{"title":"在保守治疗背景下预测自发性幕上脑出血急性期预后的整体神经影像学标准","authors":"O. А. Kozolkin, A. Kuznietsov","doi":"10.14739/2310-1210.2022.5.260450","DOIUrl":null,"url":null,"abstract":"The aim of the study was to develop criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy, taking into consideration the lesion localization in conjunction with neuroimaging parameters of the quantitative severity assessment of the damage to cerebral structures.\nMaterials and methods. Prospective cohort examination of 314 patients in acute period of SSICH on the ground of conservative treatment. Clinical and neurological examination consisted of using the Full Outline of Unresponsiveness coma scale and NIHHS, neuroimaging with the help of computed tomography with detection of SSICH localization, volume of intracranial hemorrhage, secondary intraventricular hemorrhage and midline shift. Disease acute period outcome was evaluated on the 21st day by the Rankin scale.\nResults. It was detected that integrated neuroimaging SSICH’s type considering its localization and quantitative severity estimation of cerebral structure injury was closely associated with the disease acute period outcome on the ground of conservative therapy (χ2 Pearson = 308.6, Р < 0.0001). Thus, mortality rate was the highest in patients with posteromedial type of thalamic hemorrhage (50.0 %), global type of thalamic hemorrhage (91.7 %) and massive type of striatocapsular hemorrhage (89.8 %). Unfavorable functional outcome as the modified Rankin scale score 4–5 on 21st disease day predominated among patients with posterolateral types of thalamic hemorrhage (76.5 %) and striacapsular hemorrhage (64.3 %). Whereas the frequency of favorable outcome was the highest among patients with anterior/dorsal type of thalamic hemorrhage (100.0 %), posteromedial (88.0 %), middle (95.0 %), lateral types of striatocapsular hemorrhage (61.9 %) and lobar (74.5 %) hemorrhage.\nConclusions. Posteromedial type of thalamic hemorrhage, global type of thalamic hemorrhage and massive type of striatocapsular hemorrhage are the predictors of lethal outcome of the acute period of SSIСH on the background of conservative therapy. Criteria for unfavorable short-term functional outcome are posterolateral types of thalamic and striatocapsular hemorrhage, while anterior/dorsal type of thalamic hemorrhage, posteromedial/middle type of striatocapsular hemorrhage and lobar hemorrhage are associated with favorable outcome of the acute period of the disease.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.1000,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Integral neuroimaging criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage on the background of conservative therapy\",\"authors\":\"O. А. Kozolkin, A. Kuznietsov\",\"doi\":\"10.14739/2310-1210.2022.5.260450\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The aim of the study was to develop criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy, taking into consideration the lesion localization in conjunction with neuroimaging parameters of the quantitative severity assessment of the damage to cerebral structures.\\nMaterials and methods. Prospective cohort examination of 314 patients in acute period of SSICH on the ground of conservative treatment. Clinical and neurological examination consisted of using the Full Outline of Unresponsiveness coma scale and NIHHS, neuroimaging with the help of computed tomography with detection of SSICH localization, volume of intracranial hemorrhage, secondary intraventricular hemorrhage and midline shift. Disease acute period outcome was evaluated on the 21st day by the Rankin scale.\\nResults. It was detected that integrated neuroimaging SSICH’s type considering its localization and quantitative severity estimation of cerebral structure injury was closely associated with the disease acute period outcome on the ground of conservative therapy (χ2 Pearson = 308.6, Р < 0.0001). Thus, mortality rate was the highest in patients with posteromedial type of thalamic hemorrhage (50.0 %), global type of thalamic hemorrhage (91.7 %) and massive type of striatocapsular hemorrhage (89.8 %). Unfavorable functional outcome as the modified Rankin scale score 4–5 on 21st disease day predominated among patients with posterolateral types of thalamic hemorrhage (76.5 %) and striacapsular hemorrhage (64.3 %). Whereas the frequency of favorable outcome was the highest among patients with anterior/dorsal type of thalamic hemorrhage (100.0 %), posteromedial (88.0 %), middle (95.0 %), lateral types of striatocapsular hemorrhage (61.9 %) and lobar (74.5 %) hemorrhage.