Jo KwangWook, Bajgur Suhas S, Kim Hoon, Choi Huimahn A, Huh Pil-Woo, Lee Kiwon
Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Neurosurgery, School of Medicine, University of Texas, Houston, Texas, United States of America.
PLoS One. 2017 Feb 8;12(2):e0171425. doi: 10.1371/journal.pone.0171425. eCollection 2017.
Malignant brain edema (MBE) due to hemispheric infarction can result in brain herniation, poor outcomes, and death; outcome may be improved if certain interventions, such as decompressive craniectomy, are performed early. We sought to generate a prediction score to easily identify those patients at high risk for MBE. 121 patients with large hemispheric infarction (LHI) (2011 to 2014) were included. Patients were divided into two groups: those who developed MBE and those who did not. Independent predictors of MBE were identified by logistic regression and a score was developed. Four factors were independently associated with MBE: baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.048), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (p = 0.007), collateral score (CS) (p<0.001) and revascularization failure (p = 0.013). Points were assigned for each factor as follows: NIHSS ≤ 8 (= 0), 9-17 (= 1), ≥ 18 (= 2); ASPECTS≤ 7 (= 1), >8 (= 0); CS<2 (= 1), ≥2 (= 0); revascularization failure (= 1),success (= 0). The MBE Score (MBES) represents the sum of these individual points. Of 26 patients with a MBES of 0 to 1, none developed MBE. All patients with a MBES of 6 developed MBE. Both MBE development and functional outcomes were strongly associated with the MBES (p = 0.007 and 0.002, respectively). The MBE score is a simple reliable tool for the prediction of MBE.
半球梗死所致恶性脑水肿（MBE）可导致脑疝形成、预后不良及死亡；若早期实施某些干预措施，如减压性颅骨切除术，则可能改善预后。我们试图生成一个预测评分，以便轻松识别那些发生MBE风险较高的患者。纳入了121例大面积半球梗死（LHI）患者（2011年至2014年）。患者被分为两组：发生MBE的患者和未发生MBE的患者。通过逻辑回归确定MBE的独立预测因素并制定评分。有四个因素与MBE独立相关：基线美国国立卫生研究院卒中量表（NIHSS）评分（p = 0.048）、阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）（p = 0.007）、侧支循环评分（CS）（p<0.001）和血管再通失败（p = 0.013）。每个因素的赋分如下：NIHSS≤8（=0），9 - 17（=1），≥18（=2）；ASPECTS≤7（=1），>8（=0）；CS<2（=1），≥2（=0）；血管再通失败（=1），成功（=0）。MBE评分（MBES）代表这些单个分数的总和。在26例MBES为0至1分的患者中，无一人发生MBE。所有MBES为6分的患者均发生了MBE。MBE的发生和功能结局均与MBES密切相关（分别为p = 0.007和0.002）。MBE评分是预测MBE的一种简单可靠的工具。
