Gerriets T, Stolz E, Modrau B, Fiss I, Seidel G, Kaps M
Department of Neurology, Medical University at Lübeck, Germany.
Neurology. 1999 Jan 1;52(1):45-9. doi: 10.1212/wnl.52.1.45.
Transcranial color-coded sonography (TS) allows a noninvasive, accurate evaluation of lateral displacement of the third ventricle. The authors studied the prognostic value of TS monitoring of the midline shift (MLS) in acute hemispheric stroke.
Sixteen patients with acute middle cerebral artery (MCA) occlusion were investigated. On admission, the median modified Scandinavian Stroke Scale (mSSS) score was 6.0 (range, 5 to 8). Five patients died from cerebral herniation (group 1), 10 survived (group 2), and 1 patient (Patient 16) survived after decompressive surgery. TS was performed on days 1 to 4 (10 +/- 3, 32 +/- 4, 57 +/- 5, and 82 +/- 5 hours after onset of symptoms). Distance from the TS probe to the center of the third ventricle was measured both from the symptomatic (A) and asymptomatic (B) sides. MLS was calculated using the formula MLS = (A - B)/2.
Ten hours after stroke onset, MLS and mSSS scores were not significantly different between the two groups. At 32, 57, and 82 hours, MLS was higher in group 1 (32 hours, p = 0.001; 57 hours, p = 0.003; 82 hours, p = 0.023) whereas there was no difference in mSSS score after 32 hours. All patients with an MLS < 4 mm at 32 hours survived, whereas patients with an MLS > 4 mm died as a result of cerebral herniation, with the exception of the one patient who underwent decompressive hemicraniectomy.
The study of MLS at 32 hours after stroke onset in patients with severe MCA infarctions may identify patients who are unlikely to survive. The value of MLS in determining the indication of decompressive craniectomy merits further study.
经颅彩色编码超声检查（TS）可对第三脑室的侧方移位进行无创、准确的评估。作者研究了TS监测急性半球性卒中中线移位（MLS）的预后价值。
对16例急性大脑中动脉（MCA）闭塞患者进行了研究。入院时，改良斯堪的纳维亚卒中量表（mSSS）评分中位数为6.0（范围5至8）。5例患者死于脑疝（第1组），10例存活（第2组），1例患者（患者16）在减压手术后存活。在症状出现后的第1至4天（症状出现后10±3、32±4、57±5和82±5小时）进行TS检查。从有症状侧（A）和无症状侧（B）测量TS探头到第三脑室中心的距离。使用公式MLS =（A - B）/2计算MLS。
卒中发作后10小时，两组之间的MLS和mSSS评分无显著差异。在32、57和82小时时，第1组的MLS更高（32小时，p = 0.001；57小时，p = 0.003；82小时，p = 0.023），而32小时后mSSS评分无差异。32小时时MLS < 4 mm的所有患者均存活，而MLS > 4 mm的患者除1例接受减压性颅骨切除术的患者外，均死于脑疝。
对严重MCA梗死患者卒中发作后32小时的MLS进行研究，可能识别出不太可能存活的患者。MLS在确定减压性颅骨切除术指征方面的价值值得进一步研究。
