ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Av. Carl Friedrich Gauss, 3, Castelldefels, Barcelona, 08860, Spain.
Department of Neurology, Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Neurol. 2019 Apr;266(4):990-997. doi: 10.1007/s00415-019-09226-y. Epub 2019 Feb 9.
Previously, microvascular cerebral blood flow (CBF) response to a mild head-of-bed (HOB) elevation has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). We have hypothesized that early CBF response is related to the functional outcome.
Patients with a non-lacunar AIS in the anterior circulation were monitored by DCS to measure relative CBF (ΔrCBF) on the frontal lobes bilaterally during a 0°-30° HOB elevation at early (≤ 12) or late (> 12) hours from symptom onset. National Institutes of Health Stroke Scale (NIHSS) scores were recorded at baseline at 24 and at 48 h. Functional outcome was measured by the modified Rankin Scale (mRS) at 3 months.
Thirty-eight (n = 38) AIS patients [baseline NIHSS = 19 (interquartile range: 16, 21)] were studied. ΔrCBF decreased similarly in both hemispheres (p = 0.4) when HOB was elevated and was not associated with baseline and follow-up NIHSS scores or patient demographics. At the early phase (n = 17), a lower or paradoxical ΔrCBF response to HOB elevation was associated with an unfavorable functional outcome (mRS > 2) in the ipsilesional (but not in the contralesional) hemisphere (p = 0.010). ΔrCBF response in the late acute phase was not related to mRS.
Early CBF response to mild HOB elevation in the ipsilesional hemisphere is related to functional outcome. Further studies may enable optical monitoring at the bedside to individualize management strategies in the early phase of AIS.
先前的弥散相关光谱（DCS）研究表明，急性缺血性脑卒中（AIS）患者轻度床头抬高时，微血管脑血流（CBF）反应发生改变。我们假设早期 CBF 反应与功能结局相关。
通过 DCS 监测前循环非腔隙性 AIS 患者，在发病后早期（≤12 小时）或晚期（>12 小时），双侧额区测量 0°-30°床头抬高时的相对 CBF（ΔrCBF）。在基线、24 小时和 48 小时记录国立卫生研究院卒中量表（NIHSS）评分。3 个月时采用改良 Rankin 量表（mRS）评估功能结局。
研究了 38 例 AIS 患者（基线 NIHSS 评分 19 分[四分位间距：16，21]）。当床头抬高时，两侧半球的ΔrCBF 均相似地降低（p = 0.4），与基线和随访 NIHSS 评分或患者人口统计学特征无关。在早期阶段（n = 17），同侧半球（而非对侧半球）中床头抬高时 ΔrCBF 反应降低或反常与不良功能结局（mRS>2）相关（p = 0.010）。晚期急性阶段的ΔrCBF 反应与 mRS 无关。
同侧半球轻度床头抬高时的早期 CBF 反应与功能结局相关。进一步的研究可能使床边光学监测能够在 AIS 的早期阶段个体化管理策略。
