intracellular acidosis,NADH redox state,and infarction in the ischemic penumbra[J]. Stroke,1999,30(1):160-170.
[40] Lowe GD,Rumley A,Whincup PH,et al. Hemostatic and rheological variables and risk of cardiovascular disease[J]. Semin Vasc Med,2002,2(4):429-439.
[41] Park YW,Koh EJ,Choi HY. Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke[J]. J Korean Neurosurg Soc,2011,50(2):89-94.
[42] Zhang J,Song Y,Shan B,et al. Elevated level of D-dimer increases the risk of stroke[J]. Oncotarget,2017,9(2):2208-2219.
[43] Folsom AR,Gottesman RF,Appiah D,et al. Plasma d-Dimer and Incident Ischemic Stroke and Coronary Heart Disease:The Atherosclerosis Risk in Communities Study[J]. Stroke,2016,47(1):18-23.
[44] Dopsaj V,Bogavac-Stanojevic N,Vasic D,et al. Excluding deep venous thrombosis in symptomatic outpatients:Is fibrin monomer aid to D-dimer analysis?[J]. Blood Coagul Fibrinolysis,2009,20(7):546-551.
[45] Al-Khaled M,Eggers J. MRI findings and stroke risk in TIA patients with different symptom durations[J]. Neurology,2013,80(21):1920-1926.
[46] Shono K,Satomi J,Tada Y,et al. Optimal Timing of Diffusion Weighted Imaging to Avoid False-Negative Findings in Patients With Transient Ischemic Attack[J]. Stroke,2017,48(7):1990-1992.