Al Safatli Diaa, Guenther Albrecht, McLean Aaron Lawson, Waschke Albrecht, Kalff Rolf, Ewald Christian
Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany.
Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany.
Surg Neurol Int. 2017 Nov 20;8:282. doi: 10.4103/sni.sni_479_16. eCollection 2017.
Cerebellar hemorrhage is a potentially life-threatening condition and an understanding of the factors influencing outcome is essential for sound clinical decision-making.
We retrospectively evaluated data from 50 consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) from 2005 to 2014, analysing their short-term outcomes and identifying possible clinical, radiological and therapeutic risk factors for poor prognosis and death within 30 days.
Among 50 patients with first SCH, the mean age was 72 ± 10 years. Median Glasgow Coma Scale (GCS) score on admission was 11 [interquartile range (IQR) = 7-11]. Among 50 patients, 19 patients (38%) underwent surgical hemorrhage evacuation with placement of an external ventricular drain (EVD), 12 patients (24%) received an EVD only and 19 patients (38%) were treated conservatively. The 30-day mortality rate was 36%. In multivariate analysis only the GCS score on admission was a significant predictor of 30-day mortality [odds ratio (OR) = 0.598; 95% confidence interval (CI) = 0.406-0.879; = 0.009]. For prediction of 30-day mortality, receiver operating characteristic curve analysis confirmed that the best cut-off point was a GCS score of 10 on admission [area under the curve: 0.882, 95% CI = 0.717-1, < 0.001].
Lower GCS score on admission was associated with increased 30-day mortality and poorer short-term outcome in patients with SCH. For patients with a GCS score <10 on admission, it is important to balance the possibility of survival afforded by further therapy against the formidable risk of significant functional disability and poor quality of life.
小脑出血是一种潜在的危及生命的疾病，了解影响预后的因素对于合理的临床决策至关重要。
我们回顾性评估了2005年至2014年期间连续50例首次发生自发性小脑出血（SCH）患者的数据，分析其短期预后，并确定30天内预后不良和死亡的可能临床、影像学和治疗风险因素。
50例首次发生SCH的患者中，平均年龄为72±10岁。入院时格拉斯哥昏迷量表（GCS）评分中位数为11[四分位间距（IQR）=7-11]。50例患者中，19例（38%）接受了手术血肿清除并放置了脑室外引流管（EVD），12例（24%）仅接受了EVD治疗，19例（38%）接受了保守治疗。30天死亡率为36%。多因素分析显示，仅入院时的GCS评分是30天死亡率的显著预测因素[比值比（OR）=0.598；95%置信区间（CI）=0.406-0.879；P=0.009]。对于30天死亡率的预测，受试者工作特征曲线分析证实最佳切点为入院时GCS评分为10[曲线下面积：0.882，95%CI=0.717-1，P<0.001]。
入院时较低的GCS评分与SCH患者30天死亡率增加及短期预后较差相关。对于入院时GCS评分<10的患者，重要的是要权衡进一步治疗带来的生存可能性与严重功能残疾和生活质量差的巨大风险。
