|
|
|
| Predictive value of the ratio of cerebral infarction on cerebral hernia formation in patients with large area cerebral infarction |
| DU Xiaoyan1，2 LIU Qingjun1，2 ZHAO Libo1，2，3 GONG Hongmin1，2 WU Lin1，2 WEI Jing1，2 TAN Qing1，2 ZHAO Rui1，2 |
1.Department of Neurology, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China;
2.Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing 402160, China;
3.Department of Neurology, the Third People′s Hospital of Chongqing City, Chongqing 400010, China |
|
|
|
Abstract Objective To assess predictive value of the ratio of cerebral infarction on cerebral hernia formation in patients with large area cerebral infarction. Methods The clinical data of 71 patients with massive cerebral infarction hospitalized in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2017 to January 2019 were retrospectively analyzed. They were divided into brain hernia group (17 cases) and non brain hernia group (54 cases) according to the formation of brain hernia. Single factor and binary logistic regression analysis were carried out for clinical data and imaging data. ROC curve was used to evaluate the diagnosis effect and find the best predictive value. Results Clinical data between two groups was not statistically significant (P > 0.05). The volume of cerebral infarction, the proportion of cerebral infarction and the buffer volume of cerebral hernia group were larger than those of non cerebral hernia group, the differences were statistically significant (P < 0.05). There were no significant differences in volume of brain tissue and cranial cavity between two groups (P > 0.05). The proportion of cerebral infarction was an independent risk factor for the formation of cerebral hernia in patients with massive cerebral infarction (OR = 7.749, 95%CI: 1.539-38.284, P ＜ 0.05). The proportion of cerebral infarction and the area under the volume curve of cerebral infarction was 0.818 and 0.808 respectively. When the proportion of cerebral infarction was 21%, it was the best turning point, the sensitivity was 77%, and the specificity was 76%. Conclusion The cerebral infarction proportion is an independent risk factor for the formation of cerebral hernia in patients with massive cerebral infarction, which provides a certain predictive value for judging the formation of cerebral hernia.
|
|
|
|
|
|
[1] Naghavi M，Abajobir AA，Abbafati C，et al. Global，regional，and national age-sex specific mortality for 264 causes of death，1980-2016：a systematic analysis for the Global Burden of Disease Study 2016 [J]. Lancet，2017，390（10100）：1151-1210.
[2] Mozaffarian D，Benjamin EJ，Go AS，et al. Executive summary：heart disease and stroke statistics—2016 update：a report from the American Heart Association [J]. Circulation，2016，127（1）：143-152.
[3] Thomalla G，Hartmann F，Juettler E，et al. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset：a prospective multicenter observational study [J]. Ann Neurol，2010，68（4）：435-445.
[4] Minnerup J，Wersching H，Ringelstein EB，et al. Prediction of malignant middle cerebral artery infarction using computed tomography-based intracranial volume reserve measurements [J]. Stroke，2011，42（12）：3403-3409.
[5] Oppenheim C，Samson Y，Manai R，et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging [J]. Stroke，2000，31（9）：2175-2181.
[6] 车旭东，何朝晖.蛛网膜下腔出血后脑萎缩与认知功能障碍相关性研究进展[J].重庆医科大学学报，2016，41（8）：869-872.
[7] Goto Y，Kumura E，Watabe T，et al. Prediction of malignant middle cerebral artery infarction in elderly patients [J]. J Stroke Cerebrovasc Dis，2016，25（6）：1389-1395.
[8] 中华医学会神经病学分会神经重症协作组，中国医师协会神经内科医师分会神经重症专委会.大脑半球大面积梗死监护与治疗中国专家共识[J].中华医学杂志，2017， 97（9）：645-652.
[9] Sims JR，Gharai LR，Schaefer PW，et al. ABC/2 for rapid clinical estimate of infarct，perfusion，and mismatch volumes [J]. Neurology，2009，72（24）：2104-2110.
[10] Huttner HB，Schwab S. Malignant middle cerebral artery infarction：clinical characteristics，treatment strategies，and future perspectives [J]. Lancet Neurol，2009，8（10）：949-958.
[11] Heiss WD. Malignant MCA infarction：pathophysiology and imaging for early diagnosis and management decisions [J]. Cerebrovasc Dis，2016，41（1/2）：1-7.
[12] Su Y，Fan L，Zhang Y，et al. Improved neurological outcome with mild hypothermia in surviving patients with massive cerebral hemispheric infarction [J]. Stroke，2016， 47（2）：457.
[13] Stokum JA，Gerzanich V，Simard JM. Molecular pathophysiology of cerebral edema [J]. J Cerebr Blood F Met，2016，36（3）：513-538.
[14] Kauw F，Bennink E，de Jong HWAM，et al. Intracranial cerebrospinal fluid volume as a predictor of malignant middle cerebral artery infarction [J]. Stroke，2019.[Epub ahead of print].
[15] Beck C，Kruetzelmann A，Forkert ND，et al. A simple brain atrophy measure improves the prediction of malignant middle cerebral artery infarction by acute DWI lesion volume [J]. J Neurol，2014，261（6）：1097-1103.
[16] Bektas H，Wu TC，Kasam M，et al. Increased blood-brain barrier permeability on perfusion CT might predict malignant middle cerebral artery infarction [J]. Stroke，2010，41（11）：2539-2544.
[17] Copen WA，Yoo AJ，Rost NS，et al. In patients with suspected acute stroke，CT perfusion-based cerebral blood flow maps cannot substitute for DWI in measuring the ischemic core [J]. PLoS One，2017，12（11）：e0188891.
[18] Bongiorni GT，Hockmuller MCJ，Klein C，et al. Decompressive craniotomy for the treatment of malignant infarction of the middle cerebral artery：mortality and outcome [J]. Arq Neuropsiquiatr，2017，75（7）：424-428.
[19] Shah A，Almenawer S，Hawryluk G. Timing of decompressive craniectomy for ischemic stroke and traumatic brain injury：a review [J]. Front Neurol，2019，10：11.
[20] Dasenbrock HH，Robertson FC，Vaitkevicius H，et al. Timing of decompressive hemicraniectomy for stroke：a nationwide inpatient sample analysis [J]. Stroke，2017，48（3）：704-711. |
|
|
|
