The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics
The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics
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DOI：
10.1016/j.jstrokecerebrovasdis.2017.12.035
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发表时间：
2018-06-01
影响因子：
2.5
通讯作者：
Meyer, Brett C.
中科院分区：
文献类型：
--
作者：
Attenhofer, Kevin S.;Hailey, Lovella;Meyer, Brett C.
简介：急性卒中的快速成像至关重要，通常发生在全面检查之前。早期、可靠的检查结果可明确诊断并缩短治疗时间。DeyeCOM征已被描述为缺血性卒中的预测因子。在这项研究中，我们评估了连续计算机断层扫描的持续DeyeCOM征在预测大血管闭塞中的作用。研究方法：2017年4月至6月期间，我们回顾性审查了来自加州大学圣地亚哥分校中风登记处的46名急性中风患者，他们在急性检查中接受了计算机断层扫描和计算机断层扫描血管造影。DeyeCOM（+）征定义为成像时共轭凝视偏离至少15度。DeyeCOM（++）定义为两次扫描的持续性凝视偏离。结果：观察到三组患者：DeyeCOM（++）、非持续性凝视偏离和无凝视偏离（DeyeCOM（-））。DeyeCOM（++）中的所有患者（8/8，100%）均发生大血管闭塞。在非持续性凝视偏离的患者中，2/7例（29%）有大血管闭塞。DeyeCOM（-）中无患者（0/31，100%）发生大血管闭塞。DeyeCOM（++）对大血管闭塞的特异性和灵敏度分别为100%（置信区间[CI].90-1.0）和80%（CI.44-.97）。DeyeCOM（-）对无大血管闭塞的特异性和敏感性分别为100%（CI. 69 - 1. 0）和86%（CI. 70-. 95）。结论：DeyeCOM（++）对大血管闭塞的特异性为100%，而DeyeCOM（-）对无大血管闭塞的特异性为100%。持续的DeyeCOM，无论是阳性还是阴性，都是最终诊断的有力预测因素，可能导致更快的血管内治疗时间。
Introduction: Rapid imaging in acute stroke is critical and often occurs before full examination. Early, reliable examination findings clarify diagnosis and improve treatment times. The DeyeCOM sign has been described as a predictor of ischemic stroke. In this study, we evaluate a sustained DeyeCOM sign on serial computed tomography scans in prediction of large vessel occlusion. Methods: Between April and June 2017, we retrospectively reviewed 46 patients with acute stroke from the University of California, San Diego Stroke Registry, who had both computed tomography and computed tomography angiography as part of their acute workup. A DeyeCOM(+) sign was defined as a conjugate gaze deviation on imaging of at least 15 degrees. DeyeCOM(++) was defined as sustained gaze deviation on both scans. Results: Three groups of patients were observed: DeyeCOM(++), nonsustained gaze deviation, and no gaze deviation (DeyeCOM(-)). All patients in the DeyeCOM(++) (8 of 8, 100%) had large vessel occlusion. Of those with nonsustained gaze deviation, 2 of 7 (29%) had large vessel occlusion. No patients in the DeyeCOM(-) (0 of 31, 100%) had large vessel occlusion. The specificity and sensitivity of DeyeCOM(++) for large vessel occlusion was 100% (confidence interval [CI].90-1.0) and 80% (CI.44-.97). The specificity and sensitivity of DeyeCOM(-) for absence of large vessel occlusion was 100% (CI.69-1.0) and 86% (CI.70-.95). Conclusions: DeyeCOM(++) had 100% specificity for large vessel occlusion, whereas DeyeCOM(-) had a 100% specificity for absence of large vessel occlusion. Sustained DeyeCOM, whether positive or negative, is a strong predictor of ultimate diagnosis that could lead to quicker endovascular treatment times.