Neurology Department, Ege University, Medical School Hospital, İzmir, Turkey.
Neurology Department, Acıbadem Hospital, Bursa, Turkey.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105337. doi: 10.1016/j.jstrokecerebrovasdis.2020.105337. Epub 2020 Sep 30.
Isolated medullary hemorrhage (MH) is an uncommon presentation of spontaneous intraparenchymal hemorrhage. The relationship between MH and neurological outcome is not well known. This study aims to assess predictive parameters for the outcome of medullary hemorrhage.
We conducted an extensive search of the literature for cases with spontaneous, isolated MH. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA). Forty-three cases diagnosed by CT or MRI have been reported in the literature, to which we add three confirmed by MRI. The ventrodorsal size of hemorrhage was taken into account as a parameter of outcome. Early neurologic deterioration (END) was defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power, or ≥2 points in the total score within the first week after admission. Modified Rankin Score (mRS) 0-2 was presumed as favorable outcome (FO) and mRS 3-6 score as unfavorable outcome (UO) at discharge and at 3 months after stroke.
We enrolled 46 patients, and 17 (37%) patients were diagnosed with END. The cause of medullary hemorrhage was mostly vascular malformations, including cavernous malformation (33%) and arteriovenous malformation (11%). In univariate analyses, neither arteriovenous malformations (OR, 1.04; 95%CI, 0.10-10.53; P = 0.68) nor cavernomas (OR, 1.04; 95%CI, 0.22-4.89; P = 0.62) were associated with UO. Acute respiratory distress syndrome was higher in patients with UO group (44%) compared to those with FO group (16%), but this difference did not reach to a significant level (OR, 4.13; 95%CI, 0.85-20.04; P = 0.09). The diameter of hemorrhage was significantly larger (≥1 cm) in patients with UO compared to those with FO (OR, 16.67; 95%CI, 1.87-148.89; P = 0.003). Three months after stroke, 37 patients (80%) had FO and 9 (19.5%) had UO, and 5 (11%) died. Multiple logistic regression analysis using predetermined variables found to be significant in univariate analyses (END, consciousness disturbance at admission, hemorrhage size, and hypertension) showed that END at stroke onset was significantly associated with UO (OR, 4.97; CI95%, 1.13-21.94; P = 0.03).
These results suggest that the END is a predictor for UO in patients with medullary hemorrhage. The extent of the medullary hemorrhage along the conduction tract may contribute to deterioration.
孤立性脑桥出血（MH）是脑实质内出血的一种罕见表现。MH 与神经功能预后的关系尚不清楚。本研究旨在评估脑桥出血预后的预测参数。
我们对自发性孤立性 MH 的病例进行了广泛的文献检索。该研究根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。文献中有 43 例经 CT 或 MRI 诊断，我们在此基础上增加了 3 例经 MRI 确诊的病例。将出血的背腹径作为预后的参数。早期神经功能恶化（END）定义为入院后第一周内运动功能 NIH 卒中量表评分增加≥1 分，或总分增加≥2 分。改良 Rankin 量表（mRS）0-2 分被认为是良好预后（FO），mRS 3-6 分是出院时和卒中后 3 个月时的不良预后（UO）。
我们共纳入 46 例患者，其中 17 例（37%）患者被诊断为 END。脑桥出血的病因多为血管畸形，包括海绵状血管瘤（33%）和动静脉畸形（11%）。单因素分析显示，动静脉畸形（OR，1.04；95%CI，0.10-10.53；P=0.68）和海绵状血管瘤（OR，1.04；95%CI，0.22-4.89；P=0.62）均与 UO 无关。UO 组患者急性呼吸窘迫综合征（ARDS）发生率（44%）高于 FO 组（16%），但差异无统计学意义（OR，4.13；95%CI，0.85-20.04；P=0.09）。UO 组出血直径明显大于 FO 组（≥1cm）（OR，16.67；95%CI，1.87-148.89；P=0.003）。卒中后 3 个月，37 例（80%）患者预后良好，9 例（19.5%）预后不良，5 例（11%）死亡。对单因素分析中具有统计学意义的预定变量进行多因素逻辑回归分析发现，卒中发作时的 END 与 UO 显著相关（OR，4.97；95%CI，1.13-21.94；P=0.03）。
这些结果表明，END 是脑桥出血患者 UO 的预测因素。脑桥沿传导束的出血范围可能导致病情恶化。
