Sudden neurologic death masquerading as out-of-hospital sudden cardiac death
Sudden neurologic death masquerading as out-of-hospital sudden cardiac death
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DOI：
10.1212/wnl.0000000000003238
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发表时间：
2016-10-18
期刊：
影响因子：
9.9
通讯作者：
Tseng, Zian H.
中科院分区：
文献类型：
--
作者：
Kim, Anthony S.;Moffatt, Ellen;Tseng, Zian H.
目的：了解医院外神经系统猝死的发生率及其危险因素。方法：在旧金山心脏猝死死后系统调查研究的前25个月(2011年2月1日至2013年3月1日)，通过对连续院外死亡的主动监测，获取突发的WHO标准心脏性猝死(SCDS)，并依法向法医报告。所有病例都进行了全面尸检，并对心脏和颅顶、毒理学和组织学进行了详细检查。结果：在352例突发事件中，335例(95%)接受了包括完整尸检在内的系统评估。335例中神经系统猝死18例(5.4%)，占121例非心源性猝死的14.9%(平均年龄60.6岁[SD17.6，范围27-87]；女性占67.7%)。在男性和白人参与者中，与非神经性SCD相比，神经性猝死的风险较低(p<；0.01)。神经系统原因包括颅内出血(8例)、癫痫猝死(6例，其中2例为幼年型肌阵挛癫痫)、动脉瘤性蛛网膜下腔出血(2例)、急性缺血性卒中(1例)、亨廷顿病误吸(1例)。大多数死亡病例(16例；89%)在发病时出现心搏停止(17例；94%)。既往卒中/短暂性脑缺血发作与卒中风险无关(优势比[OR]1.4[95%可信区间(CI)0.18~11.8]，p=0.73)，但抗血栓药物使用与卒中风险相关(OR 3.9[95%1.01~15.5]，p=0.05)。结论：神经性猝死是院外明显SCDS的重要原因。普遍的低尸检率可能导致对明显的SCD的系统性错误分类和低估神经性猝死的发生率。
Objective: To characterize the frequency of and risk factors for out-of-hospital sudden neurologic deaths.Methods: During the initial 25 months (February 1, 2011-March 1, 2013) of the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study, we captured incident WHO criteria sudden cardiac deaths (SCDs) through active surveillance of consecutive out-of-hospital deaths, which must be reported to the medical examiner by law. All cases were referred for full autopsy with detailed examination of the heart and cranial vault, toxicology, and histology. A multidisciplinary committee adjudicated a final cause of death.Results: Of 352 incident SCDs, 335 (95%) underwent systematic evaluation including full autopsy. Of these 335 cases, 18 (5.4%) were sudden neurologic deaths (mean age 60.6 years [SD 17.6, range 27-87]; 67.7% female), which accounted for 14.9% of the 121 noncardiac sudden deaths. The risk of sudden neurologic death compared to non-neurologic SCD was lower in male and white participants (p < 0.01). Neurologic causes included intracranial hemorrhage (8), sudden unexpected death in epilepsy (6, including 2 with juvenile myoclonic epilepsy), aneurysmal subarachnoid hemorrhage (2), acute ischemic stroke (1), and aspiration from Huntington disease (1). Most deaths were unwitnessed (16; 89%) with asystole at presentation (17; 94%). Prior stroke/TIA was not associated with risk of stroke (odds ratio [OR] 1.4 [95% confidence interval (CI) 0.18-11.8], p = 0.73), but antithrombotic medication use was (OR 3.9 [95% 1.01-15.5], p = 0.05).Conclusions: Sudden neurologic death is an important cause of out-of-hospital apparent SCDs. Low prevailing autopsy rates may result in systematic misclassification of apparent SCDs and underestimation of the incidence of sudden neurologic death.