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患有恶性肿瘤的重症患者的缺血性中风

Ischemic Stroke in Critically Ill Patients with Malignancy.

作者信息

Ryu Jeong-Am, Bang Oh Young, Suh Gee Young, Yang Jeong Hoon, Lee Daesang, Park Jinkyeong, Cho Joongbum, Chung Chi Ryang, Park Chi-Min, Jeon Kyeongman

机构信息

Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

PLoS One. 2016 Jan 11;11(1):e0146836. doi: 10.1371/journal.pone.0146836. eCollection 2016.

Abstract

BACKGROUND

Cerebrovascular diseases are a frequent cause of neurological symptoms in patients with cancer. The clinical characteristics of ischemic stroke (IS) in patients with cancer have been reported in several studies; however, limited data are available regarding critically ill patients with cancer who develop IS during their stay in the intensive care unit (ICU).

METHODS

All consecutive patients who underwent brain magnetic resonance imaging (MRI) for suspicion of IS with acute abnormal neurologic symptoms or who developed signs of IS while in the ICU were retrospectively evaluated. We compared the clinical characteristics and diffusion-weighted imaging (DWI) lesion patterns between patients finally diagnosed as having or not having IS.

RESULTS

Over the study period, a total of 88 patients underwent brain MRI for suspicion of IS, with altered mental status in 55 (63%), hemiparesis in 28 (32%), and seizure in 20 (23%). A total of 43 (49%) patients were ultimately diagnosed with IS. Multiple DWI lesions (41%) were more common than single lesions (8%). The etiologies of IS were not determined in the majority of patients (n = 27, 63%). In the remaining 16 (37%) patients, the most common aetiology of IS was cardioembolism (n = 8), followed by large-vessel atherosclerosis (n = 3) and small-vessel occlusion (n = 2). However, brain metastases were newly diagnosed in only 7 (8%) patients. Univariate comparison of the baseline characteristics between patients with or without IS did not reveal any significant differences in sex, malignancy type, recent chemotherapy, vascular risk factors, or serum D-dimer levels at the time of suspicion of IS. Thrombotic events were more common in the IS group than in the non-IS group (P = 0.028). However, patients who were ultimately diagnosed with IS had more hemiparesis symptoms at the time of suspicion of IS (P = 0.001). This association was significant even after adjusting for potentially confounding factors (adjusted odds ratio 5.339; 95% confidence interval, 1.521-19.163).

CONCLUSIONS

IS developed during ICU stays in critically ill patients with cancer have particular features that may be associated with cancer-related mechanism.

摘要

背景

脑血管疾病是癌症患者神经症状的常见原因。多项研究报道了癌症患者缺血性卒中(IS)的临床特征;然而,关于在重症监护病房(ICU)住院期间发生IS的重症癌症患者的数据有限。

方法

对所有因怀疑IS伴急性异常神经症状而接受脑磁共振成像(MRI)检查或在ICU期间出现IS体征的连续患者进行回顾性评估。我们比较了最终诊断为患有或未患有IS的患者的临床特征和扩散加权成像(DWI)病变模式。

结果

在研究期间,共有88例患者因怀疑IS而接受脑MRI检查,其中55例(63%)有精神状态改变,28例(32%)有偏瘫,20例(23%)有癫痫发作。共有43例(49%)患者最终被诊断为IS。多发性DWI病变(41%)比单发性病变(8%)更常见。大多数患者(n = 27,63%)的IS病因未明确。在其余16例(37%)患者中,IS最常见的病因是心源性栓塞(n = 8),其次是大血管动脉粥样硬化(n = 3)和小血管闭塞(n = 2)。然而,仅7例(8%)患者新诊断为脑转移瘤。IS患者与非IS患者基线特征的单因素比较未显示在性别、恶性肿瘤类型、近期化疗、血管危险因素或怀疑IS时的血清D-二聚体水平方面存在任何显著差异。血栓形成事件在IS组比非IS组更常见(P = 0.028)。然而,最终诊断为IS的患者在怀疑IS时偏瘫症状更多(P = 0.001)。即使在调整潜在混杂因素后,这种关联仍然显著(调整后的优势比为5.339;95%置信区间为1.521 - 19.163)。

结论

重症癌症患者在ICU住院期间发生的IS具有可能与癌症相关机制有关的特殊特征。

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