Abstract:

Objective Alcohol drinking is a trigger factor of cerebral infarction. We summarize and discuss the characteristics, thrombolysis decisions and outcomes of alcohol-triggered cerebral infarction. Methods We retrospectively selected patients with alcohol-triggered cerebral infarction presented to the Code Stroke System of Beijing Tiantan Hospital from September 2012 to June 2013. Data of clinical presentations, imaging, thrombolysis and outcomes were collected. Results Eleven cases of patients with alcohol-triggered cerebral infarction within 0.5~8 hours after onset were presented to the Code Stroke System of Beijing Tiantan Hospital from September 2012 to June 2013. All the patients were male, with a median age of 59 years (interquartile range 53.5~60). Median interval from the onset to arrival at hospital were 120 minutes (interquartile range 45~250).The main symptoms at presentation:9 cases with partial body weakness, 1 case with involuntary movements, 1 case with single-limb numbness. Minor stroke accounted for 73% (8%). The clinical course and prognosis:2 cases received intravenous thrombolysis and significantly improved, 1 case received arterial thrombolysis and significantly improved, 2 cases refused thrombolysis but got spontaneous remission, 3 cases with mild symptoms got spontaneous remission without thrombolysis, 2 cases exceeding 3-hour window didn't receive thrombolysis due to normal perfusion-weighted imaging (PWI), 1 case exceeding 3-hour window didn't receive thrombolysis due tonormal diffusion-weighted imaging (DWI) and PWI. In all, there were 5 cases with definite infarction focus on the imaging. In the 3 patients thrombolysed with recombinanttissue-type plasminogen activator (rt-PA), based on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification criteria, 2 cases (66.7%) were attributed to large artery atherosclerosis, 1 cases (33.3%) were attributed to small artery occlusion. All the 8 patients who were excluded from or refused thrombolysis, were attributed to small artery occlusion. Conclusion The prognosis of most of the alcohol-triggered cerebral infarction is good. Alcohol- triggered cerebral infarction may benefit from thrombolysis. Cause of most patients was small artery occlusion. A small part attributes to large artery atherosclerotic occlusion.

Key words: Cerebral infarction; Alcohol drinking; Trigger factor; Thrombolysis

摘要：

目的 探讨酒后脑梗死患者的特点、 溶栓决策及结局。方法 选取2012年9月～2013年6月期间首都医科大学附属北京天坛医院神经内科急诊溶栓绿色通道的酒后脑梗死患者11例， 收集患者的临床表现、 影像特征、 溶栓情况及结局进行回顾性分析。结果 11例酒后脑梗死患者发病0.5～8 h进入急诊溶栓绿色通道， 皆为男性， 中位数年龄59岁 （四分位数间距53.5～60） ， 到达医院时平均中位数发病时间为120 min （四分位数间距45～250） 。 就诊时主要症状： 9例为偏身无力， 1例为偏身不自主运动， 1例为单肢麻木。 小卒中患者8例 （73%） 。 临床过程及转归： 2例接受静脉溶栓后明显改善， 1例接受动脉溶栓后明显改善， 2例拒绝溶栓后自发缓解， 3 例因症状轻微而未溶栓且自发缓解， 2例发病超过3 h的患者因磁共振灌注成像正常而未溶栓， 1例发病超过3 h的患者因磁共振弥散加权成像和灌注成像均正常而未溶栓。 最终5例在影像上有明确的新发梗死灶。 根据急性卒中治疗低分子肝素试验病因分型法 （Trial of Org 10172 in Acute Stroke Treatment， TOAST） 的分型标准， 接受溶栓的3例患者中 ， 2例为大动脉粥样硬化性闭塞， 1例为小动脉闭塞； 拒绝和未接受溶栓的8例患者均为小动脉闭塞。结论 酒后脑梗死多数预后好， 有可能从溶栓中获益。 酒后脑梗死病因多为小动脉闭塞， 少部分是大动脉粥样硬化性闭塞。

关键词: 脑梗死; 饮酒; 诱发因素; 溶栓