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Clinical Factors associated with Comorbid Cerebral Lesions in Syncope Patients
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Background: The prognosis of syncope is related to the severity of the underlying disease, including cerebral disease, rather than of the syncope itself. The aim of this study was to identify the clinical factors related to the cerebral comorbidity confirmed on brain imaging of syncope patients. Methods: We retrospectively reviewed the medical records of patients who were diagnosed as syncope and underwent brain magnetic resonance [MR] imaging between January 2011 and December 2014. An abnormal MR lesion was defined as the presence of one or more of the following: (1) ischemic lesion, (2) major cerebral artery occlusion or stenosis over 50%, (3) cerebral aneurysm or vascular abnormalities, and (4) other traumatic or parenchymal lesion. The findings of electroencephalography and clinical factors that might be related to abnormal lesions in brain MR images were investigated. Results: Of 347 (mean age 50.5 years, 48.1% females) patients, abnormal imaging findings were observed in 48 (13.8%). The clinical factors related to abnormal findings were age, hypertension, diabetes mellitus, and coronary artery disease. Independent factors for an abnormal MR lesion were age (odds ratio＝1.05, 95% confidence interval [CI] 1.03-1.08, p ＜0.001) and hypertension (odds ratio＝2.73, 95% CI 1.34-5.60, p＝0.006). Abnormal electroencephalography findings were noted in 52 (20.3%) of 256 investigated patients. Generalized or focal slowing was observed more frequently in elderly patients (p＜0.001) and in the presence of abnormal brain MR lesions (p＝0.013). Conclusions: In syncope patients with hypertension or who are elderly, a brain MR image may be helpful for detecting comorbid brain lesions.
Abstract
Background: The prognosis of syncope is related to the severity of the underlying disease, including cerebral disease, rather than of the syncope itself. The aim of this study was to identify the clinical factors related to the cerebral comorbidity confirmed on brain imaging of syncope patients. Methods: We retrospectively reviewed the medical records of patients who were diagnosed as syncope and underwent brain magnetic resonance [MR] imaging between January 2011 and December 2014. An abnormal MR lesion was defined as the presence of one or more of the following: (1) ischemic lesion, (2) major cerebral artery occlusion or stenosis over 50%, (3) cerebral aneurysm or vascular abnormalities, and (4) other traumatic or parenchymal lesion. The findings of electroencephalography and clinical factors that might be related to abnormal lesions in brain MR images were investigated. Results: Of 347 (mean age 50.5 years, 48.1% females) patients, abnormal imaging findings were observed in 48 (13.8%). The clinical factors related to abnormal findings were age, hypertension, diabetes mellitus, and coronary artery disease. Independent factors for an abnormal MR lesion were age (odds ratio＝1.05, 95% confidence interval [CI] 1.03-1.08, p ＜0.001) and hypertension (odds ratio＝2.73, 95% CI 1.34-5.60, p＝0.006). Abnormal electroencephalography findings were noted in 52 (20.3%) of 256 investigated patients. Generalized or focal slowing was observed more frequently in elderly patients (p＜0.001) and in the presence of abnormal brain MR lesions (p＝0.013). Conclusions: In syncope patients with hypertension or who are elderly, a brain MR image may be helpful for detecting comorbid brain lesions.
