Stamm Brian J, Lineback Christina M, Skolarus Lesli E, Morgenstern Lewis B, Shah Gaurang V
Medical School, University of Michigan, Ann Arbor, MI, USA.
Department of Neurology, Northwestern University, Chicago, IL, USA.
Neurohospitalist. 2018 Jul;8(3):141-145. doi: 10.1177/1941874417748543. Epub 2017 Dec 28.
Strokes involving the artery of Percheron (AOP), an anatomic variant of thalamic vascular supply, are rare. Little is known about the inpatient hospital course for these patients. We retrospectively identified consecutive patients with AOP in their medical charts from a university-based tertiary care hospital from January 1, 2000, to August 15, 2017. A chart review identified demographics, transfer status, in-hospital versus community onset of stroke, emergency medical services (EMS) use, presenting signs/symptoms, time to radiologic diagnosis (from time of presentation to tertiary care hospital or from time of initial symptom onset in an already hospitalized patient), tissue plasminogen activator (tPA) use, intensive care unit (ICU) stays, intubation, length of stay (LOS), and discharge location. After radiologic inclusion/exclusion criteria were applied, 12 patients were included in the study. There were 7 men and 5 women, and the mean age (SD) was 68 (15). Seven were transfers, and 4 had an in-hospital stroke. Of the 8 community-onset strokes, 7 utilized EMS. Mental status changes occurred in 11 of 12 and ocular disturbances in all patients. Time to radiologic diagnosis averaged 1.9 (median = 1.1) days. One patient received tPA. Eight received care in the ICU. Four were intubated. Average LOS was 8.3 days. Four were discharged home, 3 entered inpatient rehabilitation facilities, and 5 entered skilled nursing facilities. In-hospital stroke status further complicates the already challenging diagnosis of AOP infarct, and clinicians must maintain a high suspicion for this rare stroke in order to quickly diagnose and intervene.
累及Percheron动脉（AOP）的中风较为罕见，Percheron动脉是丘脑血管供应的一种解剖变异。对于这些患者的住院病程，我们了解甚少。我们回顾性地从一家大学附属三级护理医院2000年1月1日至2017年8月15日的病历中确定连续的AOP患者。病历审查确定了人口统计学特征、转诊状态、中风的院内发作与社区发作、急诊医疗服务（EMS）的使用情况、出现的体征/症状、到放射学诊断的时间（从就诊于三级护理医院之时或已住院患者的初始症状发作之时算起）、组织纤溶酶原激活剂（tPA）的使用情况、重症监护病房（ICU）住院时间、插管情况、住院时间（LOS）以及出院地点。应用放射学纳入/排除标准后，12名患者被纳入研究。其中男性7名，女性5名，平均年龄（标准差）为68岁（15岁）。7名是转诊患者，4名发生院内中风。在8例社区发作的中风中，7例使用了EMS。12例中有11例出现精神状态改变，所有患者均有眼部障碍。到放射学诊断的平均时间为1.9天（中位数 = 1.1天）。1例患者接受了tPA治疗。8例在ICU接受治疗。4例进行了插管。平均住院时间为8.3天。4例出院回家，3例进入住院康复设施，5例进入专业护理机构。院内中风状态使本就具有挑战性的AOP梗死诊断更加复杂，临床医生必须对这种罕见中风保持高度怀疑，以便快速诊断并进行干预。
