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中华脑血管病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 260 -265. doi: 10.3877/cma.j.issn.1673-9248.2025.03.014

所属专题: 经典病例

病例报告

卵圆孔未闭伴下腔静脉瓣致发作性意识障碍的缺血性脑血管病一例
李雪婷1,2, 马欣1,3,4,(), 董静1,3,4   
  1. 1 100053 北京,首都医科大学宣武医院神经内科
    2 164100 山东 烟台,烟台市牟平区中医医院脑病科
    3 100053 北京,首都医科大学心脑联合病变临床诊疗与研究中心
    4 100053 北京,国家老年疾病临床医学研究中心
  • 收稿日期:2025-02-08 出版日期:2025-06-01
  • 通信作者: 马欣

A case of ischemic cerebrovascular disease with paroxysmal consciousness disturbance caused by patent foramen ovale and eustachian valve

Xueting Li, Xin Ma(), Jing Dong   

  • Received:2025-02-08 Published:2025-06-01
  • Corresponding author: Xin Ma
引用本文:

李雪婷, 马欣, 董静. 卵圆孔未闭伴下腔静脉瓣致发作性意识障碍的缺血性脑血管病一例[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(03): 260-265.

Xueting Li, Xin Ma, Jing Dong. A case of ischemic cerebrovascular disease with paroxysmal consciousness disturbance caused by patent foramen ovale and eustachian valve[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(03): 260-265.

