Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes.Therefore,it is important for proper therapeutic management to identify a car...Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes.Therefore,it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients.Cardiac computed tomography(CCT)can detect the detailed visualization of various cardiac pathologies in the cardiac chambers,interatrial and interventricular septum,valves,and myocardium with few motion artifacts and few dead angles.Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner.Consequently,CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke.In addition,CCT can simultaneously evaluate obstructive coronary artery disease,which may be helpful in surgical planning in patients who need urgent surgery,such as cardiac tumors or infective endocarditis.This review will introduce the potential clinical applications of CCT in an ischemic stroke population,with a focus on diagnosing cardioembolic sources using CCT.展开更多
Eosinophilia has been reported as a very rare cause of stroke in children.The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein,that is,the major basic protein,or t...Eosinophilia has been reported as a very rare cause of stroke in children.The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein,that is,the major basic protein,or the systemic hypercoagulable state induced by eosinophilia.We report here a case of eosinophilia whose initial presentation was recurrent strokes and cardiac and arterial thrombosis.展开更多
Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona...Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.展开更多
Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave dura...Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.展开更多
This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral ang...This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.展开更多
目的本研究旨在探索血浆D-二聚体(D-dimer,D-D)对心源性栓塞(cardiogenic embolization,CE)型急性大血管闭塞性脑卒中(acute large vascular occlusion stroke,ALVOS)患者行机械取栓(mechanical thrombectomy,MT)术后预后不良的预测价...目的本研究旨在探索血浆D-二聚体(D-dimer,D-D)对心源性栓塞(cardiogenic embolization,CE)型急性大血管闭塞性脑卒中(acute large vascular occlusion stroke,ALVOS)患者行机械取栓(mechanical thrombectomy,MT)术后预后不良的预测价值分析。方法连续选取2020年1月—2023年3月南京医科大学附属常州第二人民医院接受MT的心源性栓塞(cardioembolism,CE)型ALVOS患者,共158例,回顾性分析其临床基础资料、手术信息及预后情况,比较预后良好组与预后不良组基线资料。采用Logistic回归分析MT术后90 d预后不良的独立危险因素,并应用ROC曲线评估MT术后24 h内的D-D水平对90 d转归不良的预测价值。结果CE型ALVOS患者预后不良组在基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、空腹血糖(fasting plasm glucose,FPG)、D-D水平均显著高于预后良好组,吸烟、饮酒史、症状性颅内出血(symptomatic intracerebral hemorrhage,sICH)及较差的改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级与预后不良正相关。Logistic回归在校正NIHSS评分、吸烟、饮酒、FPG、sICH、mTICI后,发现D-D(OR=2.14,95%CI:2.02~2.27,P<0.05)是CE型ALVOS患者MT术后90 d转归不良的独立危险因素。D-D预测MT术后90 d转归不良的曲线下面积(area under the curve,AUC)为0.708,最佳截断值为0.404,此时敏感度和特异度分别为81.0%和58.5%。结论MT术后24 h内D-D水平升高对预测CE型ALVOS患者90 d预后不良有一定的价值。展开更多
目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性...目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性栓塞53例。比较两组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷量表(GCS)评分、梗死核心区和缺血半暗带体积及二者差值以及后循环血管闭塞率、颅内大动脉闭塞率。结果大动脉粥样硬化组AIS患者入院时NIHSS评分低于心源性栓塞组[9.5(2.0,16.0)分vs 15.0(6.0,24.0)分,Z=2.31,P<0.001],GCS评分高于心源性栓塞组[(13.52±2.69)分vs(11.60±3.31)分,t=1.04,P=0.002]。心源性栓塞组梗死核心区和缺血半暗带体积分别为1(0,22)m L和64(30,126)m L,均大于大动脉粥样硬化组[分别为0(0,1)m L和10(0,70)m L;Z=3.85、3.43,P均<0.001];但心源性栓塞组和大动脉粥样硬化组缺血半暗带与梗死核心区体积的差值差异无统计学意义[46(4,103)m L vs 10(0,64)m L,Z=1.92,P>0.05]。大动脉粥样硬化组颅内大动脉闭塞率和后循环血管闭塞率分别为30.43%(14/46)和36.96%(17/46),与心源性栓塞组[分别为50.94%(27/53)和9.43%(5/53)]相比差异均有统计学意义(χ~2=11.82、6.77,P均<0.001)。结论大动脉粥样硬化与心源性栓塞AIS患者的临床症状、脑组织改变及颅内大动脉改变不同,基于临床及多模态CT检查的病因学评估有助于精确评估AIS患者缺血状态。展开更多
文摘Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes.Therefore,it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients.Cardiac computed tomography(CCT)can detect the detailed visualization of various cardiac pathologies in the cardiac chambers,interatrial and interventricular septum,valves,and myocardium with few motion artifacts and few dead angles.Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner.Consequently,CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke.In addition,CCT can simultaneously evaluate obstructive coronary artery disease,which may be helpful in surgical planning in patients who need urgent surgery,such as cardiac tumors or infective endocarditis.This review will introduce the potential clinical applications of CCT in an ischemic stroke population,with a focus on diagnosing cardioembolic sources using CCT.
