Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke.
Prognostic Significance of Infarct Size and Location: The Case of Insular Stroke.
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DOI：
10.1038/s41598-018-27883-3
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发表时间：
2018-06-22
影响因子：
4.6
通讯作者：
Urra X
中科院分区：
文献类型：
--
作者：
Laredo C;Zhao Y;Rudilosso S;Renú A;Pariente JC;Chamorro Á;Urra X
不同部位中风的预后相关性存在争议。例如，岛叶性中风与死亡率增加有关，但这种关联可能反映了其更严重的程度。在两个独立的幕上缺血性卒中患者队列（n = 90和105）中，我们使用体积控制前后基于体素的病变-症状映射研究了病变大小和位置的预后后果，这更好地解释了总病变体积。影响小脑的卒中比非岛叶卒中大（两个队列中28 vs 2cc和25 vs 3cc，p < 0.001）。在容量控制前（4014体素）和容量控制后（1378体素），许多幕上区域（主要在左半球），包括小脑幕，与两个队列中的不良功能结局相关，而与死亡的相关性在容量控制后大大降低（从8716到325体素）。探索性分析表明，病变体积量化方法、美国国立卫生研究院卒中量表半球偏倚和患者选择可能导致特定脑病变与结局之间存在错误关联。总之，卒中后第一个月内的死亡主要由大梗死体积解释，而特定幕上结构的病变（主要在左半球）也导致功能结局不良。
The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0.001 in both cohorts). A number of supratentorial areas (mainly in the left hemisphere), including the insula, were associated with poor functional outcome in both cohorts before (4014 voxels) and after volume control (1378 voxels), while the associations with death were greatly reduced after volume control (from 8716 to 325 voxels). Exploratory analyses suggested that the method of lesion volume quantification, the National Institutes of Health Stroke Scale hemispheric bias and patient selection can result in false associations between specific brain lesions and outcomes. In conclusion, death in the first months after stroke is mainly explained by large infarct volumes, whereas lesions of specific supratentorial structures, mostly in the left hemisphere, also contribute to poor functional outcomes.
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