| Part I The comparative study of clinical and image in acute cardio embolism and thrombotic MCAO infarctionObjectiveTo compare the difference of clinical and image features in acute cardioembolism and thrombotic MCAO infarction, look for the clinical outcome, infarct size and other differences, in order to enhance the ability of clinical prognosis.Methods:102 acute ischemic stroke patients who had symptomatic middle cerebral artery M1 segment occlusion determined according by DWI and MRA, all patients were classified into large artery atherosclerosis thrombotic (LAA) group and cardioembolism group (CE) according to TOAST criteria, comparing admission DWI sequence showed of lesion size and morphology ,and the NIHSS score during hospitalization dynamic changes between two group.Results⑴CE group infarct volume at day admission were significantly higher than the LAA group (65.66±84.74, n = 33, vs 31.96±39.20, n = 69, P <0.05)⑵CE group admission NIHSS score were significantly higher than LAA group (11.67±8.50 vs 6.42±3.38, P <0.05)⑶CE group day 14 NIHSS score were significantly higher than LAA group (5.97±3.60 vs 4.87±6.61, P <0.05).⑷the relevance of infarct volume and NIHSS score at day admission : CE group (R = 0.077, P> 0.05) and LAA group (R = 0.220, P> 0.05) showed no correlation.⑸the relevance of infarct volume and NIHSS score at day 14 :CE group (R = 0.625, P <0.05) and LAA group (R = 0.295, P <0.05) were significantly correlated.⑹symptom improvement (NIHSS score at day admission - NIHSS score at day 14), CE group were significantly higher than the LAA group (5.75±9.28 vs 1.55±6.43, P <0.05).⑺Occurrence infarction results : LAA group multiple lesions were 49 cases (71.04%), single lesions were 20 cases (28.96%), CE group multiple lesions were15 cases (45.45%), single lesions were 18 cases (54.55%), multiple lesions in LAA group exceed CE group, single lesion in CE group exceed LAA group, the infarction between two groups had significant difference (P <0.05).⑻single lesion subtype comparison: LAA group single cortical - subcortical infarcts were 9 cases (13.04%), CE group were 12 cases (36.36%), there were significant difference between the two groups (P <0.05), but small cortical infarct, large subcortical infarcts and cortical infarction subtypes were no significant difference.⑼m ultiple lesions subtypes comparison: there were no significant difference in all subtypes, including cortical+subcortical infarcts, cortical+cortical infarction and multiple subcortical infarction between two groups.Conclusions:Cardioembolism and large artery atherosclerosis thrombotic infarction were different in lesion types and evolution of clinical symptoms. Part IIThe guidance value of Clinical-Diffusion mismatch in MCAO infarction arterial thrombolysisObjectiveTo explore the guidance value of Clinical-diffusion mismatch (CDM) in MCAO infarction arterial thrombolytic therapy.Methods:53 acute MCAO stroke patients examination by MRA with onset within 6 hours, divided into the thrombolysis group and the conventional treatment group, according to the definition of CDM, divided them into two groups of CDM sub-group and non-CDM sub-group, and analyze the specificity of using the CDM determine ischemic penumbra according to the clinical prognosis of patients with thrombolytic therapy.Results:1. Thrombolysis group, 9 cases met the definition of CDM, 9 p cases do not comply. Non-CDM Group DWI showed lesions in the volume were significantly higher than the CDM group (113.51±74.83 ml vs 10.41±8.52 ml, P <0.05), NIHSS score of day admission in CDM sub-group and non-CDM sub-group were no significant difference (13.89±8.99 vs 15.78±10.17, P> 0.05). NIHSS score of day 14 in CDM sub-group and non-CDM sub-group were significant difference (3.22±2.39 vs 7.22±4.55, P <0.05). NIHSS score change value (NIHSS score at day admission - NIHSS score at day 14) in CDM sub-group and non-CDM sub-group were no significant difference (10.67±9.70 vs 8.55±11.94, P> 0.05). NIHSS score before and after treatment in CDM group were significant difference (P <0.05), the Non-CDM group were no significant difference (P> 0.05). 2. Non-thrombolysis group: 11 cases (31.43%) met the definition of CDM, 24 cases (68.57%) do not comply. Non-CDM Group DWI lesion volume showed significantly higher than the CDM group (64.45±52.39 ml, n = 24, vs 9.70±2.78 ml, n = 11, P <0.05). NIHSS score of day admission in CDM sub-group and non-CDM sub-group were no significant differences (9.45±1.80 vs 7.96±3.06, P> 0.05). NIHSS score of day 14 in CDM sub-group and non-CDM sub-group were no significant difference (4.90±3.20 vs 5.88±3.67, P> 0.05). NIHSS score change value (NIHSS score day admission - NIHSS score day 14) in CDM sub-group and non-CDM sub-group were no significant difference (4.54±4.03 vs 2.08±2.79, P> 0.05). NIHSS score test before and after treatment in the two subgroups were significantly different (P <0.05).3. All admitted within 6 hours meet the definition of CDM patients, lesion volume between thrombolysis group and non-thrombolysis group showed no significant difference (10.41±8.52 ml, n = 9, vs 9.70±2.78 ml, n = 11, P> 0.05). NIHSS score of day admission between thrombolysis group and non-thrombolysis group showed no significant difference (13.89±8.99 vs 9.55±1.70, P> 0.05). NIHSS score of day 14 between thrombolysis group and non-thrombolysis group showed no significant difference (3.22±2.39 vs 4.90±3.2, P> 0.05). NIHSS score change value (NIHSS score day admission - NIHSS score day 14) between thrombolysis group and non-thrombolysis group had significant differences (10.67±9.70 vs 4.54±4.03, P> 0.05).ConclusionClinical-diffusion mismatch predicts the putative penumbra with high specificity, to guide thrombolytic therapy of acute cerebral infarction had several value. |
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