中青年隐源性DWI阴性急性缺血性脑卒中合并卵圆孔未闭两例

刘莹莹 马丽丽 马晓萌 陈晓红

【摘要】该文报道2例中青年隐源性弥散加权成像（DWI）阴性急性缺血性脑卒中合并卵圆孔未闭男性患者，均为38岁，急性起病，以轻度神经功能缺损症状就诊，既往无脑血管病危险因素，以左侧肢体功能障碍为主要表现，DWI均阴性，经颅多普勒超声发泡检查和经食管心脏彩色多普勒超声检查发现卵圆孔未闭，其后均接受抗血小板、调脂等治疗，好转出院后随访显示2例均接受了卵圆孔未闭封堵治疗，均痊愈。应通过该2例的诊治过程提高对局灶性神经功能缺损合并卵圆孔未闭的认识，当患者出现局灶性神经功能缺损，即使DWI阴性亦不能排除急性缺血性脑卒中，应积极进行危险因素筛查，尤其是在中青年隐源性患者中，应高度重视卵圆孔未闭的检测及治疗，减少卵圆孔未闭所致的脑卒中及卒中复发。

【关键词】肢体功能障碍;缺血性卒中;卵圆孔未闭

Cryptogenic DWI-negative ischemic stroke complicated with patent foramen ovale： report of two cases Liu Yingying， Ma Lili， Ma Xiaomeng， Chen Xiaohong. Department of Neurology， the Third Affiliated Hospital of Sun Yat-sen University， Guangzhou 510630， China

Corresponding author，Chen Xiaohong， E-mail： chenxh5@mail.sysu.edu.cn

【Abstract】Two 38-year-old male patients with cryptogenic diffusion weighted imaging（DWI）-negative ischemic stroke complicated with patent foramen ovale （PFO） were reported. Both two patient presented with acute onset， mild neurological deficits， no previous risk factors of cerebrovascular disease and left limb dysfunction as the main manifestation. DWI yielded negative results. Transcranial Doppler （TCD） sonography and esophageal echocardiography confirmed the diagnosis of PFO. Two patients were treated with antiplatelet and lipid-reducing interventions and successfully discharged. Subsequent follow-up indicated that two patients received PFO occlusion and were healed. The diagnosis and treatment of these two cases deepened the understanding of focal neurologic deficit complicated with PFO. The possibility of ischemic stroke cannot be ruled out when the DWI is negative in patients presenting with focal neurological deficit. We should actively carry out risk factors screening， especially in young patients with cryptogenic stroke. We should attach great importance to the diagnosis and treatment of PFO， aiming to reduce the incidence and recurrence of stroke caused by PFO.

【Key words】Limb dysfunction; Ischemic stroke; Patent foramen ovale

卵圓孔未闭（PFO）是一种常见的先天性心脏病，有研究者发现其与缺血性脑卒中相关，是部分隐源性卒中患者的致病原因[1-3]。本文报道了2例中青年隐源性弥散加权成像（DWI）阴性急性缺血性脑卒中合并PFO患者，综合考虑其脑卒中由PFO引起。

病例资料

例1 患者男，38岁，因突发左侧肢体活动不灵3 d于2020年7月1日至本院神经内科就诊。患者于剧烈运动后觉左侧肢体乏力，伴有麻木感，尚能行走、持物，症状有轻微加重趋势，无头晕、头痛，无言语不利，无口角歪斜。否认有高血压、糖尿病、心脏病、高脂血症等病史。……