ELECTROENCEPHALOGRAPHY IMPROVES THE PREDICTION OF FUNCTIONAL OUTCOME IN THE ACUTE STAGE OF CEREBRAL-ISCHEMIA
ELECTROENCEPHALOGRAPHY IMPROVES THE PREDICTION OF FUNCTIONAL OUTCOME IN THE ACUTE STAGE OF CEREBRAL-ISCHEMIA
复制标题
DOI：
10.1161/01.str.25.10.1968
复制
发表时间：
1994-10-01
期刊：
影响因子：
8.3
通讯作者：
VANGIJN, J
中科院分区：
文献类型：
--
作者：
CILLESSEN, JPM;VANHUFFELEN, AC;VANGIJN, J
背景和目的：我们研究了临床和脑电图评估急性首次幕上缺血患者在预测功能outcome.Methods在55例连续入院后，中位数间隔小于24小时，残疾程度分为中度（兰金等级1，2，3）或严重（兰金等级4或5）的价值。根据腔隙性或皮质综合征的体征对临床缺陷进行分类。在不了解临床资料的情况下，根据预测预后良好或不良的结果对脑电图（EEG）进行分类。1年后的结果被评估为良好（兰金3级或以下）或较差（兰金分级4 ~ 5级或死于脑卒中），并与临床资料及急性期脑电图结果进行相关性分析（初始障碍的预测值[PV]，1.00; 95%置信区间[CI]，0.88至1.00）。在25例入院时有严重残疾的患者中，13例发生不良结局（PV，0.52; 95%CI，0.31 - 0.72）。如果根据临床特征对这些基线时有严重残疾的患者进行细分，则腔隙综合征预测5例患者中有4例预后良好（PV，0.80; 95% CI，0.28 - 1.00），但皮质综合征预测20例患者中仅有12例预后不良（PV，0.60; 950/0 CI，0.36 - 0.81）。在20例基线时有严重残疾和皮质综合征的患者中，具有预测良好预后特征的EEG正确预测了7例患者中6例的良好预后（PV，0.86; 95%CI，0.42 - 1.00）。13例患者中有11例患者的EEG具有预测不良预后的特征，正确预测了不良预后（PV，0.85; 95%CI，0.55 ~ 0.98）。结论脑电图可提高对脑缺血急性期严重神经功能缺损患者功能预后的预测。这可能对未来急性卒中干预试验的设计有影响。
Background and Purpose We studied the value of clinical and electroencephalographic assessment in patients with acute first-ever supratentorial ischemia in predicting functional outcome after 1 year.Methods In 55 consecutive patients admitted after a median interval of less than 24 hours, the degree of handicap was dichotomized as moderate (Rankin grade 1, 2, or 3) or severe (Rankin grade 4 or 5). Clinical deficits were categorized according to signs of a lacunar or a cortical syndrome. Without knowledge of clinical data, electroencephalograms (EEGs) were classified according to findings predicting good or poor prognosis. The outcome after 1 year was assessed as good (Rankin grade 3 or less) or poor (Rankin grade 4 or 5 or death from stroke) and was correlated to clinical data and to EEG findings in the acute stage.Results Thirty patients with a moderate handicap on admission all had a good outcome (predictive value [PV] of the initial handicap, 1.00; 95% confidence interval [CI], 0.88 to 1.00). Of the 25 patients with severe handicap on admission a poor outcome occurred in 13 (PV, 0.52; 95% CI, 0.31 to 0.72). If these patients with severe handicap at baseline were subdivided according to clinical features, a lacunar syndrome predicted good outcome in 4 of 5 patients (PV, 0.80; 95% CI, 0.28 to 1.00), but a cortical syndrome predicted poor outcome in only 12 of 20 patients (PV, 0.60; 950/0 CI, 0.36 to 0.81). Of the 20 patients with severe handicap and a cortical syndrome at baseline, an EEG with features predicting a good prognosis correctly predicted good outcome in 6 of 7 patients (PV, 0.86; 95% CI, 0.42 to 1.00). An EEG with features predicting poor prognosis correctly predicted poor outcome in 11 of 13 patients (PV, 0.85; 95% CI, 0.55 to 0.98).Conclusions Electroencephalography improves the prediction of functional outcome in patients with a severe neurological deficit in the acute stage of cerebral ischemia. This may have implications for the design of future intervention trials in acute stroke.