图1 伴意识障碍的短暂性脑缺血发作患者的经颅多普勒超声结果。监测血管为右侧大脑中动脉,图a为静息状态推注激活盐水后20 s内可见2个微泡信号(箭头);图b为Valsalva动作后推注激活盐水后20 s内可见35个微泡信号(箭头)
图2 伴意识障碍的短暂性脑缺血发作患者的头颅核磁共振成像结果。图a~d分别为延髓层面、脑桥层面、中脑层面、基底节层面的T2序列成像;图e~h分别为延髓层面、脑桥层面、中脑层面、基底节层面的弥散加权成像,均未见异常
图3 伴意识障碍的短暂性脑缺血发作患者的右心声学造影结果。图a为房间隔卵圆孔处的双层结构,Valsalva动作后最大回声分离2.4 mm(箭头);图b为进行Valsalva动作后可见大量右向左分流(箭头);图c为右心房内探及条带状回声飘动,起自下腔静脉口(箭头)
图4 伴意识障碍的短暂性脑缺血发作患者的心脑动脉CT血管造影联合扫描。图a为头颈部血管正面观;图b为颅内动脉血管正面观;图c为颅内动脉血管侧面观,全程血管均未见明显异常
1
Puppala VK, Akkaya M, Dickinson O, et al. Risk stratification of patients presenting with transient loss of consciousness[J]. Cardiol Clin, 2015, 33(3): 387-396.
2
黎敏, 傅晓凤, 张井艳, 等. 颈内动脉狭窄致发作性意识障碍1例并文献复习[J]. 神经损伤与功能重建, 2021, 16(12): 698-701.
3
Sonohata M, Eriguchi M, Ogata A, et al. Paradoxical brain embolism due to a popliteal venous aneurysm after minor orthopedic surgery in a 19-year-old man with patent foramen ovale: a case report[J]. J Orthop Sci, 2021, 26(4): 714-718.
4
Zhang B, Li D, Song A, et al. Characteristics of patent foramen ovale: analysis from a single center[J]. Cardio Res Pract, 2022, 2022: 5430596-5430598.
5
Wang X, Liu X, Zheng L, et al. Correlation between percutaneous patent foramen ovale closure and recurrence of unexplained syncope[J]. Front Neurol, 2023, 14: 1104621.
6
Liu D, Chen K, Gong J, et al. Right-to-left shunts in unexplained syncope: an age- and sex-matched case-control study[J]. Quant Imaging Med Surg, 2022, 12(7): 3592-3602.
7
Berthet K, Lavergne T, Cohen A, et al. Significant association of atrial vulnerability with atrial septal abnormalities in young patients with ischemic stroke of unknown cause[J]. Stroke (1970), 2000, 31(2): 398-403.
8
Ihara M, Tanaka H, Nishimura Y. Primary antiphospholipid syndrome with recurrent transient ischemic attacks: report of a case and its successful treatment[J]. Intern Med, 1998, 37(8): 704-707.
9
王笑雨, 白小欣, 蔡军. 以典型内囊预警综合征发病的卵圆孔未闭2例报道[J]. 卒中与神经疾病, 2020, 27(4): 533-535.
10
Ng AC. Posterior circulation ischaemic stroke[J]. Am J Med Sci, 2022, 363(5): 388-398.
11
Sparaco M, Ciolli L, Zini A. Posterior circulation ischaemic stroke-a review part I: anatomy, aetiology and clinical presentations[J]. Neurol Sci, 2019, 40(10): 1995-2006.
12
胡运洁, 于筠琛, 李永兴, 等. 卵圆孔未闭与偏头痛相关性的研究进展[J]. 心肺血管病杂志, 2021, 40(8): 882-884.
13
Perego M, Porteiro Vàzquez DM, Ramera L, et al. Heart rhythm characterisation during unexplained transient loss of consciousness in dogs[J]. Vet J, 2020, 263: 105523.
14
Singhal AB. Reversible cerebral vasoconstriction syndrome: a review of pathogenesis, clinical presentation, and treatment[J]. Int J Stroke, 2023, 18(10): 1151-1160.
15
Hara H, Virmani R, Ladich E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status[J]. J Am Coll Cardiol, 2005, 46(9): 1768-1776.
16
Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis[J]. Lancet Neurol, 2007, 6(12): 1063-1072.
17
de Belder MA, Tourikis L, Leech G, et al. Risk of patent foramen ovale for thromboembolic events in all age groups[J]. Am J Cardiol, 1992, 69(16): 1316-1320.
18
Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients[J]. Lancet, 1988, 2(8601): 11-12.
19
van Dijk JG, Thijs RD, Benditt DG, et al. A guide to disorders causing transient loss of consciousness: focus on syncope[J]. Nat Rev Neurol, 2009, 5(8): 438-448.
20
姜新鹏, 张喆. 卵圆孔未闭相关隐源性脑梗死影像学特征的研究现状[J/OL]. 中华脑血管病杂志(电子版), 2021, 15(2): 112-114.
21
Yasaka M, Otsubo R, Oe H, et al. Is stroke a paradoxical embolism in patients with patent foramen ovale?[J]. Intern Med, 2005, 44(5): 434-438.
22
Telman G, Yalonetsky S, Kouperberg E, et al. Size of PFO and amount of microembolic signals in patients with ischaemic stroke or TIA[J]. Eur J Neurol, 2008, 15(9): 969-972.
23
王丁, 张隽, 刘娅妮. 高风险型卵圆孔未闭的研究进展[J/OL]. 中华医学超声杂志 (电子版), 2021, 18(2): 224-226.
24
李玮. 基于Logistic回归分析法评价卵圆孔未闭患者经食道超声心动图测量参数与隐源性卒中的关系[J]. 现代医用影像学, 2023, 32(5): 961-964.
25
Mojadidi MK, Zaman MO, Elgendy IY, et al. Cryptogenic stroke and patent foramen ovale[J]. J Am Coll Cardiol, 2018, 71(9): 1035-1043.
