Attenhofer Kevin S, Hailey Lovella, Mortin Melissa, Rapp Karen S, Agrawal Kunal, Huisa-Garate Branko, Modir Royya, Meyer Dawn M, Hemmen Thomas M, Meyer Brett C
Stroke Center, University of California at San Diego (UCSD), San Diego, California.
Stroke Center, University of California at San Diego (UCSD), San Diego, California.
J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1466-1470. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.035. Epub 2018 Feb 15.
Rapid imaging in acute stroke is critical and often occurs before full examination. Early, reliable examination findings clarify diagnosis and improve treatment times. The DeyeCOM sign has been described as a predictor of ischemic stroke. In this study, we evaluate a sustained DeyeCOM sign on serial computed tomography scans in prediction of large vessel occlusion.
Between April and June 2017, we retrospectively reviewed 46 patients with acute stroke from the University of California, San Diego Stroke Registry, who had both computed tomography and computed tomography angiography as part of their acute work-up. A DeyeCOM(+) sign was defined as a conjugate gaze deviation on imaging of at least 15°. DeyeCOM(++) was defined as sustained gaze deviation on both scans.
Three groups of patients were observed: DeyeCOM(++), nonsustained gaze deviation, and no gaze deviation (DeyeCOM(--)). All patients in the DeyeCOM(++) (8 of 8, 100%) had large vessel occlusion. Of those with nonsustained gaze deviation, 2 of 7 (29%) had large vessel occlusion. No patients in the DeyeCOM(--) (0 of 31, 100%) had large vessel occlusion. The specificity and sensitivity of DeyeCOM(++) for large vessel occlusion was 100% (confidence interval [CI] .90-1.0) and 80% (CI .44-.97). The specificity and sensitivity of DeyeCOM(--) for absence of large vessel occlusion was 100% (CI .69-1.0) and 86% (CI .70-.95).
DeyeCOM(++) had 100% specificity for large vessel occlusion, whereas DeyeCOM(--) had a 100% specificity for absence of large vessel occlusion. Sustained DeyeCOM, whether positive or negative, is a strong predictor of ultimate diagnosis that could lead to quicker endovascular treatment times.
急性卒中的快速成像至关重要，且通常在全面检查之前进行。早期、可靠的检查结果有助于明确诊断并缩短治疗时间。DeyeCOM征已被描述为缺血性卒中的一个预测指标。在本研究中，我们评估了在连续计算机断层扫描上出现的持续性DeyeCOM征对大血管闭塞的预测价值。
2017年4月至6月期间，我们对来自加利福尼亚大学圣地亚哥分校卒中登记处的46例急性卒中患者进行了回顾性研究，这些患者在急性检查时均接受了计算机断层扫描和计算机断层血管造影检查。DeyeCOM(+)征定义为成像上至少15°的共轭凝视偏斜。DeyeCOM(++)定义为两次扫描上均出现持续性凝视偏斜。
观察到三组患者：DeyeCOM(++)组、非持续性凝视偏斜组和无凝视偏斜组（DeyeCOM(–)组）。DeyeCOM(++)组的所有患者（8例中的8例，100%）均存在大血管闭塞。在非持续性凝视偏斜组中，7例中有2例（29%）存在大血管闭塞。DeyeCOM(–)组的患者均无大血管闭塞（31例中的0例，100%）。DeyeCOM(++)对大血管闭塞的特异性和敏感性分别为100%（置信区间[CI].90 - 1.0）和80%（CI.44 -.97）。DeyeCOM(–)对无大血管闭塞的特异性和敏感性分别为100%（CI.69 - 1.0）和86%（CI.70 -.95）。
DeyeCOM(++)对大血管闭塞具有100%的特异性，而DeyeCOM(–)对无大血管闭塞具有100%的特异性。持续性DeyeCOM征，无论阳性还是阴性，都是最终诊断的有力预测指标，可缩短血管内治疗时间。
