Chaudhry Saqib A, Kwon Soo Young, Kneale Hillary, Al Jajeh Ammar, Hussain Syed, Razak Anmar
Department of Neurology and Ophthalmology (SAC, AAJ, SH, AR), Michigan State University, East Lansing, MI; and Department of Neurology (SYK, HK), University of Cincinnati College of Medicine, Cincinnati, OH.
Neurol Clin Pract. 2016 Feb;6(1):22-28. doi: 10.1212/CPJ.0000000000000212.
Headache during or soon after administration of IV tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) is a concern for hemorrhagic transformation (HT). However, no data are available regarding the incidence of HT in these patients or the prognostic indication of these headaches. We examine the importance of tPA-associated headaches among AIS patients in terms of HT rates and clinical outcomes. AIS patients treated with IV tPA at a comprehensive stroke center between January 2007 and November 2012 were retrospectively reviewed for documented tPA-associated headache in the first 24 hours post-tPA. We compared the headache and nonheadache groups for differences in various clinical and radiologic outcomes. Of the 193 patients, 63 (32.6%) had tPA-associated headache. Headache patients (HP) were younger than nonheadache patients (NHP) (mean ± SD, 59.5 ± 17.4 years vs 69.9 ± 15.5 years, < 0.0001), and 53% of HP were men, compared to 49.2% of NHP ( = 0.537). Comorbid conditions did not differ between the 2 groups. There were no statistical differences between HP and NHP in admission NIH Stroke Scale (NIHSS) score (11.2 ± 5.7 vs 11.5 ± 5.5, = 0.646), NIHSS score at 24 hours (6.5 ± 5.7 vs 7.4 ± 6.9, = 0.466), NIHSS score at discharge (6.7 ± 10.1 vs 8.1 ± 11.6, = 0.448), HT (12.7% vs 18.4%, = 0.3), cervical artery dissection (4.7% vs 5.38%, = 0.764), length of hospitalization (6.29 ± 5 days vs 6.35 ± 4.7 days, = 0.935), and disposition. tPA-associated headache does not predict increased risk of HT and has no other prognostic importance in patients with AIS. Prospective studies with a larger cohort may be needed to further explore this relationship.
急性缺血性卒中（AIS）患者静脉注射组织型纤溶酶原激活剂（tPA）期间或之后不久出现头痛是出血性转化（HT）的一个关注点。然而，关于这些患者中HT的发生率或这些头痛的预后指标尚无数据。我们从HT发生率和临床结局方面研究了AIS患者中与tPA相关头痛的重要性。对2007年1月至2012年11月期间在一家综合卒中中心接受静脉tPA治疗的AIS患者进行回顾性研究，以记录tPA治疗后24小时内与tPA相关的头痛情况。我们比较了头痛组和非头痛组在各种临床和影像学结局方面的差异。在193例患者中，63例（32.6%）出现与tPA相关的头痛。头痛患者（HP）比非头痛患者（NHP）年轻（平均±标准差，59.5±17.4岁对69.9±15.5岁，<0.0001），HP中53%为男性，而NHP中为49.2%（P=0.537）。两组之间的合并症无差异。HP和NHP在入院时美国国立卫生研究院卒中量表（NIHSS）评分（11.2±5.7对11.5±5.5，P=0.646）、24小时时的NIHSS评分（6.5±5.7对7.4±6.9，P=0.466）、出院时的NIHSS评分（6.7±10.1对8.1±11.6，P=0.448）、HT（12.7%对18.4%，P=0.3）、颈动脉夹层（4.7%对5.38%，P=0.764）、住院时间（6.29±5天对6.35±4.7天，P=0.935）和出院情况方面均无统计学差异。与tPA相关的头痛不能预测HT风险增加，且对AIS患者没有其他预后重要性。可能需要更大队列的前瞻性研究来进一步探讨这种关系。
