Jiang Nan N, Sahlas Demetrios J, Fong Crystal, Wu Wei, Monteiro Sandra, Larrazabal Ramiro
Department of Diagnostic Radiology, Hamilton General Hospital, McMaster University, United States of America.
Department of Medicine (Neurology), Hamilton General Hospital, McMaster University, Canada.
J Neurol Sci. 2021 Jan 15;420:117226. doi: 10.1016/j.jns.2020.117226. Epub 2020 Nov 13.
Horizontal gaze deviation (HGD) is a predictor of acute large vessel occlusion (LVO) and helps to expedite the triage of patients to CTA and endovascular-capable sites. Patients with acute cerebellar ischemia, particularly involving the PICA territory, can also exhibit HGD.
We reviewed 2260 CTA stroke assessment cases between January 2016 and May 2020. Forty-six patients with CTA-proven acute PICA occlusions were identified and compared with 114 patients with acute LVO (ICA, M1, and M1/2). Both clinical and radiographic HGD were examined. The degree of radiographic HGD was measured for each patient. Site of ischemia was confirmed on subsequent MRI.
Of the 46 patients with acute PICA occlusions, 20 (43.5%) patients had radiographic (+) HGD with either ipsilateral or contralateral gaze deviation, 6 of whom (13.0%) displayed clinical HGD. Of the 114 patients with LVO (control group), 72 (63.2%) patients had radiographic (+) HGD, all ipsilateral, 49 of whom (68.0%) displayed clinical HGD. The mean degree of HGD between PICA and LVO were 30.0° vs. 22.9°, respectively, p < 0.001; AUC = 0.68.
Patients with acute PICA occlusion can exhibit either ipsilateral or contralateral HGD and a higher degree of HGD than LVO occlusion on NECT. In hyperacute stroke, the presence of radiographic HGD > 30° in the absence of ischemic changes in the MCA territory should prompt clinicians to closely evaluate for features of early ischemic changes in the cerebellar hemispheres that suggest acute PICA occlusion.
水平凝视偏斜（HGD）是急性大血管闭塞（LVO）的一个预测指标，有助于加快对患者进行CT血管造影（CTA）检查以及将患者分诊至有血管内治疗能力的医疗机构。急性小脑缺血患者，尤其是累及小脑后下动脉（PICA）供血区域的患者，也可出现HGD。
我们回顾了2016年1月至2020年5月期间的2260例CTA卒中评估病例。确定了46例经CTA证实为急性PICA闭塞的患者，并与114例急性LVO（颈内动脉、大脑中动脉M1段和M1/M2段）患者进行比较。对临床和影像学HGD均进行了检查。测量了每位患者影像学HGD的程度。后续通过磁共振成像（MRI）确定缺血部位。
在46例急性PICA闭塞患者中，20例（43.5%）患者存在影像学（+）HGD，表现为同侧或对侧凝视偏斜，其中6例（13.0%）出现临床HGD。在114例LVO患者（对照组）中，72例（63.2%）患者存在影像学（+）HGD，均为同侧，其中49例（68.0%）出现临床HGD。PICA闭塞组和LVO组HGD的平均度数分别为30.0°和22.9°，p<0.001；曲线下面积（AUC）=0.68。
急性PICA闭塞患者可出现同侧或对侧HGD，且在非增强CT（NECT）上HGD程度高于LVO闭塞患者。在超急性卒中中，若在大脑中动脉供血区域无缺血改变的情况下，影像学HGD>30°，临床医生应密切评估小脑半球早期缺血改变的特征，以提示急性PICA闭塞。
