急性双侧后循环脑梗死的临床症状、病因及预后
Clinical Symptoms, Etiology and Prognosis of Acute Bilateral Posterior Circulation Cerebral Infarction.
作者信息
Zhao Yuan, Han Yanfei, Sun Weidong, Zhang Yongbo
机构信息
Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
出版信息
Int J Gen Med. 2022 Mar 10;15:2787-2793. doi: 10.2147/IJGM.S351560. eCollection 2022.
BACKGROUND
Acute BPCCI was previously presented only as a case report. The prognosis of acute BPCCI is related to many factors, such as gender, age, NIHSS, Hypertension and so on. We first systematically analyzed the clinical symptoms, imaging, etiology and prognosis of acute BPCCI and identified a statistically significant factor.
METHODS
A total of 72 acute BPCCI patients admitted to the Department of Neurology, Beijing Friendship hospital, Capital Medical University were included. The demographics, risk factors, clinical manifestations, National Institute of Health stroke scale (NIHSS) on admission, imaging findings, and the modified Rankin Scale (mRS) at the third month after onset were collected. The mRS score greater than 3 indicated poor prognosis. The factors affecting their prognosis were analyzed.
RESULTS
We included 72 Chinese patients with acute BPCCI (82% male). The most common symptoms and signs of the patients were dizziness and unilateral limb weakness. Patients with acute BPCCI involving cerebellum accounted for 85% of the patients. The number of patients with large-artery atherosclerosis was 46 (64%), the number of patients with cardiogenic embolism was 12 (17%), and the number of patients with other causes and unknown causes was 14 (19%). After multivariate regression analyses, NIHSS score (odds ratio 0.725, 95% confidence interval 0.586-0.896, P = 0.003) was closely related with the prognosis of acute BPCCI.
CONCLUSION
Our study found that the symptoms and signs of acute BPCCI were nonspecific and mainly depended on imaging diagnosis. Acute BPCCI involving cerebellum was the most common case of acute BPCCI. The main cause of acute BPCCI was large-artery atherosclerosis. NIHSS score is identified as a statistically significant factor. The higher NIHSS score on admission showed the worse prognosis. Therefore, an acute BPCCI patient with a high NIHSS score should be paid more attention at the time of diagnosis.
背景
急性双侧大脑后循环梗死（BPCCI）此前仅作为病例报告呈现。急性BPCCI的预后与许多因素相关，如性别、年龄、美国国立卫生研究院卒中量表（NIHSS）、高血压等。我们首次系统分析了急性BPCCI的临床症状、影像学表现、病因及预后，并确定了一个具有统计学意义的因素。
方法
纳入首都医科大学附属北京友谊医院神经内科收治的72例急性BPCCI患者。收集患者的人口统计学资料、危险因素、临床表现、入院时的美国国立卫生研究院卒中量表（NIHSS）评分、影像学检查结果以及发病后第三个月的改良Rankin量表（mRS）评分。mRS评分大于3表明预后不良。分析影响其预后的因素。
结果
我们纳入了72例中国急性BPCCI患者（82%为男性）。患者最常见的症状和体征是头晕和单侧肢体无力。急性BPCCI累及小脑的患者占85%。大动脉粥样硬化患者46例（64%），心源性栓塞患者12例（17%），其他原因及病因不明患者14例（19%）。多因素回归分析后，NIHSS评分（比值比0.725，95%置信区间0.586 - 0.896，P = 0.003）与急性BPCCI的预后密切相关。
结论
我们的研究发现，急性BPCCI的症状和体征不具有特异性，主要依赖影像学诊断。急性BPCCI累及小脑是急性BPCCI最常见的情况。急性BPCCI的主要病因是大动脉粥样硬化。NIHSS评分被确定为具有统计学意义的因素。入院时NIHSS评分越高，预后越差。因此，诊断时应更加关注NIHSS评分高的急性BPCCI患者。
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