卒中预警时行急诊脑 MRI 的标准
Criteria for Emergency Brain MRI During Stroke-Alert.
机构信息
Department of Neurology, University of Oklahoma Health Sciences Center, 920 S.L.Young Blvd #2040, Oklahoma City, OK 73104, USA; Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave., Oklahoma City, OK 73104, USA.
Department of Neurology, University of Oklahoma Health Sciences Center, 920 S.L.Young Blvd #2040, Oklahoma City, OK 73104, USA.
出版信息
J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105890. doi: 10.1016/j.jstrokecerebrovasdis.2021.105890. Epub 2021 Jun 6.
OBJECTIVES
Intravenous (IV) tissue plasminogen activator (tPA) should be given to patients with acute ischemic stroke (AIS) and avoided in stroke mimics (SM). Select use of emergency brain magnetic resonance imaging (eMRI-brain) in stroke-alerts aids diagnosis, but accepted utilization criteria for eMRI-brain do not currently exist. We developed criteria for eMRI-brain and report the yield of eMRI-brain in stroke-alert patients.
MATERIALS AND METHODS
We developed three history-based criteria for performing eMRI-brain during stroke-alerts: (1) history of previous similar deficits, (2) change in consciousness at onset of symptoms, (3) symptom presentation consistent with migraine aura. We then performed a retrospective chart review of patients who presented as a stroke-alert over a 5-year period and determined how these criteria affected administration of IV tPA to AIS and SM patients.
RESULTS
Among 3,512 stroke-alerts, 230 (8.1%) patients met our criteria for eMRI-brain exams: 217 (92.6%) had SM and 17 (7.4%) had AIS. Our IV tPA decision-making analysis showed that based on eMRI-brain IV tPA was less frequently administered to SM patients (PCC-0.841, p=0.036) with less failures to administer IV tPA to patients with AIS (PCC -0.907, p-value=0.013, Pearson correlation coefficient). No patients became ineligible for IV tPA due to MRI-related time delays.
CONCLUSIONS
Our history based criteria for performing eMRI-brain during stroke-alerts show a high yield of stroke mimics. Selective eMRI-brain improves decision-making accuracy regarding IV tPA administration.
目的
急性缺血性脑卒中（AIS）患者应给予静脉（IV）组织型纤溶酶原激活剂（tPA），而脑卒中模拟症（SM）患者应避免使用。在脑卒中预警中选择性地使用紧急脑磁共振成像（eMRI-brain）有助于诊断，但目前尚无公认的 eMRI-brain 使用标准。我们制定了 eMRI-brain 的使用标准，并报告了脑卒中预警患者中 eMRI-brain 的检出率。
材料与方法
我们制定了三项基于病史的 eMRI-brain 检查标准，用于脑卒中预警：（1）既往有类似发作史，（2）症状发作时意识改变，（3）症状表现符合偏头痛先兆。然后，我们对 5 年内以脑卒中预警就诊的患者进行了回顾性病历审查，并确定这些标准如何影响 AIS 和 SM 患者 IV tPA 的使用。
结果
在 3512 例脑卒中预警中，有 230 例（8.1%）患者符合我们的 eMRI-brain 检查标准：217 例（92.6%）为 SM，17 例（7.4%）为 AIS。我们的 IV tPA 决策分析表明，基于 eMRI-brain，SM 患者接受 IV tPA 的频率较低（PCC-0.841，p=0.036），而 AIS 患者未能接受 IV tPA 的比例较低（PCC-0.907，p 值=0.013，Pearson 相关系数）。没有患者因 MRI 相关时间延迟而失去 IV tPA 的使用资格。
结论
我们基于病史的脑卒中预警中进行 eMRI-brain 的标准显示出较高的脑卒中模拟症检出率。选择性 eMRI-brain 可提高 IV tPA 给药决策的准确性。
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