颅内迟发性脑梗死与脑动脉瘤性蛛网膜下腔出血患者的梗死部位、梗死负荷及 3 个月预后的关系
Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage.
机构信息
From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.).
出版信息
Stroke. 2015 Nov;46(11):3099-104. doi: 10.1161/STROKEAHA.115.010844. Epub 2015 Sep 29.
BACKGROUND AND PURPOSE
Aneurysmal subarachnoid hemorrhage is a serious disease with high case fatality and morbidity. Delayed cerebral infarction (DCI) is an important surrogate marker. How location and infarct load affected outcomes was unclear. We aimed to assess the effects of load and location of DCI on outcomes of aneurysmal subarachnoid hemorrhage at 3 months.
METHODS
We prospectively enrolled patients with subarachnoid hemorrhage presenting to an academic neurosurgical unit in Hong Kong during a 3-year period. DCI was defined by new hypoattenuation on computed tomography at 4 to 6 weeks, which was not present in the postaneurysm-treatment computed tomography at 24 to 48 hours. DCI was assessed for location according to cerebral artery territories and load semiquantitatively. Cognitive and functional outcome assessments were carried out 3 months after ictus.
RESULTS
One hundred twenty-six patients with subarachnoid hemorrhage consented for this study. DCI occurred in 56 (44%) patients and was associated with poorer cognitive and functional outcomes (Montreal Cognitive Assessment, Mini-Mental State Examination, modified Rankin Scale, and Lawton Instrumental Activity of Daily Living) at 3 months. In patients with DCI, the presence of perforator zone infarct was associated with poorer cognitive and functional outcomes, and cortical middle cerebral artery infarct was associated with poorer modified Rankin Scale. After adjustment for age, admission World Federation of Neurosurgical Societies Grade and mode of aneurysm treatment, both middle cerebral artery cortical infarct load and perforator infarct load were independently associated with poor cognitive outcomes (Montreal Cognitive Assessment and Mini-Mental State Examination) and modified Rankin Scale.
CONCLUSIONS
Middle cerebral artery cortical and perforator zone infarct loads are potential surrogate marker to assess the severity of delayed cerebral ischemia.
背景与目的
蛛网膜下腔出血是一种严重的疾病，病死率和病残率均较高。迟发性脑梗死（DCI）是一个重要的替代标志物。其位置和梗死负荷如何影响结局尚不清楚。我们旨在评估 DCI 的负荷和位置对 3 个月时蛛网膜下腔出血结局的影响。
方法
我们前瞻性纳入了在香港一所学术神经外科中心就诊的 3 年内蛛网膜下腔出血患者。DCI 定义为在 4 至 6 周时 CT 上新出现的低衰减，而在 24 至 48 小时时的动脉瘤治疗后 CT 上不存在。根据脑动脉区域和负荷半定量评估 DCI 的位置。在发病后 3 个月进行认知和功能结局评估。
结果
126 例蛛网膜下腔出血患者同意参加本研究。56 例（44%）患者发生 DCI，认知和功能结局（蒙特利尔认知评估、简易精神状态检查、改良 Rankin 量表和 Lawton 工具性日常生活活动量表）在 3 个月时较差。在发生 DCI 的患者中，穿支区梗死与较差的认知和功能结局相关，皮质大脑中动脉梗死与较差的改良 Rankin 量表相关。在调整年龄、入院时世界神经外科学会分级和动脉瘤治疗方式后，大脑中动脉皮质梗死负荷和穿支梗死负荷均与认知结局不良（蒙特利尔认知评估和简易精神状态检查）和改良 Rankin 量表独立相关。
结论
大脑中动脉皮质和穿支区梗死负荷是评估迟发性脑缺血严重程度的潜在替代标志物。
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