Villalobos-Díaz Rodolfo, Ortiz-Llamas Laura A, Rodríguez-Hernández Luis A, Flores-Vázquez José G, Calva-González Metztli, Sangrador-Deitos Marcos V, Mondragón-Soto Michel G, Uribe-Pacheco Rodrigo, Villanueva Castro Eliezer, Barrera-Tello Manuel A
Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.
Neurosurgery, Hospital Regional Mérida, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mérida, MEX.
Cureus. 2022 Sep 9;14(9):e28993. doi: 10.7759/cureus.28993. eCollection 2022 Sep.
Objective The purpose of this study was to analyze and discuss the clinical characteristics, long-term outcome, and prognostic factors of cerebellar strokes treated in a single health care facility in Mexico. Methods We retrospectively reviewed the medical records of adult patients admitted to our hospital with diagnosis of cerebellar ischemic and hemorrhagic stroke between 2018 and 2020. Baseline data included sociodemographic and radiological variables, treatment (surgical versus conservative), and Glasgow Coma Scale on arrival (GCSOA). The final neurological outcome was evaluated with the Glasgow Outcome Scale (GOS) six months after hospital discharge. Results Ten patients (seven male and three female) with a mean age of 57.9 ± 9.3 years were included, six with cerebellar ischemic infarction and four with cerebellar hemorrhage. Out of the 10 patients, four underwent surgery (suboccipital decompressive craniectomy {SDC} ± ventriculostomy). The outcome was favorable in four cases (40%) and unfavorable in six (60%). Patients who underwent surgical treatment fared worse with all four cases associating poor outcome. The comparison between good and poor outcome groups showed significant differences in the presence of obstructive hydrocephalus (one versus six, p = 0.05) and poorer GCSOA (6.16 ± 1.72 versus 12.5 ± 3.6, p = 0.05), associating poorer outcome. Conclusion There is still controversy regarding the appropriate management of cerebellar strokes. The presence of obstructive hydrocephalus and poorer GCSOA are associated to worse outcomes.
目的 本研究旨在分析和讨论在墨西哥一家医疗机构接受治疗的小脑卒中的临床特征、长期预后及预后因素。方法 我们回顾性分析了2018年至2020年间我院收治的诊断为小脑缺血性和出血性卒中的成年患者的病历。基线数据包括社会人口统计学和放射学变量、治疗方式(手术与保守治疗)以及入院时的格拉斯哥昏迷量表(GCSOA)。出院6个月后用格拉斯哥预后量表(GOS)评估最终神经功能预后。结果 纳入10例患者(7例男性,3例女性),平均年龄57.9±9.3岁,其中6例为小脑缺血性梗死,4例为小脑出血。10例患者中,4例行手术治疗(枕下减压颅骨切除术{SDC}±脑室造瘘术)。4例(40%)预后良好,6例(60%)预后不良。接受手术治疗的患者预后更差,4例均预后不良。良好预后组与不良预后组比较,在梗阻性脑积水的存在情况(1例与6例,p=0.05)和较差的GCSOA(6.16±1.72与12.5±3.6,p=0.05)方面存在显著差异,提示预后较差。结论 小脑卒中的恰当治疗仍存在争议。梗阻性脑积水的存在和较差的GCSOA与较差的预后相关。