Shotar Eimad, Chiaroni Pierre-Marie, Haffaf Idriss, Cortese Jonathan, Jacquens Alice, Garzelli Lorenzo, Allard Julien, Elhorany Mahmoud, Amouyal Caroline, Mathon Bertrand, Nouet Aurélien, Premat Kévin, Lenck Stéphanie, Sourour Nader-Antoine, Degos Vincent, Clarençon Frédéric
Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, INSERM, Institut de la Vision, Paris, France.
Front Neurol. 2024 Aug 23;15:1432687. doi: 10.3389/fneur.2024.1432687. eCollection 2024.
This study aims to explore the impact of ultra-early neurological deterioration (U-END) on the outcome (mortality and poor neurological status) following a brain arteriovenous malformation (BAVM) rupture and identify determinants of U-END.
Patients with BAVM ruptures admitted to a single tertiary care center were retrospectively reviewed. U-END was defined as a worsening by two or more points on the Glasgow Coma Scale (GCS). U-END was tested as a potential predictor of in-hospital mortality and poor outcomes. Univariate and multivariate analyses were performed to identify determinants of U-END. Patients with U-END were also matched and compared with BAVM rupture controls presenting with a GCS close or equal to either their initial or their lowest GCS.
A total of 248 patients with BAVM ruptures met the inclusion criteria, with 39 (15.7%) patients presenting with U-END. U-END was not associated with and was not an independent predictor of in-hospital mortality (12.8 vs. 10.5% in the rest of the study population; = 0.67) or poor outcomes (39.5 vs. 36.9%; = 0.77). The only independent determinants of U-END were hydrocephalus (OR 2.6 [95%CI, 1.1-6.4]; = 0.03) and intraventricular hemorrhage (IVH; OR 3.5 [95%CI, 1.1-11.7]; = 0.04). When compared to the initial GCS control group, U-END patients more often presented with IVH (89.5 vs. 64.1%; = 0.009) and hydrocephalus (73 vs. 38.5%; = 0.003). When compared to the lowest GCS control group, U-END patients had lower early S100B serum levels (0.35 ± 0.37 vs. 0.83 ± 1; = 0.009) and a lower rate of poor outcome (39.5 vs. 64.9%; = 0.03).
Ultra-early neurological deterioration in ruptured BAVMs did not result in increased mortality or poor outcomes and was most often related to IVH and hydrocephalus.
本研究旨在探讨超早期神经功能恶化（U-END）对脑动静脉畸形（BAVM）破裂后结局（死亡率和神经功能不良状态）的影响，并确定U-END的决定因素。
对入住单一三级医疗中心的BAVM破裂患者进行回顾性研究。U-END定义为格拉斯哥昏迷量表（GCS）评分下降两分或更多。将U-END作为住院死亡率和不良结局的潜在预测因素进行检验。进行单因素和多因素分析以确定U-END的决定因素。还对U-END患者与GCS评分接近或等于其初始或最低GCS评分的BAVM破裂对照组进行匹配和比较。
共有248例BAVM破裂患者符合纳入标准，其中39例（15.7%）出现U-END。U-END与住院死亡率（研究人群其余部分为12.8%对10.5%；P = 0.67）或不良结局（39.5%对36.9%；P = 0.77）无关，也不是其独立预测因素。U-END的唯一独立决定因素是脑积水（比值比[OR] 2.6 [95%置信区间，1.1 - 6.4]；P = 0.03）和脑室内出血（IVH；OR 3.5 [95%置信区间，1.1 - 11.7]；P = 0.04）。与初始GCS对照组相比，U-END患者更常出现IVH（89.5%对64.1%；P = 0.009）和脑积水（73%对38.5%；P = 0.003）。与最低GCS对照组相比，U-END患者早期血清S100B水平较低（0.35±0.37对0.83±1；P = 0.009），不良结局发生率较低（39.5%对64.9%；P = 0.03）。
破裂BAVM的超早期神经功能恶化不会导致死亡率增加或不良结局，且最常与IVH和脑积水相关。
