Clinical And Imaging Characteristics Of Young And Middle-aged Cryptogenic Cerebral Infarction Patients With Patent Foramen Ovale

BackgroundCryptogenic cerebral infarction(CCI)is defined as cerebral ischemia of obscure or unknown origin after an extensive search.CCI has a close relationship with patent foramen ovale(PFO).Present study showed that the incidence of PFO in CCI patients was as high as40%,PFO associated with atrial septal aneurysm or vein thrombosis has been considered an independent risk factor for ischemic stroke,especially for young and middle-aged CCI patients.At present,transesophageal echocardiography(TEE)diagnosis of PFO is the gold standard,but it is limited in clinical applications because it is an invasive examination,also it may bring some complications.Cardiac magnetic resonance imaging(MRI)is the most promising means of cardiac examination in recent years.In this study,the occurrence of PFO in CCI patients was detected by cardiac MRI,clinical and imaging characteristics of young and middle-aged CCI patients with PFO were analyzed,to provide guidance for the clinical diagnosis and treatment of PFO.ObjectiveTo evaluate the application of cardiac MRI for detection of PFO in CCI patients,analysis the clinical and imaging characteristics of young and middle-aged CCI patients with PFO.Method(1)Totally 31 CCI patients aged from 18 to 55 years old were chosed as trial group,cerebral infarction in line with the 2014 version of "Chinese Acute Ischemic Stroke Treatment Guidelines" standard and was confirmed by head MRI.CCI in accordance with the latest Timsit’s definition in 2009.(2)All the patients’ name,gender,age and other general information were recorded;their smoking habits,drinking habits,hypertension,hyperlipidemia,diabetes,family history of cerebral infarction and other stroke risk factors were investigated;their stroke onset form,symptoms,neurological deficit scores were recored;patients were performed blood routine,blood clotting,liver and kidney function,blood fat,blood glucose,homocysteine,immunological markers,brain MRI,brain magnetic resonance angiography(MRA),cervical vascular ultrasound,transcranial doppler(TCD),transthoracic echocardiography(TTE)and other tests.(3)The presence of PFO and its size were observed by cardiac MRI,according to the results,patients were divided into PFO group and non PFO group.(4)SPSS19.0 statistical software package was used for processing data,and P<0.05 was considered that difference was statistically significant.The clinical and imaging characteristics of young and middle-aged CCI patients with PFO were analyzed betwen the two groups.Result(1)Total of 31 CCI patients were investigated,including 16 patients((51.61%)with PFO and 15 patients(48.39%)without PFO.(2)In all 16 CCI patients with PFO,different degrees of atrial septal defect and dynamic blood signals flow from left atrium to right atrium through the atrial septal defect in systole phase can be observed by cardiac MRI,but their is no obvious weakness and defects in negative patients.According to the size of PFO,16 PFO patient was further divided into large PFO group(≥2.0 mm)and small group(<2.0mm).There were 8 patients(50.00%)in the big PFO group and the diameter of the defect were6.0,5.8,3.8,3.0,3.0,2.8,2.0,2.0mm.There were 8 patients(50.00%)in the small PFO group including 1 cases of 1.6mm defect and 7 cases of wire-like defects.(3)The proportions of positive history of diabetes(0.00%),carotid plaque(18.75%),and cerebral vascular stenosis(31.25%)in PFO group were lower than that in non-PFO group,the proportions of hyperhomocysteine(50.00%)in PFO group were higher,MRIshowed the cerebral lesions in PFO group mainly distributed in the anterior circulation area(75.00%),in the form of single blood supply area(56.25%),less than 2cm single small perforator infarction(50.00%),but there were no significant difference of the clinical and imaging characteristics between two groups(P>0.05).Conclusion(1)Young and middle-aged CCI patients has a higher incidence of PFO.(2)Most young and middle-aged CCI patients with PFO had no typical clinical and infarct distribution characteristics,at present they can’t be served as effectively identify indicators of PFO in young and middle-aged CCI patients.(3)Cardiac MRI can be used as an effective means of detection PFO in young and middle-aged CCI patients.