摘要
心肌球形综合征是一种一过性可逆性的以左心室短暂性局部收缩功能障碍为特征的综合征,症状与急性冠状动脉综合征类似。心肌球形综合征可导致左心室血栓形成,血栓脱落后引发缺血性卒中,但此类病例十分少见。本文报道1例心肌球形综合征引起急性大脑中动脉闭塞性缺血性卒中患者。该患者以左侧肢体无力为主要临床表现,脑血管造影提示右侧大脑中动脉闭塞,急诊予以取栓治疗后血管完全再通。头颅磁共振成像提示前后循环多发性脑梗死,超声心动图提示左室心尖部血栓形成、左室收缩功能明显减低。予以短期抗凝联合抗血小板聚集治疗后,患者左室心尖部血栓消失,左室收缩功能明显改善。本病例提示,尽管心肌球形综合征导致大血管闭塞性急性缺血性卒中较为罕见,但对于可疑心源性脑栓塞的患者,应高度重视相关筛查工作。动态监测超声心动图的变化,对于明确病因诊断具有重要意义。
Takotsubo syndrome is a transient,reversible syndrome characterized by acute regional dysfunction of the left ventricle,with symptoms resembling those of acute coronary syndrome.Takotsubo syndrome can lead to left ventricular thrombus formation,which may embolize and cause ischemic stroke.However,such cases are relatively rare.A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article.The patient presented primarily with left-sided limb weakness.Cerebral angiography indicated occlusion of the right middle cerebral artery,and complete vascular recanalization was achieved after endovascular thrombectomy.Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations.Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function.After a short course of anticoagulation combined with antiplatelet therapy,the apical thrombus resolved,and left ventricular systolic function significantly improved.This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare,comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke.Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.
作者
张诗雅
环素秋
庄圣
肖国栋
曹勇军
尤寿江
Zhang Shiya;Huan Suqiu;Zhuang Sheng;Xiao Guodong;Cao Yongjun;You Shoujiang(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《中华神经科杂志》
北大核心
2025年第8期869-873,共5页
Chinese Journal of Neurology
基金
国家自然科学基金(82171296)。
