空间占位性小脑梗死的恶性肿胀预测因素

Predictors of malignant swelling in space-occupying cerebellar infarction

Stroke and Vascular Neurology

影响因子:4.9

分区:医学2区 / 临床神经病学2区

发表日期:2025 Jun 30

作者: Enayatullah Baki, Lea Baumgart, Victoria Kehl, Felix Hess, Andreas Wolfgang Wolff, Arthur Wagner, Moritz Roman Hernandez Petzsche, Tobias Boeckh-Behrens, Bernhard Hemmer, Bernhard Meyer, Jens Gempt, Silke Wunderlich

DOI: 10.1136/svn-2024-003360

摘要

恶性肿胀是空间占位性小脑梗死中可能突然发生的致命并发症。我们旨在建立预测小脑梗死恶性肿胀的标志物。我们回顾性分析了2014年至2020年在我院治疗的中风患者资料。恶性肿胀定义为颅后窝的占位效应，伴有意识下降（由脑干受压引起）或阻塞性脑积水的发生。对多变量进行统计分析以识别预测恶性肿胀的因素。在7284名中风患者中，筛选出487例小脑梗死患者。其中93例适合分析，患有空间占位性小脑梗死的患者。33例（35.5%）发生了恶性肿胀。多变量分析显示，梗死体积是最主要的独立预测因素，截断值为38 cm3，超过此体积的患者发生肿胀的概率超过50%（OR=32.0，p<0.001）。入院时的NIHSS（国立卫生研究院中风量表）评分较高（中位数NIHSS 12对4，OR=1.078，p=0.008）和伴有脑干梗死（51.5%对16.7%，OR=5.312，p=0.013）与恶性肿胀的发生相关。在33例恶性肿胀中，13例（39.4%）发生在超过3天后。梗死体积是空间占位性小脑梗死中恶性肿胀的关键预测指标。鉴于许多病例在72小时后发生肿胀，我们建议进行持续的神经系统监测。

Abstract

Malignant swelling is a fatal complication that can occur abruptly in space-occupying cerebellar infarction. We aimed to establish markers that predict malignant swelling in cerebellar infarction.We retrospectively analysed data of stroke patients who were treated in our hospital between 2014 and 2020. Malignant swelling was defined as a mass effect in the posterior cranial fossa, accompanied by a decrease in consciousness due to compression of the brainstem and/or the development of obstructive hydrocephalus. Statistical analyses were performed on multiple variables to identify predictors of malignant swelling.Among 7284 stroke patients, we identified 487 patients with an infarct in the cerebellum. 93 patients were suitable for analysis having space-occupying cerebellar infarction. 33 of 93 (35.5%) patients developed malignant swelling. Multivariable analysis revealed infarct volume as the main predictor being independently associated with the development of malignant swelling with a cut-off infarct volume of 38 cm3 being associated with a swelling rate of >50% (OR 32.0, p<0.001). Higher NIHSS (National Institutes of Health Stroke Scale) score on admission (median NIHSS 12 vs 4, OR 1.078; p=0.008) and the presence of additional brainstem infarction (51.5% vs 16.7%, OR 5.312; p=0.013) were associated with the development of malignant swelling in univariate analyses. 13 of 33 (39.4%) cases of malignant swellings occurred after more than 3 days.Infarct volume was the key significant predictor of malignant swelling in space-occupying cerebellar infarction. With many cases of malignant swelling occurring after more than 72 hours, we advocate prolonged neurological monitoring.