Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage.
Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage.
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DOI：
10.1161/jaha.113.000090
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发表时间：
2013-08-02
影响因子：
5.4
通讯作者：
Wijman CA
中科院分区：
文献类型：
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作者：
Venkatasubramanian C;Kleinman JT;Fischbein NJ;Olivot JM;Gean AD;Eyngorn I;Snider RW;Mlynash M;Wijman CA
本研究的目的是使用系列 MR 成像来确定自发性脑出血 (ICH) 中皮质脊髓束华勒变性 (CST-WD) 的发病率、影像学特征、自然史和预后意义。连续发生幕上 ICH 的 ICH 患者前瞻性地在第 2、7、14 和 21 天接受了系列 MRI。由独立评估者在弥散加权成像 (DWI) 上分析 MRI 是否存在 CST-WD 及其地形分布。系统记录基线人口统计、血肿特征、ICH 评分和入院美国国立卫生研究院卒中评分 (NIHSS)。 3 个月时的功能结果通过改良 Rankin 量表 (mRS) 和运动 NIHSS 进行评估。 27 名患者接受了 93 次 MRI 检查；其中 88 个是在第一个月内连续获得的。在 13 名患者 (48%) 中，所有患者均患有深部 ICH，中位 7 天后观察到 CST-WD 变化（四分位数范围，7 至 8），DWI 弥散减少，并沿 CST 向头尾进展。中位 11 天后（四分位数范围，6 至 14），CST-WD 变化演变为 T2 高信号区域，并在 3 个月后获得的 MRI 上显示萎缩。在单变量分析中，CST-WD 的存在与 3 个月时较差的功能结果（即 mRS 4 至 6；P=0.046）和较差的运动 NIHSS（5 比 1，P=0.001）相关。沿着 CST 的华勒氏变性在自发性幕上 ICH 中很常见，特别是在深部 ICH 中。它可以在 ICH 后 1 周通过 DWI 检测到，并随着时间的推移沿着 CST 向头尾方向进展。 CST-WD 的存在与 ICH 后运动和功能恢复不良有关。
The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration (CST‐WD) in spontaneous intracerebral hemorrhage (ICH) using serial MR imaging. Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRIs at 2, 7, 14, and 21 days. MRIs were analyzed by independent raters for the presence and topographical distribution of CST‐WD on diffusion‐weighted imaging (DWI). Baseline demographics, hematoma characteristics, ICH score, and admission National Institute of Health Stroke Score (NIHSS) were systematically recorded. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS) and the motor‐NIHSS. Twenty‐seven patients underwent 93 MRIs; 88 of these were serially obtained in the first month. In 13 patients (48%), all with deep ICH, CST‐WD changes were observed after a median of 7 days (interquartile range, 7 to 8) as reduced diffusion on DWI and progressed rostrocaudally along the CST. CST‐WD changes evolved into T2‐hyperintense areas after a median of 11 days (interquartile range, 6 to 14) and became atrophic on MRIs obtained after 3 months. In univariate analyses, the presence of CST‐WD was associated with poor functional outcome (ie, mRS 4 to 6; P=0.046) and worse motor‐NIHSS (5 versus 1, P=0.001) at 3 months. Wallerian degeneration along the CST is common in spontaneous supratentorial ICH, particularly in deep ICH. It can be detected 1 week after ICH on DWI and progresses rostrocaudally along the CST over time. The presence of CST‐WD is associated with poor motor and functional recovery after ICH.