中风变色龙静脉溶栓的排除标准：一项观察性研究。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2024-11-07 DOI:10.1016/j.jocn.2024.110913

Alejandro M. Brunser , Pablo M. Lavados , Paula Muñoz-Venturelli , Verónica V. Olavarría , Eloy Mansilla , Gabriel Cavada , Maria Elena Trejo , Pablo E. González

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引用次数: 0

摘要

背景：中风变色龙（SC）通常在病程中被诊断得太晚，无法从急诊室（ER）的静脉溶栓（IVT）治疗中获益。目前仍不清楚这类患者中有多大比例适合接受静脉溶栓治疗。我们试图确定有静脉溶栓禁忌症的 SC 患者的比例，并明确这些禁忌症是什么：方法：我们对 2014 年 12 月至 2023 年 10 月期间在智利圣地亚哥一家中心急诊室就诊的所有连续 SC 患者进行了评估：共评估了 1193 名 S 患者，其中 63 人（5.2%，95 %CI 4.1-6.6）被诊断为 SC（平均年龄为 59 ± 21.3 岁，32 人（50.7%）为女性）。NIHSS 中位数为 1（IQR 1-3），50 名（79.3%）患者的 NIHSS ≤ 3。在 63 名 SC 患者中，14 人（22.2%）被确定为 IVT 候选者。在其余 49 名患者中，有 71 项 IVT 禁忌症：28 名患者有 1 项禁忌症，20 名患者有 2 项禁忌症，1 名患者有 3 项禁忌症。最常见的禁忌症是 31 名患者（49.2%）没有 NIHSS 可测量的缺陷或非常轻微的缺陷。其次是处于溶栓治疗窗口期之外，有 30 名患者（47.6%）属于这种情况。14名患者（22.2%）同时存在这两种禁忌症。SC患者在急诊室就诊时最常见的错误诊断是代谢性脑病（11例，17.4%）、癫痫发作（9例，14.2%）和偏头痛（7例，11.2%）：三分之二以上的 SC 患者在急诊室就诊时存在 IVT 禁忌症。最常见的禁忌症包括 NIHSS 无法测量的功能障碍、极轻微的功能障碍以及超出治疗窗口期。

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Exclusion criteria for intravenous thrombolysis in stroke Chameleons: An observational study

Background

Stroke chameleons (SC), are often diagnosed too late in their course to benefit from intravenous thrombolysis (IVT) treatment in the Emergency Room (ER). It remains unclear what proportion of this patient population would be a candidate for IVT. We sought to identify the proportion of SC patients with contraindications to IVT and to delineate what those contraindications are.

Methods

All consecutive SC patients who presented to the ER at a single center in Santiago Chile were evaluated between December 2014 and October 2023.

Results

A total of 1193 S patients were evaluated, of which sixty-three (5.2 %, 95 %CI 4.1–6.6) were diagnosed as SC (mean age 59 ± 21.3 years, 32 (50.7 %) women). The median NIHSS was 1 (IQR 1–3) and 50 (79.3 %) patients had an NIHSS ≤ 3. Of the 63 SC patients, 14 (22.2 %) were determined to be IVT candidates. In the remaining 49 patients, 71 contraindications for IVT were present: 28 patients had 1 contraindication, 20 patients had 2 contraindications, and 1 patient had 3 contraindications. The most common contraindication was absence of deficits measurable by NIHSS or very mild deficits in 31 (49.2 %) patients. This was followed by being outside of the therapeutic window for thrombolysis in 30 (47.6 %) patients. Both of these contraindications were present in 14 (22.2 %) patients. The most common erroneous diagnoses that SC patients received on presentation the ER were metabolic encephalopathy (11, 17.4 %), seizure disorder (9, 14.2 %), and migraine (7, 11.2 %).

Conclusions

More than two thirds of SC patients presented to the ER with contraindications to IVT. The most frequent contraindications included deficits not measurable by NIHSS, extremely mild deficits, and being out of therapeutic window.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.