Rabinstein Alejandro A, Tisch Stephen H, McClelland Robyn L, Wijdicks Eelco F M
Neurological-Neurosurgical Intensive Care Unit, Saint Mary's Hospital, Rochester, Minn., USA.
Cerebrovasc Dis. 2004;17(1):66-71. doi: 10.1159/000073900. Epub 2003 Oct 3.
Pontine hemorrhages frequently lead to death or severe disability. Predictors of early mortality have been previously described but little is known about the factors influencing long-term disability.
Determine clinical predictors of long-term outcome in a large hospital series of patients with acute pontine hemorrhage.
Review of all patients with acute pontine hemorrhage admitted to a single tertiary center from 1990 to 2002 who underwent a diagnostic workup including brain magnetic resonance imaging (MRI). Long-term outcome was rated using the modified Rankin Scale (mRS) score at the time of the last follow-up. Odds ratios (ORs) for predictive factors were calculated using univariate and multivariable logistic regression analysis. Level of significance was established at p < 0.01.
We identified 44 consecutive patients with acute pontine hemorrhage. Twenty-four patients had primary hemorrhages (no cause other than hypertension). Arteriovenous or cavernous malformations were documented by brain MRI in 20 patients. Patients with primary hemorrhages had worse Glasgow Coma Scale sum scores (p = 0.01) and more unfavorable CT patterns (p = 0.005) at presentation. Eighteen percent of the patients died in the hospital. Mean follow-up among survivors was 20 months (range 3-144 months). Twenty-two percent of the patients remained severely disabled (mRS greater than 2) at 3 months and at the time of the last follow-up. All deaths occurred in patients with primary pontine hemorrhage. Poor outcome (death or severe disability) was more frequent in patients with primary hemorrhages when compared with patients harboring cavernous malformations (62 versus 5%; p < 0.01). Primary hemorrhage was the only independent predictor of poor outcome in multivariable regression analysis (OR 12; p = 0.029).
Cause is a main predictor of clinical and radiological severity at presentation and outcome in patients with pontine hemorrhage. The first episode of hemorrhage in patients with brainstem cavernous malformations is usually benign. Pontine hemorrhage associated with prior hypertension is much more devastating.
脑桥出血常导致死亡或严重残疾。先前已描述了早期死亡率的预测因素，但对于影响长期残疾的因素知之甚少。
确定大型医院系列急性脑桥出血患者长期预后的临床预测因素。
回顾1990年至2002年入住单一三级中心的所有急性脑桥出血患者，这些患者均接受了包括脑磁共振成像（MRI）在内的诊断检查。在最后一次随访时使用改良Rankin量表（mRS）评分对长期预后进行评估。使用单变量和多变量逻辑回归分析计算预测因素的比值比（OR）。显著性水平设定为p < 0.01。
我们确定了44例连续的急性脑桥出血患者。24例患者为原发性出血（除高血压外无其他病因）。20例患者经脑MRI检查发现动静脉或海绵状畸形。原发性出血患者在就诊时格拉斯哥昏迷量表总分更低（p = 0.01），CT表现更差（p = 0.005）。18%的患者在医院死亡。幸存者的平均随访时间为20个月（范围3 - 144个月）。22%的患者在3个月及最后一次随访时仍严重残疾（mRS大于2）。所有死亡均发生在原发性脑桥出血患者中。与患有海绵状畸形的患者相比，原发性出血患者预后不良（死亡或严重残疾）更为常见（62%对5%；p < 0.01）。在多变量回归分析中，原发性出血是预后不良的唯一独立预测因素（OR 12；p = 0.029）。
病因是脑桥出血患者就诊时临床和放射学严重程度及预后的主要预测因素。脑干海绵状畸形患者的首次出血通常是良性的。与既往高血压相关的脑桥出血破坏性更大。
