Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Neurol. 2021 Aug;268(8):3020-3025. doi: 10.1007/s00415-021-10456-2. Epub 2021 Mar 1.
The clinical factors predisposing to ischemic stroke in reversible cerebral vasoconstriction syndrome (RCVS) are unclear. In this observational cross-sectional study, we aimed to evaluate the risk factors and clinical outcomes associated with the development of ischemic stroke in patients with RCVS.
We utilized the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations with RCVS, with or without acute ischemic stroke. Independent predictors of and clinical outcomes associated with ischemic stroke were analyzed using logistic regression.
Among 1065 hospitalizations for RCVS (mean ± SD age 49.0 ± 16.7 years, female 69.7%), 267 (25.1%) had ischemic stroke. Patients with ischemic stroke were more likely to have hypertension (OR 2.33, 95% CI 1.51-3.60), diabetes (OR 1.81, 95% CI 1.11-2.98), and tobacco use (OR 1.64, 95% CI 1.16-2.33) and were less likely to have a history of migraine (OR 0.56, 95% CI 0.35-0.90). Ischemic stroke was associated with higher odds of cerebral edema (OR 3.15, 95% CI 1.31-7.57) and respiratory failure (OR 2.39, 95% CI 1.28-4.44). Patients with ischemic stroke also had longer hospital stay by a mean duration of 6.7 days, P < 0.001, higher hospital charges by a mean of $72,961, P < 0.001, and a higher likelihood of not being discharged to home (OR 3.57, 95% CI 2.39-5.33). They had higher in-hospital mortality rate; however, the difference was not statistically significant.
Ischemic stroke affects nearly 25% of patients with RCVS and is associated with adverse clinical outcomes. RCVS patients with cerebrovascular risk factors might have a higher predisposition for developing ischemic lesions during the disease process.
导致可逆性脑血管收缩综合征（RCVS）中发生缺血性卒中的临床因素尚不清楚。在这项观察性横断面研究中，我们旨在评估 RCVS 患者发生缺血性卒中的相关风险因素和临床结局。
我们利用 2016-2017 年全国再入院数据库，确定所有伴有或不伴有急性缺血性卒中的 RCVS 住院患者。采用逻辑回归分析缺血性卒中相关的独立预测因素和临床结局。
在 1065 例 RCVS 住院患者中（平均年龄 49.0±16.7 岁，女性占 69.7%），267 例（25.1%）发生了缺血性卒中。与无缺血性卒中的 RCVS 患者相比，发生缺血性卒中的患者更可能患有高血压（比值比 2.33，95%置信区间 1.51-3.60）、糖尿病（比值比 1.81，95%置信区间 1.11-2.98）和吸烟（比值比 1.64，95%置信区间 1.16-2.33），且更不可能患有偏头痛病史（比值比 0.56，95%置信区间 0.35-0.90）。缺血性卒中与脑水肿（比值比 3.15，95%置信区间 1.31-7.57）和呼吸衰竭（比值比 2.39，95%置信区间 1.28-4.44）的发生风险更高。与无缺血性卒中的 RCVS 患者相比，发生缺血性卒中的患者平均住院时间延长 6.7 天（P<0.001），平均住院费用增加 72961 美元（P<0.001），且更不可能出院回家（比值比 3.57，95%置信区间 2.39-5.33）。缺血性卒中患者的院内死亡率更高，但差异无统计学意义。
缺血性卒中影响近 25%的 RCVS 患者，且与不良临床结局相关。RCVS 患者伴有脑血管危险因素可能在疾病过程中更易发生缺血性病变。
