Zhongguo cuzhong zazhi (Mar 2018)
青年卒中患者头痛与脑小血管病影像学特征的关系研究 Relationship between Headache and Characteristics of Cerebral Small Vessel Disease Imaging in Young Stroke Patients
Abstract
目的 研究非遗传性青年卒中患者卒中时头痛是否与脑小血管病（small vessel disease，SVD）相关，以 及头痛的相关因素。 方法 回顾性分析北京大学第三医院神经科2006年1月-2015年12月因首次急性缺血性卒中入院的 18～45岁青年患者200例。所有患者于发病1周内行头颅磁共振成像（magnetic resonance imaging，MRI） 和磁共振血管成像（magnetic resonance angiography，MRA）检查。患者按有无卒中时头痛症状分为 两组，比较两组缺血性SVD[无症状腔隙性脑梗死（asymptomatic lacunar infarcts，ALAs）、脑白质病变 （white matter lesions，WMLs）和血管周围间隙扩大（enlarged perivascular spaces，EPVS）]的发生率；研究 青年卒中时头痛的相关因素。 结果 200例患者中，男性明显高发（男∶女=6.41∶1）。ALAs在本组患者的发生率为32.5%（65/200）， WMLs为25.5%（51/200），EPVS为30.5%（61/200）。卒中时头痛患者为11%（22/200）。头痛患者组 ALAs和EPVS发生率更低，差异有统计学意义（P =0.045，P =0.021），头痛组WMLs发生率也低于无 头痛组，但差异无统计学意义。头痛组患者急性卒中治疗低分子肝素试验（Trial of Org 10 172 in Acute Stroke Treatment，TOAST）分型中非大动脉粥样硬化者为63.6%（14/22），高于非头痛组（26.4%， 47/178），差异有统计学意义（P =0.001）。头痛组病灶部位在幕下（脑干或小脑）者为63.6%（14/22）， 高于非头痛组（26.4%，47/178），差异有统计学意义（P ＜0.001）。头痛组责任血管在后循环者为 68.2%（15/22），高于非头痛组（37.6%，67/178），差异有统计学意义（P =0.006）。 结论 青年缺血性卒中时头痛更多见于幕下病灶和后循环血管为责任血管的患者，卒中时头痛症状 在SVD患者中发生率更低。头痛更多见于非大动脉粥样硬化患者。 Abstract: Objective The study aimed to investigate the prevalence of cerebral small vessel disease (SVD), the prevalence of headache, and the relationship between SVD and headache in non-hereditary young stroke patients. Methods A retrospective analysis was made upon 200 patients who were hospitalized in department of neurology of Peking University Third Hospital due to first-ever ischemic stroke during January 2006 and January 2015. All patients were aged 18 to 45 years old, who underwent MR imaging (MRI) and MR angiography (MRA) within 7 days after stroke onset. Patients were divided into two groups: those with headache and those without headache. The prevalence of ischemic SVD in 2 groups, including asymptomatic lacunar infarcts (ALAs), white matter lesions (WMLs), and enlarged perivascular spaces (EPVS), were compared to study headache associated factors. Results Of the 200 patients, male had higher prevalence (male vs female=6.41:1). Of all, 32.5% (65/200) had ALAs, 25.5% (51/200) had WMLs, and 30.5% (61/200) had EPVS. There were 11% (22/200) had headache during acute stroke onset. ALAs and EPVS were less frequently associated with headache (P =0.045 and P =0.021 respectively). The percentage of Non-large artery atherosclerosis type in Trial of Org 10 172 in Acute Stroke Treatment (Toast) was significantly higher in headache group than that in non-headache group [63.6% (14/22) vs 26.4%(47/178), P =0.001]. The lesions located under the tentorium (brain stem or cerebellum) were significantly higher in headache group than that in non-headache group [63.6% (14/22) vs 26.4% (47/178), P< 0.001]. Culprit vessels in the posterior circulation were significantly higher in headache group than that in non-headache group [68.2% (15/22) vs 37.6% (67/178), P =0.006]. Conclusion Our data suggest that the lesions in young patients with headache onset during acute stroke mainly located under the tentorium (brain stem or cerebellum) and culprit vessels mostly in the posterior circulation. Onset of headache is significantly lower in the SVD group. Headache is significantly higher in the non- large artery atherosclerosis type in TOAST.
Keywords
