단독 전대뇌동맥 뇌경색의 예후와 예후인자
Outcome and Prognostic Factor of Isolated Anterior Cerebral Artery Territory Infarction
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Background: Isolated anterior cerebral artery (ACA) territory infarction is uncommon and there have been no prospective out-come studies in Korea. Methods: From September 2004 to August 2005, patients with isolated ACA territory infarction ad-mitted within 7 days of symptom onset from 4 university hospitals were collected prospectively. We analyzed clinical and lab-oratory characteristics, stroke subtypes, stroke severity, and medical complications by a predetermined protocol. The out-come was measured by the modified Rankin Scale (mRS) at 3-months after stroke onset and classified as good (mRS score of 0 to 3) or poor (mRS score of 4 to 6) outcome. Results: Thirty-seven (2.9%) patients were identified to have isolated ACA ter-ritory infarction among 1,254 patients with acute ischemic stroke. Mean age was 67 years (range 45 to 83) and female were 22 (59%). Stroke subtypes were large-artery atherosclerosis in 57%, cardioembolism in 22%, undetermined in 19%, and small-vessel occlusion in 3%. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 4 (range 0 to 28). Neurological progression was developed in 9 patients (24%) and medical complications in 13 patients (35%). At 3 months after the stroke onset, 27 patients (72%) showed good outcome and 10 patients (27%) showed poor outcome. On univariate a-nalysis, medical complication, and NIHSS scores at admission were significantly associated with good outcome. Multivar-iate analysis revealed NIHSS scores at admission was independent predictor of functional outcome at 3 months. Conclusion: The overall prognosis of isolated ACA infarction was favorable and NIHSS scores at admission were important prognostic factor. (Korean J Stroke 2009;11:19-24)
Abstract
Background: Isolated anterior cerebral artery (ACA) territory infarction is uncommon and there have been no prospective out-come studies in Korea. Methods: From September 2004 to August 2005, patients with isolated ACA territory infarction ad-mitted within 7 days of symptom onset from 4 university hospitals were collected prospectively. We analyzed clinical and lab-oratory characteristics, stroke subtypes, stroke severity, and medical complications by a predetermined protocol. The out-come was measured by the modified Rankin Scale (mRS) at 3-months after stroke onset and classified as good (mRS score of 0 to 3) or poor (mRS score of 4 to 6) outcome. Results: Thirty-seven (2.9%) patients were identified to have isolated ACA ter-ritory infarction among 1,254 patients with acute ischemic stroke. Mean age was 67 years (range 45 to 83) and female were 22 (59%). Stroke subtypes were large-artery atherosclerosis in 57%, cardioembolism in 22%, undetermined in 19%, and small-vessel occlusion in 3%. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 4 (range 0 to 28). Neurological progression was developed in 9 patients (24%) and medical complications in 13 patients (35%). At 3 months after the stroke onset, 27 patients (72%) showed good outcome and 10 patients (27%) showed poor outcome. On univariate a-nalysis, medical complication, and NIHSS scores at admission were significantly associated with good outcome. Multivar-iate analysis revealed NIHSS scores at admission was independent predictor of functional outcome at 3 months. Conclusion: The overall prognosis of isolated ACA infarction was favorable and NIHSS scores at admission were important prognostic factor. (Korean J Stroke 2009;11:19-24)
참고문헌 (35)
- Bogousslavsky J, "Anterior cerebral artery territory infarction in the Lausanne stroke registry. Clinical and etiologic patterns", Arch Neurol, 47, pp.144~150 (1990)
- Kumral E, "Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings", Eur J Neurol, 9, pp.615~624 (2002)
