Mora-Boga R, Díaz Recarey M E, Salvador de la Barrera S, Ferreiro Velasco M E, Rodríguez Sotillo A, Montoto Marqués A
Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España.
Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España.
Rehabilitacion (Madr). 2024 Jan-Mar;58(1):100819. doi: 10.1016/j.rh.2023.100819. Epub 2023 Oct 18.
The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size.
Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4mm) and macrohemorrhages (greater than 4mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS).
Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2±22.2 in the microhemorrhages and 40.9±20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4±20.5 for 42.7±22.8 (P=.033). Eight patients (17.4%) died during admission.
There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4mm presenting a better evolution.
脊髓出血的存在被认为是创伤性脊髓损伤（SCI）的一个不良预后因素。然而，已发表的研究表明，小出血灶的预后并非如此悲观。本文旨在根据脑实质内出血的大小评估其神经功能演变情况。
回顾性观察研究。选取2010年至2018年间因急性创伤性SCI入院且早期进行磁共振检查并发现脊髓出血的所有患者。根据出血大小分为两组：微出血（小于4mm）和大出血（大于4mm）。根据美国脊髓损伤协会（AIS）分级和运动评分（MS）比较入院时和出院时的神经学检查结果。
共收集46例病例，其中17例为微出血，29例为大出血。微出血患者中70.6%为AIS A级，而大出血患者中这一比例为89.6%。出院时，微出血患者中有40.0%的AIS分级有所改善，而大出血患者中这一比例为4.0%（P = 0.008）。初始MS相似，微出血患者为45.2±22.2，大出血患者为40.9±20.4（P = 0.459），但出院时第一组更高：微出血患者为60.4±20.5，大出血患者为42.7±22.8（P = 0.033）。8例患者（17.4%）在住院期间死亡。
脑实质内出血的大小与SCI的神经学预后之间存在关联，出血小于4mm的患者预后更好。