26
Schuchlenz HW, Saurer G, Weihs W, et al. Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events[J]. J Am Soc Echocardiogr, 2004, 17(3): 231-233.
27
Kato Y, Dembo T, Takeda H, et al. Prominent persisting Eustachian valve initiates spontaneous right-to-left shunt and paradoxical embolism in a patient with patent foramen ovale[J]. Neurol Sci, 2011, 32(5): 925-926.
28
岳庆雄, 刘佳, 周瑜, 等. 基于经食管超声心动图的卵圆孔未闭形态与隐源性卒中的关系研究[J]. 中国卒中杂志, 2021, 16(9): 915-920.
29
高贵留, 聂希会, 孙佩辉. 频发短暂性脑缺血发作的危险因素分析[J]. 山东医药, 2013, 53(45): 84-86.
30
Piechaud JF. Hypoxemia related to right-to-left shunting through a patent foramen ovale: successful percutaneous treatment with the CardioSeal device[J]. J Interv Cardiol, 2001, 14(1): 57-60.
31
Onorato EM. Large eustachian valve fostering paradoxical thromboembolism: passive bystander or serial partner in crime?[J]. World J Cardiol, 2021, 13(7): 204-210.
32
Rigatelli G, Dell'Avvocata F, Braggion G, et al. Persistent venous valves correlate with increased shunt and multiple preceding cryptogenic embolic events in patients with patent foramen ovale: an intracardiac echocardiographic study[J]. Catheter Cardiovasc Interv, 2008, 72(7): 973-976.
33
Nakayama R, Takaya Y, Akagi T, et al. Identification of high-risk patent foramen ovale associated with cryptogenic stroke: development of a scoring system[J]. J Am Soc Echocardiogr, 2019, 32(7): 811-816.
34
Vale TA, Newton JD, Orchard E, et al. Prominence of the eustachian valve in paradoxical embolism[J]. Eur J Echocardiogr, 2011, 12(1): 33-36.
35
Zhu Y, Zhang J, Huang B, et al. Impact of patent foramen ovale anatomic features on right-to-left shunt in patients with cryptogenic stroke[J]. Ultrasound Med Biol, 2021, 47(5): 1289-1298.
36
Samuel S, Reddy ST, Parsha KN, et al. Routine surveillance of pelvic and lower extremity deep vein thrombosis in stroke patients with patent foramen ovale[J]. J Thromb Thrombolysis, 2021, 51(4): 1150-1156.
37
Miranda B, Fonseca AC, Ferro JM. Patent foramen ovale and stroke[J]. J Neurol, 2018, 265(8): 1943-1949.
38
Yan C, Li H, Wang C, et al. Frequency and size of in situ thrombus within patent foramen ovale[J]. Stroke, 2023, 54(5): 1205-1213.
39
Yu S, Zhang H, Li H. Cardiac computed tomography versus transesophageal echocardiography for the detection of left atrial appendage thrombus: a systemic review and meta-analysis[J]. J Am Heart Assoc, 2021, 10(23): e022505.
40
沐回凯, 孙煌, 李锐洁, 等. 比较心脏CT血管造影与经食道超声心动图检测左心耳封堵术后残余分流和器械相关血栓的价值[J]. 中国循环杂志, 2020, 35(8): 765-770.
41
王睿, 周碧怡, 马杰, 等. 与卵圆孔未闭相关的不明原因脑卒中的研究进展[J]. 中华神经医学杂志, 2021, 20(1): 92-97.
42
Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke[J]. N Engl J Med, 2017, 377(11): 1011-1021.
43
Lee PH, Song JK, Kim JS, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial[J]. J Am Coll Cardiol, 2018, 71(20): 2335-2342.
44
Deng W, Yin S, McMullin D, et al. Residual shunt after patent foramen ovale closure and long-term stroke recurrence[J]. Ann Intern Med, 2020, 173(11): 946-947.
45
Kasner SE, Swaminathan B, Lavados P, et al. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial[J]. Lancet Neurol, 2018, 17(12): 1053-1060.
46
董静, 郄静媛, 马欣. 伴有卵圆孔未闭隐源性缺血性脑血管病不同治疗方式的长期疗效及其影响因素分析[J]. 中华医学杂志, 2022, 102(45): 3604-3610.
47
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association[J]. Stroke, 2021, 52(7): e364-e467.
48
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南2022[J]. 中华神经科杂志, 2022, 55(10): 1071-1110.
49
Romoli M, Giannandrea D, Eusebi P, et al. Aspirin or anticoagulation after cryptogenic stroke with patent foramen ovale: systematic review and meta-analysis of randomized controlled trials[J]. Neurol Sci, 2020, 41(10): 2819-2824.
50
Pristipino C, Sievert H, D'Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism[J]. Eur Heart J, 2019, 40(38): 3182-3195.
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