- 이병철, "한림 뇌졸중 등록 자료를 통한 1,129명의 급성 뇌졸중 환자의 임상 양상", 대한뇌졸중학회지, 1(1), pp.21~27 (1999), 대한뇌졸중학회
- 강석윤, "전뇌동맥 영역의 뇌경색;원인 및 임상증상과 방사선과적 소견의 상관관계에 대한 연구", 대한뇌졸중학회지, 3(1), pp.47~59 (2001), 대한뇌졸중학회
- Kang SY, "Anterior cerebral artery infatction: stroke mechanism and clinical-imaging study in 100 patients", Neurology, 70, pp.2386~2393 (2008)
- Silver FL, "Early mortality following stroke: a prospective review", Stroke, 15, pp.492~496 (1984)
- Bounds JV, "Mechanisms and tim-ing of deaths from cerebral infarction", Stroke, 12, pp.474~477 (1981)
- Johnston KC, "Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators", Stroke, 29, pp.447~453 (1998)
- Dromerick A, "Medical and neurological complications during inpatient stroke rehabilitation", Stroke, 25, pp.358~361 (1994)
- Langhorne P, "Medical complications after stroke: a multicenter study", Stroke, 31, pp.1223~1229 (2000)
- McClatchie G, "Survey of the rehabilitation outcome of strokes", Med J Aust, 1, pp.649~651 (1980)
- Daveport RJ, "Complications after acute stroke", Stroke, 27, pp.415~420 (1996)
- Kalra L, "Medical complications during stroke rehabilitation", Stroke, 26, pp.990~994 (1995)
- Hong KS, "Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke", Eur J Neurol, 15, pp.1324~1331 (2008)
- Gacs G, "Occurence and mechanisms of occlusion of the anterior cerebral artery", Stroke, 14, pp.952~959 (1983)
- Brust JCM, "Anterior cerebral artery disease, In Stroke pathophysiology, diagnosis, and management", pp.401~425 (1998), Churchill Livingstone
- Kazui S, "A clinical study of patients of cerebral infarction localized in the territory of anterior cerebral artery", Jpm J Stroke, 9, pp.317~324 (1987)
- Kazui S, "Angiographic evaluation of brain infarction limited to the anterior cerebral artery territory", Stroke, 24, pp.549~553 (1993)
- Howward G, "Community Hospital-based Stroke Program: North Carolina, Oregon, and New York. III. Factors influencing survival after stroke: proportional hazards analysis of 4219 patients", Stroke, 17, pp.294~299 (1986)
- Chambers BR, "Prognosis of acute stroke", Neurology, 37, pp.221~225 (1987)
- Bamford J, "Classification and natural history of clinically identifiable subtypes of cerebral infarction", Lancet, 337, pp.1521~1526 (1991)
- Anderson CS, "Predicting survival for 1 year among different subtypes of stroke. Results from the Perth Community Stroke Study", Stroke, 25, pp.1935~1994 (1994)
- Tatemichi TK, "Dementia after stroke is a predictor of long-term survival", Stroke, 25, pp.1915~1919 (1994)
- Chamorro A, "Early prediction of stroke severity. Role of the erythrocyte sedimentation rate", Stroke, 26, pp.573~576 (1995)
- Ebrahim S, "Stroke epidemiology, evidence, and clinical practice, 2nd ed", pp.217~228 (1999), Oxford University Press
- Jung WY, "The longterm prognostic factors after acute cerebral infarction", J Korean Neurol Assoc, 13, pp.806~814 (1995)
- Allen CM, "Predicting the outcome of acute stroke: a prognostic score", J Neurol Neurosurg Psychiatry, 47, pp.475~480 (1984)
- Hénon H, "Early predictors of deaths and disability after acute cere-bral ischemic event", Stroke, 26, pp.392~398 (1995)
- Heir DB, "Deriving clinical prediction rules from stroke outcome research", Stroke, 22, pp.1431~1436 (1991)
- Giaquinto S, "EEG recordings in the course of recovery from stroke", Stroke, 25, pp.2204~2209 (1994)
- Syrjänen J, "Acute phase response in cerebral infarction", J Clin Pathol, 42, pp.63~68 (1989)
- Weimar C, "Complications following Acute Ischemic Stroke", Eur Neurol, 48, pp.133~140 (2002)
- 윤두상, "병원기반 코호트에서 급성 허혈성 뇌졸중 및 일과성 뇌허혈 환자의 치명률 및 합병증이 장기 예후에 미치는 영향", 대한신경과학회지, 22(5), pp.433~439 (2004), 대한신경과학회
- Grau AJ, "Fever and infection early after ischemic stroke", J Neurol Sci, 171, pp.115~120 (1999)
- Minn YK, "The prognostic significance of infrction in acute stroke: preliminary study", J Korean Neurol Assoc, 14, pp.382~388 (1996)