文摘Eosinophilia has been reported as a very rare cause of stroke in children.The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein,that is,the major basic protein,or the systemic hypercoagulable state induced by eosinophilia.We report here a case of eosinophilia whose initial presentation was recurrent strokes and cardiac and arterial thrombosis.
文摘Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.
文摘Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.
文摘This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.
文摘目的本研究旨在探索血浆D-二聚体(D-dimer,D-D)对心源性栓塞(cardiogenic embolization,CE)型急性大血管闭塞性脑卒中(acute large vascular occlusion stroke,ALVOS)患者行机械取栓(mechanical thrombectomy,MT)术后预后不良的预测价值分析。方法连续选取2020年1月—2023年3月南京医科大学附属常州第二人民医院接受MT的心源性栓塞(cardioembolism,CE)型ALVOS患者,共158例,回顾性分析其临床基础资料、手术信息及预后情况,比较预后良好组与预后不良组基线资料。采用Logistic回归分析MT术后90 d预后不良的独立危险因素,并应用ROC曲线评估MT术后24 h内的D-D水平对90 d转归不良的预测价值。结果CE型ALVOS患者预后不良组在基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、空腹血糖(fasting plasm glucose,FPG)、D-D水平均显著高于预后良好组,吸烟、饮酒史、症状性颅内出血(symptomatic intracerebral hemorrhage,sICH)及较差的改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级与预后不良正相关。Logistic回归在校正NIHSS评分、吸烟、饮酒、FPG、sICH、mTICI后,发现D-D(OR=2.14,95%CI:2.02~2.27,P<0.05)是CE型ALVOS患者MT术后90 d转归不良的独立危险因素。D-D预测MT术后90 d转归不良的曲线下面积(area under the curve,AUC)为0.708,最佳截断值为0.404,此时敏感度和特异度分别为81.0%和58.5%。结论MT术后24 h内D-D水平升高对预测CE型ALVOS患者90 d预后不良有一定的价值。
文摘目的探究大动脉粥样硬化与心源性栓塞急性缺血性脑卒中(AIS)梗死特征的差异。方法回顾性纳入2016年10月至2018年6月于我院急诊入院治疗,且入院后、治疗前均行多模态计算机断层扫描(CT)检查的AIS患者99例,其中大动脉粥样硬化46例,心源性栓塞53例。比较两组患者的入院时美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷量表(GCS)评分、梗死核心区和缺血半暗带体积及二者差值以及后循环血管闭塞率、颅内大动脉闭塞率。结果大动脉粥样硬化组AIS患者入院时NIHSS评分低于心源性栓塞组[9.5(2.0,16.0)分vs 15.0(6.0,24.0)分,Z=2.31,P<0.001],GCS评分高于心源性栓塞组[(13.52±2.69)分vs(11.60±3.31)分,t=1.04,P=0.002]。心源性栓塞组梗死核心区和缺血半暗带体积分别为1(0,22)m L和64(30,126)m L,均大于大动脉粥样硬化组[分别为0(0,1)m L和10(0,70)m L;Z=3.85、3.43,P均<0.001];但心源性栓塞组和大动脉粥样硬化组缺血半暗带与梗死核心区体积的差值差异无统计学意义[46(4,103)m L vs 10(0,64)m L,Z=1.92,P>0.05]。大动脉粥样硬化组颅内大动脉闭塞率和后循环血管闭塞率分别为30.43%(14/46)和36.96%(17/46),与心源性栓塞组[分别为50.94%(27/53)和9.43%(5/53)]相比差异均有统计学意义(χ~2=11.82、6.77,P均<0.001)。结论大动脉粥样硬化与心源性栓塞AIS患者的临床症状、脑组织改变及颅内大动脉改变不同,基于临床及多模态CT检查的病因学评估有助于精确评估AIS患者缺血状态。
