Functional Unit of Cerebrovascular Diseases, Hospital Clinic, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Sci Rep. 2018 Jun 22;8(1):9498. doi: 10.1038/s41598-018-27883-3.
The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0.001 in both cohorts). A number of supratentorial areas (mainly in the left hemisphere), including the insula, were associated with poor functional outcome in both cohorts before (4014 voxels) and after volume control (1378 voxels), while the associations with death were greatly reduced after volume control (from 8716 to 325 voxels). Exploratory analyses suggested that the method of lesion volume quantification, the National Institutes of Health Stroke Scale hemispheric bias and patient selection can result in false associations between specific brain lesions and outcomes. In conclusion, death in the first months after stroke is mainly explained by large infarct volumes, whereas lesions of specific supratentorial structures, mostly in the left hemisphere, also contribute to poor functional outcomes.
不同部位的卒中预后相关性存在争议。例如，岛叶卒中与死亡率增加相关，但这种关联可能反映了其更严重的程度。在两个独立的幕上缺血性卒中患者队列（n=90 和 105）中，我们使用基于体素的病变-症状映射研究了病变大小和位置对预后的影响，该方法在控制体积后更好地反映了总病变体积。影响岛叶的卒中比非岛叶卒中更大（两个队列中的 28 vs 2cc 和 25 vs 3cc，均 p<0.001）。在两个队列的体积控制前后（分别为 4014 个体素和 1378 个体素），许多幕上区域（主要在左半球），包括岛叶，与功能预后不良相关，而与死亡的相关性在体积控制后大大降低（从 8716 个体素到 325 个体素）。探索性分析表明，病变体积量化方法、美国国立卫生研究院卒中量表的半球偏倚和患者选择可能导致特定脑病变与结局之间的虚假关联。总之，卒中后最初几个月的死亡主要由大梗死体积解释，而特定幕上结构的病变，主要在左半球，也会导致功能预后不良。
