Department of Neurology, University of Bern, Bern, Switzerland.
J Neurol Neurosurg Psychiatry. 2011 Jan;82(1):33-7. doi: 10.1136/jnnp.2010.211151. Epub 2010 Aug 27.
Physicians treating patients with posterior circulation strokes (PCS) tended to debate more on whether or not to introduce anticoagulation rather than performing investigations to identify stroke aetiology, as in patients with anterior circulation strokes (ACS). Recent findings suggest that stroke aetiologies of PCS and ACS are more alike than dissimilar, suggesting that PCS deserve the same investigations as ACS. The characteristics and current diagnostic evaluation between patients with PCS and ACS were compared.
312 consecutive patients with first ever ACS and 93 patients with first ever PCS were prospectively analysed.
Patients with ACS and PCS did not differ in terms of demographic characteristics, prevalence of vascular risk factors, diagnostic evaluation or stroke aetiology. The median National Institutes of Health Stroke Scale score was 8 in ACS and 4 in PCS (p=0.004). Brain imaging revealed more often pathological findings in ACS than PCS. The proportion of non-thrombolysed patients with a favourable clinical outcome (modified Rankin score 0-2) was similar in ACS and PCS (67.0% vs 78.4%; p=0.08). In non-thrombolysed patients, stroke severity was an independent predictor of clinical outcome both in ACS (OR 1.60, 95% CI 1.2 to 2.1; p<0.0001) and in PCS (OR 1.22, 95% CI 1.03 to 1.44; p=0.02) while age predicted poor outcome only in ACS (OR 1.11, 95% CI 1.01 to 1.22; p=0.007). In thrombolysed patients, stroke severity was the only outcome predictor in ACS (OR 1.14, 95% CI 1.04 to 1.25; p=0.004) while we identified no statistically relevant predictor of PCS outcome.
In PCS and ACS, baseline variables, aetiology and outcome are more alike than different.
治疗后循环卒中（PCS）患者的医生往往更倾向于争论是否引入抗凝治疗，而不是进行调查以确定卒中病因，就像治疗前循环卒中（ACS）患者一样。最近的研究结果表明，PCS 和 ACS 的卒中病因更相似而不是不同，这表明 PCS 应该接受与 ACS 相同的检查。比较了 PCS 和 ACS 患者的特征和当前诊断评估。
前瞻性分析了 312 例首次 ACS 和 93 例首次 PCS 连续患者。
ACS 和 PCS 患者在人口统计学特征、血管危险因素患病率、诊断评估或卒中病因方面无差异。ACS 的 NIH 卒中量表评分中位数为 8，PCS 为 4（p=0.004）。脑成像显示 ACS 比 PCS 更常出现病理发现。非溶栓治疗患者临床结局良好（改良 Rankin 评分 0-2）的比例在 ACS 和 PCS 中相似（67.0% vs 78.4%；p=0.08）。在非溶栓治疗患者中，卒中严重程度是 ACS 和 PCS 临床结局的独立预测因素（ACS：OR 1.60，95%CI 1.2 至 2.1；p<0.0001；PCS：OR 1.22，95%CI 1.03 至 1.44；p=0.02），而年龄仅预测 ACS 预后不良（OR 1.11，95%CI 1.01 至 1.22；p=0.007）。在溶栓治疗患者中，卒中严重程度是 ACS 唯一的结局预测因素（OR 1.14，95%CI 1.04 至 1.25；p=0.004），而我们没有发现 PCS 结局的统计学相关预测因素。
在 PCS 和 ACS 中，基线变量、病因和结局更相似而不是不同。
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