Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis - regional and volumetric analysis in a multi-centre cohort.
Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis - regional and volumetric analysis in a multi-centre cohort.
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DOI：
10.1186/s12883-022-02926-5
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发表时间：
2022-11-07
期刊：
影响因子：
2.6
通讯作者：
Michael, B. D.
中科院分区：
文献类型：
--
作者：
Alam, A. M.;Chen, J. P. K.;Wood, G. K.;Facer, B.;Bhojak, M.;Das, K.;Defres, S.;Marson, A.;Granerod, J.;Brown, D.;Thomas, R. H.;Keller, S. S.;Solomon, T.;Michael, B. D.
急性脑炎综合征（AES）患者的癫痫发作可不可预测地发生，并且许多患者的长期神经系统后遗症较差。建立与急性发作风险和不良结果相关的因素可以支持临床护理。我们的目的是通过磁共振成像（MRI）对AES患者的脑水肿进行区域和体积分析。我们评估了脑水肿与急性发作活动和长期神经预后的关系。在一项多中心队列研究中，在英国招募了出现AES的成人和儿童。回顾性分析临床及脑MRI资料。结果变量为出院后6个月住院患者急性发作活动和神经功能障碍。不良预后定义为格拉斯哥预后评分（GOS）为1-3。我们通过独立和盲法评估的既定方法，通过对t2加权图像进行立体检查，量化MRI上的区域脑水肿。通过多变量logistic回归分析临床和神经影像学变量，评估其与急性发作活动和预后的相关性。研究队列包括69例患者（平均年龄31.8岁，53.6%为女性），其中41例（59.4%）住院时患有急性癫痫发作。入院时较高的格拉斯哥昏迷评分（GCS）是癫痫发作的阴性预测因子（OR 0.61 [0.46-0.83], p = 0.001）。即使在入院时对GCS进行校正，皮质水肿的存在也是急性癫痫发作活动的重要危险因素（OR 5.48 [1.62-18.51], p = 0.006），这些皮质结构中较大的脑水肿体积增加了急性癫痫发作的风险（OR 1.90 [1.12-3.21], p = 0.017）。出院后6个月，21例（30.4%）神经系统预后较差。单因素分析显示，单纯疱疹病毒性脑炎与不良预后的高风险相关（OR 3.92 [1.08-14.20], p = 0.038）。在控制病因后，脑水肿体积增加是6个月时不良神经预后的独立危险因素（OR 1.73 [1.06-2.83], p = 0.027）。AES患者的核磁共振成像显示脑水肿的存在和程度可能有助于识别有急性发作活动和随后长期发病风险的患者。在线版本包含补充材料，可在10.1186/s12883-022-02926-5获得。
Seizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and volumetric analysis of cerebral oedema on magnetic resonance imaging (MRI) in patients with AES. We assessed the relationship of brain oedema with acute seizure activity and long-term neurological outcome. In a multi-centre cohort study, adults and children presenting with an AES were recruited in the UK. The clinical and brain MRI data were retrospectively reviewed. The outcomes variables were inpatient acute seizure activity and neurological disability at six-months post-discharge. A poor outcome was defined as a Glasgow outcome score (GOS) of 1–3. We quantified regional brain oedema on MRI through stereological examination of T2-weighted images using established methodology by independent and blinded assessors. Clinical and neuroimaging variables were analysed by multivariate logistic regression to assess for correlation with acute seizure activity and outcome. The study cohort comprised 69 patients (mean age 31.8 years; 53.6% female), of whom 41 (59.4%) had acute seizures as inpatients. A higher Glasgow coma scale (GCS) score on admission was a negative predictor of seizures (OR 0.61 [0.46–0.83], p = 0.001). Even correcting for GCS on admission, the presence of cortical oedema was a significant risk factor for acute seizure activity (OR 5.48 [1.62–18.51], p = 0.006) and greater volume of cerebral oedema in these cortical structures increased the risk of acute seizures (OR 1.90 [1.12–3.21], p = 0.017). At six-month post-discharge, 21 (30.4%) had a poor neurological outcome. Herpes simplex virus encephalitis was associated with higher risk of poor outcomes in univariate analysis (OR 3.92 [1.08–14.20], p = 0.038). When controlling for aetiology, increased volume of cerebral oedema was an independent risk factor for adverse neurological outcome at 6 months (OR 1.73 [1.06–2.83], p = 0.027). Both the presence and degree of cerebral oedema on MRIs of patients with AES may help identify patients at risk of acute seizure activity and subsequent long-term morbidity. The online version contains supplementary material available at 10.1186/s12883-022-02926-5.
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