Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction
Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction
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DOI：
10.1159/000071121
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发表时间：
2003-01-01
影响因子：
2.9
通讯作者：
Krieger, D
中科院分区：
文献类型：
--
作者：
Barber, PA;Demchuk, AM;Krieger, D
背景。大脑大中动脉缺血性脑卒中伴广泛肿块效应可导致脑疝和神经性死亡。到目前为止，很少有指导方针来帮助患者选择积极的介入治疗，如减压、半颅切除术和/或低温。方法：我们研究了来自7个中心的需要神经危重监护的大MCA梗死患者队列。本分析的目的是评估早期放射学征象对中风发病48小时内随访的计算机断层扫描（CT）征象的应用，以预测30天的死亡率。评估的CT参数包括透明隔水平移位、松果体移位、颞叶完全或部分梗死、额外血管区域受损伤和脑积水的存在。主要结局指标为30天内院内死亡。结果：在201例单独接受常规药物治疗的大MCA梗死患者中，有135例患者在48小时内进行了随访CT扫描。中位年龄为68岁（范围29-99岁），56%为女性，48小时时NIHSS分类中位数为26-30岁。在单变量分析的CT变量中，室间隔移位：5mm，松果体移位：2mm，完全颞叶梗死，累及MCA区域以外，中度或重度脑积水同样预测死亡。调整CT扫描时间的多变量分析显示了以下致命结果的预测因素：房间隔移位5毫米（OR 10.9; 95% CI 3.2-37.6）， 48小时内NIHSS (OR 6.6; 95% CI 2.3-19.3)，以及中动脉区域以外的梗死（OR 4.9; 95% CI 1.6-15.0）。结论：我们确定了早期CT征象在预测颞叶大面积MCA梗死、其他血管区域受损伤和脑积水后死亡中的作用。主要结局指标为30天内院内死亡。结果：在201例单独接受常规药物治疗的大MCA梗死患者中，有135例患者在48小时内进行了随访CT扫描。中位年龄为68岁（范围29-99岁），56%为女性，48小时时NIHSS分类中位数为26-30岁。在单变量分析的CT变量中，室间隔移位：5mm，松果体移位：2mm，完全颞叶梗死，累及MCA区域以外，中度或重度脑积水同样预测死亡。调整CT扫描时间的多变量分析显示了以下致命结果的预测因素：房间隔位移大于或等于5mm (or 10.9; 95% CI 3.2-37.6)， 48小时内NIHSS (or 6.6; 95% CI 2.3-19.3)，以及超出MCA区域的梗死（or 4.9; 95% CI 1.6-15.0）。结论：我们确定了早期CT征象在预测颞叶大面积MCA梗死、其他血管区域受损伤和脑积水后死亡中的作用。主要结局指标为30天内院内死亡。结果：在201例单独接受常规药物治疗的大MCA梗死患者中，有135例患者在48小时内进行了随访CT扫描。年龄中位数为68(范围29 - 99),56%的是女性,和中位数署类别在48 h。26 - 30日在CT变量在单变量分析中,anteroseptal转变:5毫米,松果体转变:2毫米,完整的颞叶梗塞,参与MCA以外的领土,和中度或severeMultivariable分析调整时间CT扫描显示以下预测致命的结果:anteroseptal转变大于或等于和毫米(或10.9;95%可信区间3.2 - -37.6),署在48 h > 20(或6.6;95% CI 2.3-19.3)，以及中动脉区域以外的梗死（OR 4.9; 95% CI 1.6-15.0）。结论：我们确定了早期CT征象在预测颞叶大面积MCA梗死、其他血管区域受损伤和脑积水后死亡中的作用。主要结局指标为30天内院内死亡。结果：在201例单独接受常规药物治疗的大MCA梗死患者中，有135例患者在48小时内进行了随访CT扫描。年龄中位数为68岁（29-99岁），56%为女性，48小时时NIHSS分类中位数为26-30岁。在单变量分析的CT变量中，房间隔移位大于等于5mm，松果体移位大于等于2mm，完全颞叶梗死，累及MCA以外，中度或重度脑积水同样是死亡的预测因素。调整CT扫描时间的多变量分析显示了以下致命结果的预测因素：房间隔位移大于或等于5mm (or 10.9; 95% CI 3.2-37.6)， 48小时内NIHSS (or 6.6; 95% CI 2.3-19.3)，以及超出MCA区域的梗死（or 4.9; 95% CI 1.6-15.0）。结论：我们确定了早期CT征象在预测大面积MCA梗死后死亡中的作用。CT参数前间隔移位（bbbb5 vs小于等于5.5 mm）、松果体移位大于等于2mm、脑积水、颞叶梗死和其他血管区域梗死（如果存在）是致命结果的预测指标。这些CT参数在被认为是决策的可靠标记之前需要进行前瞻性验证。版权所有(C) 2003 S. Karger AG，巴塞尔。
Background. Large middle cerebral artery (MCA) ischaemic stroke when associated with extensive mass effect can result in brain herniation and neurological death. As yet there are few guidelines to aid the selection of patients for aggressive interventional therapies, such as decompression hemicraniectomy and/or hypothermia. Methods: We studied a cohort of patients from seven centres with large MCA infarction requiring neurocritical care. The purpose of this analysis was to assess the use of early radiological signs on follow-up computed tomographic (CT) signs performed within 48 h of stroke onset for predicting mortality at 30 days. The CT parameters assessed included horizontal displacement of the septum pellucidum, pineal shift, complete or partial infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. Results: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift :5 mm, pineal shift :2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severe hydrocephalus were equally predictive of death. Multivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift 5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). Conclusions: We identified the role of early CT signs in predicting death following massive MCA infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. Results: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift :5 mm, pineal shift :2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severe hydrocephalus were equally predictive of death. Multivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift greater than or equal to5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). Conclusions: We identified the role of early CT signs in predicting death following massive MCA infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. Results: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift :5 mm, pineal shift :2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severeMultivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift greater than or equal to5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). Conclusions: We identified the role of early CT signs in predicting death following massive MCA infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. Results: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift greater than or equal to5 mm, pineal shift greater than or equal to2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severe hydrocephalus were equally predictive of death. Multivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift greater than or equal to5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). Conclusions: We identified the role of early CT signs in predicting death following massive MCA infarction. The CT parameters anteroseptal shift (>5 versus less than or equal to5 5 mm), pineal shift greater than or equal to2 mm, hydrocephalus, temporal lobe infarction, and other vascular territory infarction if present were predictive of fatal outcome. These CT parameters require prospective validation before they should be considered reliable markers for decision-making. Copyright (C) 2003 S. Karger AG, Basel.