Mausbach Stefan, Abdallah Lamya Ahmad, Ben-David Eliel, Teitcher Michael, Bornstein Natan M, Eichel Roni
Department of Neurology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Shmuel Bait 12, Jerusalem, 9103102, Israel.
2Department of Neurocritical Care Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Neuroradiology. 2024 Dec;66(12):2223-2231. doi: 10.1007/s00234-024-03480-2. Epub 2024 Oct 10.
Early neurological deterioration (END) affects 20-30% of patients with lacunar stroke within 48 h despite optimal treatment. Previously established markers included infection and infarct location on imaging. We studied the utility of measuring global cerebral blood flow (gCBF) measured by CT-Perfusion (CTP) as an early predictor of END in patients with lacunar strokes.
162 patients with lacunar stroke were measured for gCBF including both cerebral hemispheres and cerebellum. We stratified patients by normal gCBF (> 40 ml/100 mg/min) vs. low gCBF (< 40 ml/100 mg/min). Stroke location, vascular risk factors, age and gender were assessed. The primary outcome was the change in the NIHSS score after 48 h from index stroke.
Mean gCBF of the overall cohort was 37.72 ml/100 mg/min. Both groups had a baseline NIHSS score of 4.2 with similar standard deviations. The NIHSS score decreased by 1.3 points in normal gCBF group and increased by 1.1 points in the low gCBF group. All stroke sites deteriorated in the low gCBF group, particularly the capsula interna, corona radiata, and lateral pontine area. END occurred in 37.8% in low gCBF compared to 3.1% in the normal gCBF patients. In contrast, clinical improvement after 48 h occurred in 64.2% of patients with normal gCBF but only 6.1% with low gCBF.
Our study supports measurement of gCBF by CTP as a potential imaging biomarker for END. Additionally, it adds evidence to the body of supporting the vulnerability of capsula interna and pontine infarctions to END.
尽管进行了最佳治疗，但早期神经功能恶化（END）仍会在48小时内影响20%-30%的腔隙性卒中患者。先前确定的标志物包括感染和影像学上的梗死部位。我们研究了通过CT灌注（CTP）测量全脑血流量（gCBF）作为腔隙性卒中患者END早期预测指标的效用。
对162例腔隙性卒中患者测量其全脑包括大脑半球和小脑的gCBF。我们将患者分为gCBF正常（>40 ml/100 mg/min）与gCBF低（<40 ml/100 mg/min）两组。评估卒中部位、血管危险因素、年龄和性别。主要结局是自首次卒中起48小时后美国国立卫生研究院卒中量表（NIHSS）评分的变化。
整个队列的平均gCBF为37.72 ml/100 mg/min。两组的基线NIHSS评分为4.2，标准差相似。gCBF正常组的NIHSS评分下降了1.3分，而gCBF低的组增加了1.1分。gCBF低的组中所有卒中部位均出现恶化，尤其是内囊、放射冠和脑桥外侧区域。gCBF低的患者中37.8%发生END，而gCBF正常的患者中为3.1%。相比之下，gCBF正常的患者中64.2%在48小时后临床改善，而gCBF低的患者中仅为6.1%。
我们的研究支持通过CTP测量gCBF作为END的一种潜在影像学生物标志物。此外，它为支持内囊和脑桥梗死易发生END的证据增添了内容。
