Aetiopathogenesis and long-term outcome of isolated pontine infarcts
Aetiopathogenesis and long-term outcome of isolated pontine infarcts
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DOI：
10.1007/s00415-005-0639-9
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发表时间：
2005-02-01
影响因子：
6
通讯作者：
Vassilopoulos, D
中科院分区：
文献类型：
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作者：
Vemmos, KN;Spengos, K;Vassilopoulos, D
背景和目的孤立性脑桥中风会引起特征性神经系统综合征，并且短期预后良好。本研究的目的是研究不同病因的孤立性脑桥梗死患者的长期生存率、累积复发率和临床障碍。方法对100例经影像学检查确诊的孤立性桥脑梗死患者进行前瞻性评价。经过广泛的研究，根据发病机制将病例分为基底动脉分支疾病（BABD）、小动脉疾病（SAD）和大动脉闭塞性疾病（LAOD）。在平均46个月的随访期内，对卒中表现和初始病程、早期和长期死亡率、残疾和复发进行了评价。结果单纯桥脑缺血的病因以BABD最多见（43%），其次为SAD（34%）和LAOD（21%）。高血压是最突出的危险因素，特别是在SAD患者中（94.1%）。入院时神经功能损害在LAOD组更严重，其次是BABD。1个月后，LAOD患者的累积死亡率最高（14.3%，p= 0.026），残疾更严重（61.1%，p= 0.001）。SAD组、BABD组和LAOD组的5年死亡率分别为20.6%、14%和23.8%（p= 0.776）。BABD、LAOD和SAD的累积5年复发率分别为2.3%、14.3%和29.4%（p= 0.011）。结论孤立性桥脑梗死患者总体长期生存率较好。不同病因的梗死的短期预后的最初差异随着时间的推移而消退。SAD患者中有效的二级预防可能会限制卒中复发并对长期预后产生积极影响。
Background and purpose Isolated pontine strokes cause characteristic neurological syndromes and have a good short-term prognosis. The aim of this study was to examine the long-term survival, cumulative recurrence rate and clinical handicap of patients with isolated pontine infarcts of different aetiology. Methods One hundred consecutive patients with an isolated pontine infarction were identified by imaging studies and evaluated prospectively. After extensive study, cases were classified according to the aetiopathogenetic mechanisms: stroke due to basilar artery branch disease (BABD), small-artery disease ( SAD) and large-artery-occlusive disease (LAOD). During a mean follow-up period of 46 months, stroke presentation and initial course, early and long-term mortality, disability and recurrence were evaluated. Results BABD was the most frequent cause of isolated pontine ischaemia (43%), followed by SAD (34%) and LAOD (21%). Hypertension was the most prominent risk factor, especially among patients with SAD (94.1%). Neurological impairment on admission was more severe in the LAOD group, followed by BABD. After 1 month patients with LAOD had the highest cumulative mortality (14.3%, p= 0.026) and more severe disability (61.1%, p= 0.001). Five-year mortality rate was 20.6%, 14% and 23.8% in the SAD-, BABD- and in LAOD-group respectively ( p= 0.776). Cumulative 5-year recurrence rate was 2.3% for BABD, 14.3% for LAOD, and 29.4% for SAD ( p= 0.011). Conclusions Overall long-term survival of patients with isolated pontine infarcts is good. Initial differences regarding short-term outcome in infarctions of different aetiology resolve with time. Effective secondary prevention among SAD patients may limit stroke recurrence and positively influence long-term prognosis.