Rabinstein Alejandro A, Friedman Jonathan A, Weigand Stephen D, McClelland Robyn L, Fulgham Jimmy R, Manno Edward M, Atkinson John L D, Wijdicks Eelco F M
Neurological-Neurosurgical Intensive Care Unit and the Department of Neurology, Rochester, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Stroke. 2004 Aug;35(8):1862-6. doi: 10.1161/01.STR.0000133132.76983.8e. Epub 2004 Jun 24.
Clinical and radiologic predictors of cerebral infarction occurrence and location after aneurysmal subarachnoid hemorrhage have been seldom studied.
We evaluated all patients admitted to our hospital with aneurysmal subarachnoid hemorrhage between 1998 and 2000. Cerebral infarction was defined as a new hypodensity located in a vascular distribution on computed tomography (CT) scan.
Fifty-seven of 143 patients (40%) developed a cerebral infarction. On univariate analysis, occurrence of cerebral infarction was associated with a worse World Federation of Neurological Surgeons grade (P=0.01), use of ventriculostomy catheter (P=0.01), preoperative vasospasm (P=0.03), surgical clipping (P=0.02), symptomatic vasospasm (P<0.01), and vasospasm on transcranial Doppler ultrasonography (TCD) or repeat angiogram (P<0.01). On multivariable analysis, only presence of symptoms ascribed to vasospasm (P<0.01) and evidence of vasospasm on TCD or angiogram predicted cerebral infarction (P<0.01). TCD and angiogram agreed on the diagnosis of vasospasm in 73% of cases (95% CI, 63% to 81%), but the diagnostic accuracy of this combination of tests was suboptimal for the prediction of cerebral infarction occurrence (sensitivity, 0.72; specificity, 0.68; positive predictive value, 0.67; negative predictive value, 0.72). Location of the cerebral infarction on delayed CT was predicted by neurological symptoms in 74%, by aneurysm location in 77%, and by angiographic vasospasm in 67%.
Evidence of vasospasm on TCD and angiogram is predictive of cerebral infarction on CT scan but sensitivity and specificity are suboptimal. Cerebral infarction location cannot be predicted in one quarter to one third of patients by any of the studied clinical or radiological variables.
很少有研究探讨动脉瘤性蛛网膜下腔出血后脑梗死发生及部位的临床和影像学预测因素。
我们评估了1998年至2000年间我院收治的所有动脉瘤性蛛网膜下腔出血患者。脑梗死定义为计算机断层扫描（CT）上位于血管分布区的新的低密度影。
143例患者中有57例（40%）发生脑梗死。单因素分析显示，脑梗死的发生与世界神经外科医师联合会分级较差（P=0.01）、使用脑室造瘘导管（P=0.01）、术前血管痉挛（P=0.03）、手术夹闭（P=0.02）、症状性血管痉挛（P<0.01）以及经颅多普勒超声（TCD）或重复血管造影显示血管痉挛（P<0.01）相关。多因素分析显示，只有血管痉挛相关症状的存在（P<0.01）以及TCD或血管造影显示血管痉挛的证据可预测脑梗死（P<0.01）。TCD和血管造影对血管痉挛的诊断一致性为73%（95%可信区间，63%至81%），但这种联合检查对预测脑梗死发生的诊断准确性欠佳（敏感性，0.72；特异性，0.68；阳性预测值，0.67；阴性预测值，0.72）。延迟CT上脑梗死的部位，74%可由神经症状预测，77%可由动脉瘤部位预测，67%可由血管造影显示的血管痉挛预测。
TCD和血管造影显示血管痉挛的证据可预测CT扫描上的脑梗死，但敏感性和特异性欠佳。任何所研究的临床或影像学变量均无法在四分之一至三分之一的患者中预测脑梗死的部位。
