From the Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (R.C.).
George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (X.W., C.S.A., R.I.L., J.C., C.D.).
Stroke. 2019 May;50(5):1257-1259. doi: 10.1161/STROKEAHA.118.023766.
Background and Purpose- Infratentorial intracerebral hemorrhage (ICH) has a poor outcome but is rarely analyzed by cerebellar versus brain stem location. We evaluated this relationship and clinical outcomes among participants of the INTERACT 1 and 2 (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials). Methods- Participants with brain stem and cerebellar ICH were compared. Logistic regression models were used to compare outcomes of death or major disability and quality of life. Results- Of 195 included patients, 92 (47%) and 103 (53%) had brain stem and cerebellar ICH, respectively. Patients with brain stem ICH were younger (mean [SD] age, 59±13 versus 70±11 years), less female (28.3% versus 50.5%), with higher admission National Institutes of Health Stroke Scale scores (median [interquartile range], 6 [4-10) versus 3 [2-8]), less prior ICH (3% versus 17%), smaller ICH volumes (1.6 mL [1.0-2.8 mL] versus 5.1 mL [2.6-10.7 mL]), and less intraventricular extension (3% versus 39%) than those with cerebellar ICH. Brain stem ICH had higher mortality (odds ratio, 37.1; 95% CI, 1.99-692.27) and worse scores in the European Quality of Life Scale (EQ-5D) pain domain (odds ratio, 3.36; 95% CI, 1.38-8.20). Conclusions- Cerebellar and brain stem ICH differ in their clinical characteristics and prognosis, with the latter being associated with higher case fatality and worse EQ-5D scores in the pain domain. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifiers: NCT00226096 and NCT00716079.
背景与目的- 脑桥和小脑幕下脑出血（ICH）的预后较差，但很少根据小脑或脑干的位置进行分析。我们评估了这种关系以及 INTERACT 1 和 2 试验（急性脑出血强化降压试验）参与者的临床结局。
方法- 对脑桥和小脑 ICH 患者进行比较。采用逻辑回归模型比较死亡或主要残疾和生活质量的结局。
结果- 在纳入的 195 例患者中，92 例（47%）和 103 例（53%）分别患有脑桥和小脑幕下 ICH。脑桥 ICH 患者更年轻（平均[标准差]年龄，59±13 岁对 70±11 岁）、女性比例更低（28.3%对 50.5%）、入院时 NIHSS 评分更高（中位数[四分位距]，6[4-10]对 3[2-8]）、ICH 体积更小（1.6 毫升[1.0-2.8 毫升]对 5.1 毫升[2.6-10.7 毫升]）、脑室扩张比例更低（3%对 39%）。与小脑幕下 ICH 患者相比，脑桥 ICH 的死亡率更高（优势比，37.1；95%可信区间，1.99-692.27），且 EQ-5D 量表疼痛领域评分更差（优势比，3.36；95%可信区间，1.38-8.20）。
结论- 小脑幕下和脑桥 ICH 在临床特征和预后方面存在差异，后者与更高的病死率和 EQ-5D 量表疼痛领域评分更差相关。
临床试验注册- 网址：https://www.clinicaltrials.gov. 独特标识符：NCT00226096 和 NCT00716079。
