大脑后动脉闭塞的临床表现——更积极治疗策略的临床依据？

Clinical presentation of posterior cerebral artery occlusions - Clinical rationale for a more aggressive therapeutic strategy?

作者信息

Maus Volker, Rogozinski Sophia, Borggrefe Jan, Barnikol Utako Birgit, Saklak Muharrem, Mpotsaris Anastasios

机构信息

Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany.

Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.

出版信息

eNeurologicalSci. 2021 Sep 4;25:100368. doi: 10.1016/j.ensci.2021.100368. eCollection 2021 Dec.

DOI:10.1016/j.ensci.2021.100368

PMID:34765752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8571698/

Abstract

INTRODUCTION

A proximal occlusion of the posterior cerebral artery (PCA) can affect patients severely and clinical outcome might be poor. Aim of this paper is to describe clinical presentation, diagnostic findings and outcome of patients suffering from ischemia in the PCA territory.

METHODS

We conducted a retrospective analysis of clinically affected patients with imaging-based evidence of ischemia within in the PCA territory at a comprehensive stroke center over a six-year period. Clinical (including demographics, National Institutes of Health Stroke Scale, NIHSS, modified Rankin Sclae, mRS), imaging (including occlusion site and brain infarction) and therapeutic data were evaluated. A favorable outcome was defined as an mRS ≤2.

RESULTS

Two hundred thirty-five patients were clinically affected with evidence of PCA ischemia detected by cross-sectional imaging. One-hundred fourty-five patients demonstrated an occlusion of the PCA including 43/145 (30%) with P1 occlusion, 80/145 (55%) with P2 and 22/145 (15%) with P3 occlusion. The most frequent symptom was hemi-/ quadrantanopsia (181/235, 77%). Sixty-eight patients (29%) suffered from hemiparesis. The occurrence of a hemiparesis was associated with a P1 occlusion (27/43, 63% vs. 41/192, 21%;  < 0.0001). Hemi-/quadrantanopsia was less frequently associated with a P1 occlusion (26/43, 61% vs. 155/192, 81%;  = 0.0043). P1 occlusions more frequently showed thalamic infarction (28/43, 65% vs. 65/192, 34%;  < 0.0001). At discharge, patients with P1 occlusion more often showed a poor outcome (mRS > 2, 30/43, 70% vs. 55/192, 29%; p < 0.0001).

CONCLUSION

Hemiparesis due to P1 occlusion is a common phenomenon in stroke patients and associated with a poor clinical outcome.

摘要

引言

大脑后动脉（PCA）近端闭塞可对患者造成严重影响，临床预后可能较差。本文旨在描述PCA供血区缺血患者的临床表现、诊断结果及预后。

方法

我们对一家综合性卒中中心6年内临床上出现PCA供血区缺血影像学证据的患者进行了回顾性分析。评估了临床资料（包括人口统计学数据、美国国立卫生研究院卒中量表NIHSS、改良Rankin量表mRS）、影像学资料（包括闭塞部位和脑梗死情况）以及治疗数据。良好预后定义为mRS≤2。

结果

235例患者临床上出现PCA缺血证据，经横断面成像检测确诊。145例患者显示PCA闭塞，其中43/145（30%）为P1段闭塞，80/145（55%）为P2段闭塞，22/145（15%）为P3段闭塞。最常见的症状是偏盲/象限盲（181/235，77%）。68例患者（29%）出现偏瘫。偏瘫的发生与P1段闭塞相关（27/43，63% 对比 41/192，21%；<0.0001）。偏盲/象限盲与P1段闭塞的相关性较低（26/43，61% 对比 155/192，81%；=0.0043）。P1段闭塞更常出现丘脑梗死（28/43，65% 对比 65/192，34%；<0.0001）。出院时，P1段闭塞的患者预后较差（mRS>2，30/43，70% 对比 55/192，29%；p<0.0001）。