We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure s...We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.展开更多
目的探讨首发脑卒中患者残疾接受度轨迹及影响因素。方法选取温州市中心医院2022年12月至2023年12月收治的202例首发脑卒中患者,根据患者出院后残疾接受度轨迹分为低接受度组(n=38)、中接受度组(n=96)和高接受度组(n=68)。多因素Logisti...目的探讨首发脑卒中患者残疾接受度轨迹及影响因素。方法选取温州市中心医院2022年12月至2023年12月收治的202例首发脑卒中患者,根据患者出院后残疾接受度轨迹分为低接受度组(n=38)、中接受度组(n=96)和高接受度组(n=68)。多因素Logistic回归分析影响首发脑卒中患者残疾接受度的影响因素。结果脑卒中患者伤残接受度量表(acceptance of disability scale-revised,ADS-R)总分为(89.93±13.51)分。三组在年龄、文化程度、家庭月均收入、有无照顾者、病情严重程度、医疗社会支持量表(medical social support scale,MOS-SSS)评分、Herth希望量表评分及9条目病人健康问卷抑郁量表评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=12.419,95%CI:3.967~38.882)、无照顾者(OR=5.793,95%CI:1.989~16.875)、病情严重程度(OR=5.724,95%CI:1.927~16.999)是影响首发脑卒中患者残疾接受度的危险因素(P<0.05),文化程度(OR=0.207,95%CI:0.069~0.624)、家庭月均收入(OR=0.238,95%CI:0.079~0.712)、MOS-SSS评分(OR=0.502,95%CI:0.303~0.832)是保护因素(P<0.05)。结论首发脑卒中患者残疾接受度呈现3种不同的轨迹,年龄、有无照顾者、病情严重程度、文化程度、家庭月均收入和MOS-SSS评分是首发脑卒中患者残疾接受度的影响因素,可作为预测残疾接受度轨迹的因素。展开更多
目的探讨在急性缺血性脑卒中患者中应用直接抽吸一次性取栓(A direct aspiration First-Pass thrombectomy,ADAPT)进行血管再通的安全性、可行性及技术优势。方法回顾性分析本院神经内科2021年3月至2023年10月接受血管再通术治疗的54例...目的探讨在急性缺血性脑卒中患者中应用直接抽吸一次性取栓(A direct aspiration First-Pass thrombectomy,ADAPT)进行血管再通的安全性、可行性及技术优势。方法回顾性分析本院神经内科2021年3月至2023年10月接受血管再通术治疗的54例急性脑卒中患者。根据取栓技术的不同,患者被分为研究组(应用ADAPT技术直接抽吸取栓,34例)和对照组[应用Solitaire FR支架机械取栓术(Solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM),20例]。比较两组的取栓次数、手术操作时间、血管完全再通率、术前与术后2周美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、并发症发生率及术后3个月良好预后率。结果两组采用不同取栓技术后,研究组的取栓次数和手术操作时间均低于对照组(P<0.05)。术前两组的NIHSS评分差异无统计学意义(P>0.05)。术后2周,研究组的NIHSS评分显著低于对照组(P<0.05)。两组的血管完全再通率分别为70.59%和75.00%,术后3个月良好预后率分别为64.71%和60.00%,两组间差异无统计学意义(P>0.05)。研究组的并发症发生率(8.82%)显著低于对照组(20.00%)(P<0.05)。结论与SWIM取栓技术相比,ADAPT技术在血管再通率上无显著差异,但能显著减少急性脑卒中患者的取栓次数和手术操作时间,提升术后3个月的良好预后率,改善术后2周的NIHSS评分,并降低并发症发生率。ADAPT技术在改善患者功能恢复和降低并发症方面显示了更大的潜力,为急性缺血性脑卒中的临床治疗提供了有力的替代方案。展开更多
文摘We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.
文摘目的探讨首发脑卒中患者残疾接受度轨迹及影响因素。方法选取温州市中心医院2022年12月至2023年12月收治的202例首发脑卒中患者,根据患者出院后残疾接受度轨迹分为低接受度组(n=38)、中接受度组(n=96)和高接受度组(n=68)。多因素Logistic回归分析影响首发脑卒中患者残疾接受度的影响因素。结果脑卒中患者伤残接受度量表(acceptance of disability scale-revised,ADS-R)总分为(89.93±13.51)分。三组在年龄、文化程度、家庭月均收入、有无照顾者、病情严重程度、医疗社会支持量表(medical social support scale,MOS-SSS)评分、Herth希望量表评分及9条目病人健康问卷抑郁量表评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=12.419,95%CI:3.967~38.882)、无照顾者(OR=5.793,95%CI:1.989~16.875)、病情严重程度(OR=5.724,95%CI:1.927~16.999)是影响首发脑卒中患者残疾接受度的危险因素(P<0.05),文化程度(OR=0.207,95%CI:0.069~0.624)、家庭月均收入(OR=0.238,95%CI:0.079~0.712)、MOS-SSS评分(OR=0.502,95%CI:0.303~0.832)是保护因素(P<0.05)。结论首发脑卒中患者残疾接受度呈现3种不同的轨迹,年龄、有无照顾者、病情严重程度、文化程度、家庭月均收入和MOS-SSS评分是首发脑卒中患者残疾接受度的影响因素,可作为预测残疾接受度轨迹的因素。
文摘目的探讨在急性缺血性脑卒中患者中应用直接抽吸一次性取栓(A direct aspiration First-Pass thrombectomy,ADAPT)进行血管再通的安全性、可行性及技术优势。方法回顾性分析本院神经内科2021年3月至2023年10月接受血管再通术治疗的54例急性脑卒中患者。根据取栓技术的不同,患者被分为研究组(应用ADAPT技术直接抽吸取栓,34例)和对照组[应用Solitaire FR支架机械取栓术(Solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM),20例]。比较两组的取栓次数、手术操作时间、血管完全再通率、术前与术后2周美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、并发症发生率及术后3个月良好预后率。结果两组采用不同取栓技术后,研究组的取栓次数和手术操作时间均低于对照组(P<0.05)。术前两组的NIHSS评分差异无统计学意义(P>0.05)。术后2周,研究组的NIHSS评分显著低于对照组(P<0.05)。两组的血管完全再通率分别为70.59%和75.00%,术后3个月良好预后率分别为64.71%和60.00%,两组间差异无统计学意义(P>0.05)。研究组的并发症发生率(8.82%)显著低于对照组(20.00%)(P<0.05)。结论与SWIM取栓技术相比,ADAPT技术在血管再通率上无显著差异,但能显著减少急性脑卒中患者的取栓次数和手术操作时间,提升术后3个月的良好预后率,改善术后2周的NIHSS评分,并降低并发症发生率。ADAPT技术在改善患者功能恢复和降低并发症方面显示了更大的潜力,为急性缺血性脑卒中的临床治疗提供了有力的替代方案。
