Ham Hyung-Yong, Lee Jung-Kil, Jang Jae-Won, Seo Bo-Ra, Kim Jae-Hyoo, Choi Jeong-Wook
Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea.
J Korean Neurosurg Soc. 2011 Oct;50(4):370-6. doi: 10.3340/jkns.2011.50.4.370. Epub 2011 Oct 31.
Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI.
We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed.
Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05).
In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.
创伤后脑梗死（PTCI）是头部外伤后在明确的动脉分布区域发生的梗死，是重度颅脑外伤患者已知的并发症。本研究的主要目的是评估PTCI的临床和影像学特征，并评估减压性颅骨切除术（DHC）对PTCI患者预后的影响。
我们对2003年1月至2005年8月期间接受治疗的20例PTCI患者进行了回顾性分析。其中12例患者表现为恶性PTCI，定义为包括大脑中动脉（MCA）供血区域的PTCI。回顾了患者的病历和影像学研究。
大脑后动脉分布区梗死是PTCI最常见的部位。14例患者在创伤后平均16小时接受了DHC。总体死亡率为75%。幸存者的格拉斯哥预后评分（GOS）显示，出院时1例患者处于持续植物状态，2例患者严重残疾，仅2例患者中度残疾。尽管进行了积极治疗，但所有恶性PTCI患者均死亡。恶性PTCI是临床预后不良的指标。此外，入院时的格拉斯哥昏迷评分（GCS）是最有价值的预后因素。入院时GCS小于5与高死亡率之间存在显著相关性（p<0.05）。
对于头部受伤后发生非恶性PTCI且GCS高于5的患者，应在不可逆性缺血性脑损伤发生之前考虑早期DHC和硬脑膜成形术。恶性PTCI或入院时GCS为3 - 5的PTCI患者死亡率较高。需要进行一项大型前瞻性随机对照研究，以证明对这些患者进行包括DHC和药物治疗在内的积极治疗的合理性。