\\nConclusions. Posteromedial type of thalamic hemorrhage, global type of thalamic hemorrhage and massive type of striatocapsular hemorrhage are the predictors of lethal outcome of the acute period of SSIСH on the background of conservative therapy. Criteria for unfavorable short-term functional outcome are posterolateral types of thalamic and striatocapsular hemorrhage, while anterior/dorsal type of thalamic hemorrhage, posteromedial/middle type of striatocapsular hemorrhage and lobar hemorrhage are associated with favorable outcome of the acute period of the disease.\",\"PeriodicalId\":23832,\"journal\":{\"name\":\"Zaporozhye Medical Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.1000,\"publicationDate\":\"2022-11-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Zaporozhye Medical Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14739/2310-1210.2022.5.260450\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zaporozhye Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14739/2310-1210.2022.5.260450","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
本研究的目的是在保守治疗的背景下,考虑病灶定位,结合定量评估脑结构损伤严重程度的神经影像学参数,建立预测自发性幕上脑出血(sich)急性期预后的标准。材料和方法。基于保守治疗的314例sich急性期前瞻性队列研究。临床和神经学检查包括使用无反应性昏迷量表和NIHHS,利用计算机断层扫描检测SSICH定位的神经影像学,颅内出血容量,继发性脑室内出血和中线移位。第21天采用Rankin评分法评价疾病急性期结局。在保守治疗的基础上发现,综合神经影像学诊断的SSICH类型考虑其局限性和脑结构损伤的定量严重程度与疾病急性期结局密切相关(χ2 Pearson = 308.6, Р < 0.0001)。因此,死亡率最高的是后内侧型丘脑出血(50.0%)、整体型丘脑出血(91.7%)和块状纹状囊出血(89.8%)。后外侧型丘脑出血(76.5%)和纹状囊出血(64.3%)以改良Rankin评分4-5分的21天功能预后不良为主。而丘脑前/背侧型出血(100.0%)、后内侧型(88.0%)、中部型(95.0%)、外侧型纹状囊型出血(61.9%)和大叶型出血(74.5%)患者预后良好的频率最高。后内侧型丘脑出血、整体型丘脑出血和大量型纹状囊出血是SSIСH急性期致死性结局的预测因素。不良的短期功能预后的标准是后外侧型丘脑和纹状囊出血,而前/背侧型丘脑出血、后内侧/中间型纹状囊出血和大叶出血与疾病急性期的良好预后相关。
Integral neuroimaging criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage on the background of conservative therapy
The aim of the study was to develop criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy, taking into consideration the lesion localization in conjunction with neuroimaging parameters of the quantitative severity assessment of the damage to cerebral structures.
Materials and methods. Prospective cohort examination of 314 patients in acute period of SSICH on the ground of conservative treatment. Clinical and neurological examination consisted of using the Full Outline of Unresponsiveness coma scale and NIHHS, neuroimaging with the help of computed tomography with detection of SSICH localization, volume of intracranial hemorrhage, secondary intraventricular hemorrhage and midline shift. Disease acute period outcome was evaluated on the 21st day by the Rankin scale.
Results. It was detected that integrated neuroimaging SSICH’s type considering its localization and quantitative severity estimation of cerebral structure injury was closely associated with the disease acute period outcome on the ground of conservative therapy (χ2 Pearson = 308.6, Р < 0.0001). Thus, mortality rate was the highest in patients with posteromedial type of thalamic hemorrhage (50.0 %), global type of thalamic hemorrhage (91.7 %) and massive type of striatocapsular hemorrhage (89.8 %). Unfavorable functional outcome as the modified Rankin scale score 4–5 on 21st disease day predominated among patients with posterolateral types of thalamic hemorrhage (76.5 %) and striacapsular hemorrhage (64.3 %). Whereas the frequency of favorable outcome was the highest among patients with anterior/dorsal type of thalamic hemorrhage (100.0 %), posteromedial (88.0 %), middle (95.0 %), lateral types of striatocapsular hemorrhage (61.9 %) and lobar (74.5 %) hemorrhage.
Conclusions. Posteromedial type of thalamic hemorrhage, global type of thalamic hemorrhage and massive type of striatocapsular hemorrhage are the predictors of lethal outcome of the acute period of SSIСH on the background of conservative therapy. Criteria for unfavorable short-term functional outcome are posterolateral types of thalamic and striatocapsular hemorrhage, while anterior/dorsal type of thalamic hemorrhage, posteromedial/middle type of striatocapsular hemorrhage and lobar hemorrhage are associated with favorable outcome of the acute period of the disease.