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[Prognosis in brain stem infarction]
C Exhenry1, F Regli, J Bogousslavsky
1Service de neurologie, CHUV-Lausanne.
Insights
Diabetes and bilateral brainstem lesions significantly increase mortality risk following cerebrovascular accidents (CVA). Early intervention and prevention are crucial for improving patient survival rates after stroke.
Area of Science:
- Neurology
- Epidemiology
- Clinical Medicine
Context:
- Retrospective analysis of 100 patients hospitalized for their first cerebrovascular accident (CVA) at the University Hospital Lausanne.
- Focus on brainstem damage and associated risk factors influencing survival.
- Inclusion of demographic, clinical, and lesion-specific data for comprehensive analysis.
Purpose:
- Identify pre-admission risk factors predicting survival after a first CVA, particularly those involving the brainstem.
- Determine the short-term and long-term mortality rates associated with specific risk factors.
- Evaluate the impact of diabetes and lesion bilaterality on CVA outcomes.
Summary:
- Stepwise multiple logistic regression identified diabetes and bilateral brainstem lesions as key indicators of unfavorable outcomes, with mortality rates exceeding 30%.
- In the absence of these factors, mortality rates were below 2%, highlighting their prognostic significance.
- Short-term mortality was primarily attributed to brainstem lesions affecting vital centers or respiratory complications; long-term mortality aligned with the general population.
Impact:
- Emphasizes the critical role of preventing and managing risk factors, especially diabetes, in CVA patients.
- Underscores the need for rapid and efficient management, including physiotherapy and medication, to mitigate fatal complications in severely disabled patients.
- Provides valuable insights for clinical decision-making and resource allocation in stroke care.
Unlabelled:
A retrospective study of patients who suffered cerebrovascular accidents (CVA particularly brainstem damage) was conducted to look for risk factors which, present on admission, indicated the chance of survival. The evolution of 100 patients, hospitalized in the Neurology Department, University Hospital Lausanne, after having had their first CVA was studied. The risk factors chosen were age, sex, hypertension, smoker, late onset diabetes, hypercholesterolemia as well as the conscious state, the location of the lesion and whether it was bi- or unilateral. Analysis of the data was performed by means of a stepwise multiple logistic regression program. The results demonstrated that diabetes or bilateral lesions, regardless of their position in the brainstem, or the combination of these two factors, indicated an unfavorable outcome, associated with a short term mortality rate greater than 30%. In their absence and despite the presence of the other risk factors, it was less than 2%. At one month the mortality rate was shown to be very high. At two month it was non insignificant and thereafter it became similar to that of the Swiss population. Brainstem lesions extending to the vital centres or respiratory complications related to the state of dependence were the most common causes of short term deaths. At long term the aetiology of death was the same as for the population as a whole.
Conclusion:
The results obtained show the importance of the prevention and treatment of patients at risk of CVA, particularly diabetes. To avoid the fatal complications, that arise from severe handicap in bedridden patients, the management must be rapid and efficient (physiotherapy and drugs).