Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis).
J Neuropsychiatry Clin Neurosci. 2024 Fall;36(4):316-324. doi: 10.1176/appi.neuropsych.20230114. Epub 2024 Apr 23.
Emotional and behavioral dyscontrol (EBD), a neuropsychiatric complication of stroke, leads to patient and caregiver distress and challenges to rehabilitation. Studies of neuropsychiatric sequelae in stroke are heavily weighted toward ischemic stroke. This study was designed to compare risk of EBD following intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) and to identify risk factors for EBD following hemorrhagic stroke.
The authors conducted a prospective cohort study of patients hospitalized for nontraumatic hemorrhagic stroke between 2015 and 2021. Patients or legally authorized representatives completed the Quality of Life in Neurological Disorders (Neuro-QOL) EBD short-form inventory 3 months after hospitalization. Univariable and multivariable analyses identified risk factors for EBD after hemorrhagic stroke.
The incidence of EBD was 21% (N=15 of 72 patients) at 3 months after hemorrhagic stroke. Patients with ICH were more likely to develop EBD; 93% of patients with EBD (N=14 of 15) had ICH compared with 56% of patients without EBD (N=32 of 57). The median Glasgow Coma Scale (GCS) score at hospital admission was lower among patients who developed EBD (13 vs. 15 among those without EBD). Similarly, admission scores on the National Institutes of Health Stroke Scale (NIHSS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) were higher among patients with EBD (median NIHSS score: 7 vs. 2; median APACHE II score: 17 vs. 11). Multivariable analyses identified hemorrhage type (ICH) and poor admission GCS score as predictors of EBD 3 months after hemorrhagic stroke.
Patients with ICH and a low GCS score at admission are at increased risk of developing EBD 3 months after hemorrhagic stroke and may benefit from early intervention.
情感和行为失控（EBD）是中风的一种神经精神并发症，导致患者和护理人员痛苦，并对康复造成挑战。中风后神经精神并发症的研究主要侧重于缺血性中风。本研究旨在比较脑出血（ICH）和蛛网膜下腔出血（SAH）后 EBD 的风险，并确定出血性中风后 EBD 的危险因素。
作者对 2015 年至 2021 年期间因非外伤性出血性中风住院的患者进行了前瞻性队列研究。患者或合法授权代表在住院后 3 个月完成生活质量在神经疾病中的评估（Neuro-QOL）EBD 短表清单。单变量和多变量分析确定了出血性中风后 EBD 的危险因素。
出血性中风后 3 个月，EBD 的发生率为 21%（72 例患者中有 15 例）。ICH 患者更有可能发生 EBD；15 例 EBD 患者中（N=14）有 93%患有 ICH，而无 EBD 患者中（N=32）有 56%患有 ICH。发生 EBD 的患者入院时格拉斯哥昏迷量表（GCS）评分较低（13 分，无 EBD 患者为 15 分）。同样，EBD 患者入院时的 NIH 中风量表（NIHSS）和急性生理学和慢性健康评估 II（APACHE II）评分也较高（NIHSS 评分中位数：7 分，2 分；APACHE II 评分中位数：17 分，11 分）。多变量分析确定出血类型（ICH）和入院时 GCS 评分低是出血性中风后 3 个月 EBD 的预测因素。
入院时 ICH 且 GCS 评分较低的患者发生 EBD 的风险增加，出血性中风后 3 个月可能需要早期干预。