참고문헌 (34)
- Soteriades ES, "Incidence and prognosis of syncope", N Engl J Med, 347, pp.878~885 (2002)
- Costantino G, "Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study", J Am Coll Cardiol, 51, pp.276~283 (2008)
- Reed MJ, "One-year prognosis after syncope and the failure of the ROSE decision instrument to predict one-year adverse events", Ann Emerg Med, 58, pp.250~256 (2011)
- Quinn J, "Death after emergency department visits for syncope: how common and can it be predicted", Ann Emerg Med, 51, pp.585~590 (2008)
- Colivicchi F, "Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score", Eur Heart J, 24, pp.811~819 (2003)
- Kapoor WN, "A prospective evaluation and follow-up of patients with syncope", N Engl J Med, 309, pp.197~204 (1983)
- Kapoor WN, "Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope", Am J Med, 100, pp.646~655 (1996)
- Giglio P, "Syncope and head CT scans in the emergency department", Emerg Radiol, 12, pp.44~46 (2005)
- Mitsunaga MM, "Journal Club: Head CT scans in the emergency department for syncope and dizziness", Am J Roentgenol, 204, pp.24~28 (2015)
- Dantas FG, "The role of EEG in patients with syncope", J Clin Neurophysiol, 29, pp.55~57 (2012)
- Moya A, "Guidelines for the diagnosis and management of syncope (version 2009)", Eur Heart J, 30, pp.2631~2671 (2009)
- Davidson E, "Transient ischemic attack-related syncope", Clin Cardiol, 14, pp.141~144 (1991)
- Grubb BP, "Neurocardiogenic syncope and related disorders of orthostatic intolerance", Circulation, 111, pp.2997~3006 (2005)
- Ruwald MH, "The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope: a Danish nationwide study", Europace, 14, pp.1506~1514 (2012)
- Ruwald MH, "Prognosis among healthy individuals discharged with a primary diagnosis of syncope", J Am Coll Cardiol, 61, pp.325~332 (2013)
- Fanning JP, "Emerging spectra of silent brain infarction", Stroke, 45, pp.3461~3471 (2014)
- "Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trail Investigators. Stroke outcome and neuroimaging of intracranial atherosclerosis (SONIA): design of a prospective, multicenter trial of diagnostic tests", Neuroepidemiology, 23, pp.23~32 (2004)
- Hirano LA, "Clinical yield of computed tomography brain scans in older general medical patients", J Am Geriatr Soc, 54, pp.587~592 (2006)
- Grossman SA, "The yield of head CT in syncope: a pilot study", Intern Emerg Med, 2, pp.46~49 (2007)
- Pires LA, "Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope", Arch Intern Med, 161, pp.1889~1895 (2001)
- Fanning JP, "The epidemiology of silent brain infarction:a systematic review of population-based cohorts", BMC Med, 12, pp.119~ (2014)
- Windham BG, "Small Brain Lesions and Incident Stroke and Mortality: A Cohort Study", Ann Intern Med, 163, pp.22~31 (2015)
- Bernick C, "Silent MRI infarcts and the risk of future stroke: the cardiovascular health study", Neurology, 57, pp.1222~1229 (2001)
- Abubakr A, "The diagnostic value of EEGs in patients with syncope", Epilepsy Behav, 6, pp.433~434 (2005)
- Dantas FG, "The role of EEG in patients with syncope", J Clin Neurophysiol, 29, pp.55~57 (2012)
- Canzoniero JV, "Unnecessary hospitalization and related harm for patients with low-risk syncope", JAMA Intern Med, 175, pp.1065~1067 (2015)
- Sun BC, "Characteristics and admission patterns of patients presenting with syncope to U.S. emergency departments, 1992-2000", Acad Emerg Med, 11, pp.1029~1034 (2004)
- Brignole M, "A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals", Eur Heart J, 27, pp.76~82 (2006)
- Blanc JJ, "Prospective evaluation and outcome of patients admitted for syncope over a 1 year period", Eur Heart J, 23, pp.815~820 (2002)
- Brignole M, "Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals", Europace, 8, pp.644~650 (2006)
- Baugh CW, "National cost savings from observation unit management of syncope", Acad Emerg Med, 22, pp.934~941 (2015)
- Arenillas JF, "Intracranial atherosclerosis: current concepts", Stroke, 42(1 Suppl), pp.S20~S23 (2011)
- Spence JD, "Asymptomatic carotid stenosis", Circulation, 127, pp.739~742 (2013)
- Thompson BG, "Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association", American Stroke Association, 2015, pp.46, 2368~2400