| Objective: Acute ischemic cerebral infarction is 75 percents of all the cerebral vascular disease. At present the most available treatment is thrombolysis and organized stroke units. Early diagnosis could make the thrombolysis therapy be in time so as to decrease ischemic necrosis utmost; to evaluate the pathogenetic condition and prognosis perfectly could guide the clinician to choose therapeutic regimen rationally, thus to get best therapeutic effect. So how come to diagnosis early,prognosis rationally have become an important question to breakthrough in present medical research. The purpose of our research is to observe all the index of DWI which belong to functional MRI and SEPs which belong to nervous electrophysiology in acute cerebral infarction patients and concentrate on the relationship between the changes of the index and the prognosis of the patience, thereby to evaluate the application value of DWI and SEPs in cerebral infarction.Methods: seventy-one patients(mean age 66.58±12.35 years, range 25 to 85 years old)presenting within 7days of the onset were studied. All the patients in some degree have neurological impairment such as disorder in limbs,sensory function disturbance or aphasia, et al, male 42, female 29. Patients with primary cerebral hemorrhage as assessed by computed tomography (CT) or MRI were excluded from the study. Conventional MRI (anteroposterior axes T1WI, T2WI; abscissa axis T1WI, T2WI) and DWI were performed on a Siemens Tim--avanto1.5T using a standard. Upper SEPs were performed on a Denmark Medtronic keypoint4 EMG-evoked potentials. According to the consequence of SEPs, devided into patients with normal group, mild abnormal group and severe abnormal group. Its diagnostic criteria:①severe abnormal performance for the disease hemisphere side with no identifiable of the waveform, and the contralateral normal;②mild abnormal performance for the N13-N20 IPL of the infarct side more than the control side mean±standard deviation 3.0 ( x±3.0s);③normal performance for bilateral waveform basically the same.All the patients'NIHSS score were evaluated when on admission and two months after the onset. Analysis the patients'general state of NIHSS1 scores, NIHSS2 scores, outcome of SEPs, infarct volume, outcome of DWI and T2WI. The statistics were made by SPSS 13.0 , and the difference between measurement data were decided by compared t test or single factor analysis of variance , the difference between the numeration data were assessed byχ2 test,correlation analysis use spearman correlation.Results: 1 All the patients' NIHSS score was average 6.72±3.788 (rage 1 to 20)when on admission and was average 4.72 ±4.054 (rage 0 to 20)two months after the onset.2 Seventy of the 71 patients'lesion can be seen on DWI sequence, the positive rate of DWI in infarction detection was 98.59 percent. At the same time, only 58 patients were detected through T2WI and the positive rate was 81.69 percent. The other undetected 13 patients were all hyper acute infarction. Contrast these two rate withχ2 test, DWI had higher positive rate in detecting infarction than conventional MRI (χ2=12.00 P<0.01). The evaluation between the infarct volume and prognosis:the infarct volume had obvious positive correlation with the NIHSS1,NIHSS2(r=0.393 P=0.006, r=0.407 P=0.004).3 Forty-six of the 71 patients had abnormal SEPs results, including 27 mild abnormal patients and 19 severe abnormal patients. Sixteen of the 19(84.21%) cerebral lobe infarction patients had abnormal SEPs results; the abnormal SEPs results of basal ganglia infarction, thalamus infarction, pons infarction, cerebellum infarction, multiple infarction were 52.17%, 80%, 42.85%, 33.33% and 66.67%。In normal group, there are no significant differences in the N13-N20 IPL of the two side(P=0.062). In mild abnormal group, the N13-N20 IPL of the healthy side was 5.886±0.641 ms and in infarct side was 7.664±0.466 ms, compared t test confirmed this with significance (P<0.01). In severe abnormal group, the N13-N20 IPL of the healthy side was 5.791±0.398 ms .The NIHSS1 score of the three group were 4.36±2.89,6.59±3.27 and 10.00±3.77 while the NIHSS2 were 2.04±1.70 4.52±3.30 and 8.79±3.91.There were significant differences in the NIHSS1 and NIHSS2 score of the three group (P<0.05).Conclusions:1 DWI is more sensible than conventional MRI in the diagnosis of super-early period cerebral infarction.2 Application of SEPs recording has significant value for predicting the extent of brain dysfunction and for predicting prognosis in cerebral infarction.3 SEPs associated with DWI could provide better accurate diagnosis of acute cerebral infarction ,and could provide the evidence for clinician to evaluate the pathogenetic condition and prognosis general, accordingly to choose therapeutic regimen reasonable and elevate the cure rate utmost. |
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