经颅多普勒监测微栓子阳性的临床分析及思考

Positive microembolus monitored by transcranial Doppler: A clinical analysis of 10 cases

摘要:

目的 探讨微栓子（MES）阳性患者的临床、影像学特点及随访结果。方法 对10例微栓子阳性患者的临床资料、出院后随访结果进行回顾性分析。结果 患者的平均年龄为（58±14.09）岁，其中女性患者2例，男性8例；临床主诊断均为缺血性脑血管事件。8例MES阳性侧被检血管为中重度局限性狭窄；6例颈部血管彩超提示存在不均质回声斑块；1例患者为心脏瓣膜置换术后，多次监测提示双侧大脑中动脉（MCA）大量MES通过，同时合并右侧颈内动脉闭塞，但未发生脑卒中；3例经颅多普勒超声-发泡试验阳性，1例可见栓子雨，均不伴血管狭窄。3个月后随访，1例再发MES阳性一侧大面积脑梗死，致瘫痪、失语。3例发泡试验阳性患者MES仍阳性，相同时间内MES通过数量无明显改变。5例患者颈部血管超声呈高、等回声斑块，1例患者为低回声斑块，6例患者认知功能存在不同程度减退。结论 MES阳性与颅内外动脉不稳定斑块或卵圆孔未闭相关，MES阳性患者需关注脑卒中复发及认知功能减退的问题。

Abstract:

Objective To investigate the clinical and imaging features and follow-up results of patients with microembolus (MES).Methods A retrospective analysis was performed for the clinical and follow-up data of 10 patients with MES.Results The mean age of the 10 patients was 58±14.09 years. There were 2 female and 8 male patients, with ischemic cerebrovascular events as the main clinical diagnosis. Among these patients, 8 had moderate or severe localized stenosis of the vessels at the MES-positive side; 6 had heterogeneous plaques on neck color Doppler ultrasound; 1 had a medical history of cardiac valve replacement and multiple monitors showed that a large number of MES passed through the middle cerebral artery at both sides, with occlusion of the right internal carotid artery, but the patient did not experience stroke; 3 had positive results of transcranial Doppler ultrasound foaming test without vascular stenosis, among whom 1 had thrombus rain. The patients were followed up at 3 months after surgery, and 1 patient was found to have massive cerebral infarction at the MES-positive side, which caused paralysis and aphasia. The 3 patients with positive results of the foaming test still had positive MES, and there was no significant change in the number of MES passing through the artery during the same period of time. Neck vascular ultrasound showed hyperechoic or isoechoic plaques in cervical vessels in 5 patients and hypoechoic plaques in 1 patient; 6 patients were found to have varying degrees of reduction in cognitive function.Conclusions Positive MES is associated with unstable plaques of intracranial and extracranial arteries or patent foramen ovale. Recurrence of stroke and reduction in cognitive function should be monitored in MES-positive patients.