'Malignant' middle cerebral artery territory infarction - Clinical course and prognostic signs
'Malignant' middle cerebral artery territory infarction - Clinical course and prognostic signs
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DOI：
10.1001/archneur.1996.00550040037012
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发表时间：
1996-04-01
影响因子：
--
通讯作者：
vonKummer, R
中科院分区：
文献类型：
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作者：
Hacke, W;Schwab, S;vonKummer, R
背景资料：虽然占位性缺血性中风的临床特点是众所周知的，有有限的前瞻性数据的临床过程中完全大脑中动脉领土梗死和诱发因素导致随后的脑疝和脑death.Methods：完全大脑中动脉领土梗死，定义的计算机断层扫描和血管成像的患者的临床过程进行了评价。采用斯堪的纳维亚卒中量表和格拉斯哥昏迷量表评估患者的初始临床表现。入院后立即进行连续计算机断层扫描，测量中线和透明隔移位，并通过血管造影或多普勒超声获得血管闭塞的存在和位置数据。根据入院时和随访时的临床结果分析时间进程和结局。生存患者的功能状态进行了评估，使用Barthel指数。结果：55例完全大脑中动脉领土梗死所造成的闭塞的远端颅内颈动脉或近端大脑中动脉主干进行了研究。在所有患者中，栓塞性梗死被假定。入院时平均斯堪的纳维亚卒中量表评分为20分，恶化时间为2 - 5天。49名患者在疾病急性期需要呼吸机辅助。仅12例患者（22%）存活。43例患者的死亡原因是小脑幕裂孔疝，随后发生脑死亡。存活者的平均Barthel指数评分为60（范围，45至70）。结论：完全性大脑中动脉区域卒中的预后非常差，可以通过早期临床和神经放射学数据在症状发作后的最初几个小时内进行估计。占位性肿块效应在发病后的最初5天内迅速发展，并可预测。其中43例（78%）患者以疝气为终点。
Background: Although the clinical features of space-occupying ischemic stroke are well known, there are limited prospective data on the clinical course of complete middle cerebral artery territory infarction and on the pre-disposing factors leading to subsequent herniation and brain death.Methods: The clinical course of patients with complete middle cerebral artery territory infarction, defined by computed tomography and vascular imaging, was evaluated. Initial clinical presentation was assessed by the Scandinavian Stroke Scale and the Glasgow Coma Scale. Serial computed tomography with measurement of midline and septum pellucidum shift and data on the presence and location of vascular occlusion by angiography or Doppler ultrasound were obtained directly after admission. Time course and outcome were analyzed with regard to the clinical findings on admission and at follow-up. The functional status of surviving patients was assessed using the Barthel Index.Results: Fifty-five patients with complete middle cerebral artery territory infarction caused by occlusion of either the distal intracranial carotid artery or the proximal middle cerebral artery trunk were studied. In all patients, embolic infarction was presumed. The mean Scandinavian Stroke Scale score on admission was 20, and the time course of deterioration varied between 2 and 5 days. Forty-nine patients required ventilator assistance during the acute stage of disease. Only 12 patients (22%) survived the infarct. The cause of death was transtentorial herniation with subsequent brain death in 43 patients. Survivors had a mean Barthel Index score of 60 (range, 45 to 70).Conclusions: The prognosis of complete middle cerebral artery territory stroke is very poor and can be estimated by early clinical and neuroradiological data within the first few hours after the onset of symptoms. A space-occupying mass effect develops rapidly and predictably over the initial 5 days after presentation. Herniation occurred as an end point in 43 (78%) of these patients.