占位性小脑梗死的恶性肿胀预测指标
Predictors of malignant swelling in space-occupying cerebellar infarction
影响因子:4.90000
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
摘要
恶性肿胀是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。回顾性分析了2014年至2020年在我院治疗的卒中患者数据。恶性肿胀定义为后颅窝的肿块效应，伴随脑干受压导致意识下降和/或阻塞性脑积水的发生。对多变量进行了统计分析，以识别恶性肿胀的预测因素。在7284例卒中患者中，筛选出487例小脑梗死患者。其中93例符合占位性小脑梗死的分析标准，33例（35.5%）发生了恶性肿胀。多变量分析显示，梗死体积是主要独立预测因素，且当梗死体积超过38立方厘米时，发生肿胀的概率超过50%（比值比OR=32.0，p<0.001）。入院时的NIHSS（国家卫生研究院卒中量表）评分越高（中位NIHSS 12对4，OR=1.078，p=0.008）以及伴有脑干梗死者（51.5%对16.7%，OR=5.312，p=0.013）与恶性肿胀的发生相关。13例（39.4%）的恶性肿胀在发病超过3天后发生。梗死体积是占位性小脑梗死中恶性肿胀的关键预测因素。鉴于许多病例在发病72小时后发生肿胀，建议延长神经监测时间。
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.