英國(guó)學(xué)者的一項(xiàng)前瞻性基于人群的研究發(fā)現(xiàn)：在患有明確的椎基底動(dòng)脈卒中的患者中，卒中發(fā)生前常見(jiàn)單獨(dú)的短暫性腦干癥狀，但是大多數(shù)癥狀不符合TIA的傳統(tǒng)定義。單獨(dú)的短暫性腦干癥狀的預(yù)后還有待更多研究來(lái)證實(shí)。該論文于近日在線發(fā)表于《柳葉刀·神經(jīng)學(xué)》雜志。

　　單獨(dú)的短暫性腦干癥狀如單獨(dú)的眩暈，構(gòu)音困難，復(fù)視等并沒(méi)有一貫地劃分為短暫性腦缺血發(fā)作（TIAs）且預(yù)后方面的數(shù)具有限。如果這些短暫的神經(jīng)發(fā)作（TNAs）是由于椎基底動(dòng)脈缺血，那么這些癥狀在后循環(huán)卒中發(fā)作前的幾天或幾周期間應(yīng)該很常見(jiàn)。

　　該研究旨在評(píng)價(jià)椎基底動(dòng)脈缺血性卒中發(fā)作前TNAs的發(fā)作頻率。

　　該項(xiàng)在英國(guó)牛津夏州進(jìn)行的前瞻性基于人群的發(fā)生率研究中，研究人員研究了缺血性卒中發(fā)生前90天期間的所有潛在缺血性事件，并對(duì)比了椎基底動(dòng)脈缺血性卒中和頸動(dòng)脈卒中前TNA的發(fā)生率。TNAs的劃分在不同區(qū)域有所不同：在椎基底動(dòng)脈區(qū)域?yàn)槟X干癥狀如單獨(dú)的眩暈，眩暈伴非局灶性癥狀，單獨(dú)的復(fù)視，短暫的全身虛弱和雙眼視覺(jué)障礙；在頸動(dòng)脈區(qū)域?yàn)榉堑湫鸵贿^(guò)性黑朦和肢體抖動(dòng)；在不確定區(qū)域?yàn)閱为?dú)的言語(yǔ)不清，變異性偏頭痛，短暫的意識(shí)模糊和單側(cè)麻木綜合癥。

　　結(jié)果顯示，在1141名缺血性卒中患者中，有1034名（91%）患者發(fā)生在可分類的血管分布區(qū)，其中275人椎基底動(dòng)脈卒中和759人頸動(dòng)脈卒中。與頸動(dòng)脈卒中前相比，椎基底動(dòng)脈卒中前單獨(dú)的腦干TNAs更頻繁（p<0·0001），尤其是卒中前2天。在椎基底動(dòng)脈卒中前的所有59例TNAs中，只有5例達(dá)到了美國(guó)國(guó)家神經(jīng)疾病和卒中研究所（NINDS）的TIA標(biāo)準(zhǔn)。其他54例為單獨(dú)的眩暈，非NINDS雙眼視覺(jué)障礙，眩暈伴有其他非局灶性癥狀，單獨(dú)的言語(yǔ)不清，單側(cè)肢體麻木或復(fù)視，和非局灶性事件。伴有單獨(dú)的腦干TNAs的患者只有22%在卒中發(fā)生前就醫(yī)，這些病例中只有一例患者的醫(yī)生懷疑是血管原因引起的。

　　因此，通過(guò)該研究，作者認(rèn)為在明確的椎基底動(dòng)脈卒中患者中，卒中之前有短暫性孤立性腦干癥狀是常見(jiàn)的，并且大多數(shù)癥狀未符合TIA的傳統(tǒng)定義。短暫性孤立性腦干癥狀的發(fā)生后需警惕椎基底動(dòng)脈卒中。

　　BACKGROUND: Transient isolated brainstem symptoms (eg, isolated vertigo, dysarthria, diplopia) are not consistently classified as transient ischaemic attacks (TIAs) and data for prognosis are limited. If some of these transient neurological attacks (TNAs) are due to vertebrobasilar ischaemia, then they should be common during the days and weeks preceding posterior circulation strokes. We aimed to assess the frequency of TNAs before vertebrobasilar ischaemic stroke. METHODS: We studied all potential ischaemic events during the 90 days preceding an ischaemic stroke in patients ascertained within a prospective, population-based incidence study in Oxfordshire, UK (Oxford Vascular Study; 2002-2010) and compared rates of TNA preceding vertebrobasilar stroke versus carotid stroke. We classified the brainstem symptoms isolated vertigo, vertigo with non-focal symptoms, isolated double vision, transient generalised weakness, and binocular visual disturbance as TNAs in the vertebrobasilar territory; atypical amaurosis fugax and limb-shaking as TNAs in the carotid territory; and isolated slurred speech, migraine variants, transient confusion, and hemisensory tingling symptoms as TNAs in uncertain territory. FINDINGS: Of the 1141 patients with ischaemic stroke, vascular territory was categorisable in 1034 (91%) cases, with 275 vertebrobasilar strokes and 759 carotid strokes. Isolated brainstem TNAs were more frequent before a vertebrobasilar stroke (45 of 275 events) than before a carotid stroke (10 of 759; OR 14·7, 95% CI 7·3-29·5, p<0·0001), particularly during the preceding 2 days (22 of 252 before a vertebrobasilar stroke vs two of 751 before a carotid stroke, OR 35·8, 8·4-153·5, p<0·0001). Of all 59 TNAs preceding (median 4 days, IQR 1-30) vertebrobasilar stroke, only five (8%) fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) criteria for TIA. The other 54 cases were isolated vertigo (n=23), non-NINDS binocular visual disturbance (n=9), vertigo with other non-focal symptoms (n=10), isolated slurred speech, hemisensory tingling, or diplopia (n=8), and non-focal events (n=4). Only 10 (22%) of the 45 patients with isolated brainstem TNAs sought medical attention before the stroke and a vascular cause was suspected by their physician in only one of these cases. INTERPRETATION: In patients with definite vertebrobasilar stroke, preceding transient isolated brainstem symptoms are common, but most symptoms do not satisfy traditional definitions of TIA. More studies of the prognosis of transient isolated brainstem symptoms are required. FUNDING: Wellcome Trust, UK Medical Research Council, Dunhill Medical Trust, Stroke Association, National Institute for Health Research (NIHR), Thames Valley Primary Care Research Partnership, and the NIHR Biomedical Research Centre, Oxford.