From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (L.A.M., M.D.I.V., K.G.L., Y.M.R., A.A., G.J.E.R.).
From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (L.A.M., M.D.I.V., K.G.L., Y.M.R., A.A., G.J.E.R.)
Stroke. 2018 Jun;49(6):1363-1370. doi: 10.1161/STROKEAHA.117.019843. Epub 2018 Apr 25.
We systematically reviewed the literature on epidemiology, risk factors, presumed cause, clinical course, and outcome of perimesencephalic hemorrhage.
PubMed, Embase, and the Cochrane Library were searched until March 2016. Quality assessment was done by 2 authors independently. Pooled prevalence ratios and pooled odds ratios with 95% confidence intervals were calculated for data extracted from case-control studies.
We included 208 papers. The incidence of perimesencephalic hemorrhage is ≈0.5 per 100.000 person-years, men are more often affected, and no risk factors were confirmed. Two decision analyses both found that a single, high-quality computed tomography angiography is the preferred diagnostic approach. Short-term complications, such as hydrocephalus or cranial nerve palsies, are rare, and usually transient, with the exception of acute symptomatic hydrocephalus necessitating treatment in 3% of patients. Lacunar infarcts in the brain stem were convincingly described in 4 patients only. Fatal rebleeding after installment of anticoagulation in the initial days after the hemorrhage was described in 1 patient. At long-term follow-up, death related to the hemorrhage has not been reported, disability is found in 0% to 6%, and neuropsychological sequelae are suggested.
A single, high-quality computed tomography angiography is the preferred diagnostic strategy. Short-term complications are rare and often transient. Long-term outcome is excellent with respect to disability and death, but high-quality studies focused at neuropsychological sequelae are needed.
我们系统地回顾了有关脑桥旁出血的流行病学、危险因素、推测病因、临床病程和结局的文献。
我们在 2016 年 3 月前检索了 PubMed、Embase 和 Cochrane 图书馆。由 2 位作者独立进行质量评估。从病例对照研究中提取的数据采用合并患病率比和合并优势比及其 95%置信区间进行计算。
我们纳入了 208 篇论文。脑桥旁出血的发病率约为 0.5/100000 人年，男性更常受累，且无确定的危险因素。2 项决策分析均发现，单次高质量 CT 血管造影是首选的诊断方法。短期并发症，如脑积水或颅神经麻痹，罕见且通常是短暂的，只有 3%的患者出现急性症状性脑积水需要治疗。仅有 4 例患者明确描述了脑干腔隙性梗死。仅 1 例患者在出血后最初几天安装抗凝剂后出现致命性再出血。长期随访未报告与出血相关的死亡，残疾率为 0%至 6%，存在神经心理学后遗症。
单次高质量 CT 血管造影是首选的诊断策略。短期并发症罕见且通常是短暂的。残疾和死亡方面的长期预后良好，但需要关注神经心理学后遗症的高质量研究。
