Göz Deviasyonu ve Kontralateral Hemiparezisi Olan Hastalar Doğrudan Anjiyografi Odasına Alınabilir Mı?

Yıl 2024, Cilt: 2 Sayı: 3, 13 - 18, 30.12.2024

Hasan Doğan , Çetin Kursad Akpinar , Atilla Özcan Özdemir , Erdem Gürkaş , Özlem Aykaç , Ayşenur Önalan

Öz

Amaç: Kontralateral hemiparezi/hemiplejinin eşlik ettiği göz/baş deviasyonu, frontoparietal lob hasarına işaret etmesi nedeniyle büyük damar tıkanıklığı olan hastalarda sık görülür. Bu çalışmada kontralateral hemiparezi/ hemiplejinin eşlik ettiği göz/baş deviasyonu olan hastalarda büyük damar tıkanıklığı sıklığını araştırmayı amaçladık.
Materyal ve Metot: Ocak 2018 ile Ocak 2020 tarihleri arasında acil servisimize başvuran kontralateral hemiparezi/hemipleji ile birlikte göz/baş deviasyonu olan hastalar retrospektif olarak değerlendirildi ve çalışmaya dahil edildi. Büyük damar tıkanıklığına bağlı iskemik inme tanısı ile mekanik trombektomi uygulanan hastalar belirlendi.
Bulgular: 164 hasta çalışmaya dahil edildi. Sekiz hastaya intrakraniyal kanama tanısı konuldu. Bu nedenle bu klinikle başvuran hastaların %95,1’i iskemik inme geçirmişti. Acil servise bu semptomlarla başvuran hastaların %93,9’una, iskemik inme tanısı alan hastaların ise %98.7’sine mekanik trombektomi işlemi uygulandı. İşlem sonunda hastaların %92,8’inde başarılı reperfüzyon (mTICI ≥ 2b) sağlandı ve taburculukta hastaların %39,6’sında iyi fonksiyonel sonuçlar (mRS ≤ 2) gözlendi. Semptomatik intrakraniyal kanama oranı %5,1 iken, mortalite %14,2 idi.
Sonuçlar: Bu çalışmada, göz ve/veya baş deviasyonunun eşlik ettiği kontralateral hemiparezi/hemiplejinin yüksek oranda büyük damar tıkanıklığının göstergesi olabileceği ve bu kliniğe sahip hastaların uygun merkezlerde doğrudan anjiyografi odasına alınabileceği kanaatindeyiz.

Anahtar Kelimeler

Akut inme, Anjiografi odası, Serebral anjiografi, Trombektomi

Can Patients with Eye Deviation and Contralateral Hemıparesıs Be Taken Directly to The Angiography Suıte?

Öz

Objective: Eye or head deviation accompanied by contralateral hemiparesis or hemiplegia is common in patients with large vessel occlusion, as it indicates frontoparietal lobe damage. This study aimed to investigate the frequency of large vessel occlusion in patients presenting with eye or head deviation accompanied by contralateral hemiparesis or hemiplegia.
Materials and Methods: Patients with contralateral hemiparesis or hemiplegia accompanied by eye or head deviation who were admitted to our emergency department between January 2018 and January 2020 were retrospectively evaluated and included in the study. Patients diagnosed with ischemic stroke due to large vessel occlusion and who underwent mechanical thrombectomy were identified.
Results: A total of 164 patients were included in the study, eight of whom were diagnosed with intracranial hemorrhage. Thus, 95.1% of patients presenting with these symptoms had an ischemic stroke. Mechanical thrombectomy was performed in 93.9% of patients presenting with these symptoms to the emergency department and in 98.7% of patients diagnosed with ischemic stroke. Successful reperfusion (mTICI ≥ 2b) was achieved in 92.8% of patients, and good functional outcomes (mRS ≤ 2) were observed in 39.6% of patients at discharge. The symptomatic intracranial hemorrhage rate was 5.1%, while mortality was 14.2%.
Conclusions: This study suggests that contralateral hemiparesis or hemiplegia accompanied by eye or head deviation is highly indicative of large vessel occlusion. Patients with these symptoms can be admitted directly to the angiography suite in appropriate centers.

Anahtar Kelimeler

Acute Stroke, Angiography Suite, Cerebral Angiography, Thrombectomy

Kaynakça

• Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–31.
• Sun C, Zaidat OO, Castonguay AC, Veznedaroglu E, Budzik RF, English J, et al. A Decade of Improvement in Door-to-Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care. Stroke Vasc Interv Neurol. 2022; 3: e000561.
• Ribo M, Molina CA, Cobo E, Cerdà N, Tomasello A, Quesada H, et al. Association Between Time to Reperfusion and Outcome Is Primarily Driven by the Time From Imaging to Reperfusion. Stroke 2016 Apr;47(4):999-1004.
• Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, et al. Accuracy of prediction instruments for diagnosing large vessel occlusion in individuals with suspected stroke: a systematic review for the 2018 Guidelines for the early manage- ment of patients with acute ischemic stroke. Stroke 2018; 49: 111-122.
• Suzuki K, Nakajima N, Kunimoto K, Hatake S, Sakamoto Y, Hokama H, et al. Emergent Large Vessel Occlusion Screen Is an Ideal Prehospital Scale to Avoid Missing Endovascular Therapy in Acute Stroke. Stroke 2018; 49: 2096-101.
• Fruhmann-Berger M, Karnath HO. Spontaneous eye and head position in patients with spatial neglect. J Neurol 2005; 252: 1194– 200.
• Singer OC, Dvorak F, du Mesnil de Rochemont R, Lanfermann H, Sitzer M, Neumann-Haefelin T. A simple 3-item stroke scale: compari- son with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke 2005; 36: 773–76.
• Ollikainen JP, Janhunen HV, Tynkkynen JA, Mattila KM, Hälinen MM, Oksala NK, et al. The Finnish Prehospital Stroke Scale detects thrombectomy and thrombolysis candidates-a propensity score-matched study. J Stroke Cerebrovasc Dis 2018; 27: 771–77.
• Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 2014; 45: 87–91.
• Gropen TI, Boehme A, Martin-Schild S, Albright K, Samai A, Pishanidar S, et al. Derivation and Validation of the Emergency Medical Stroke Assessment and Comparison of Large Vessel Occlusion Scales. J Stroke Cerebrovasc Dis 2018; 27: 806-15.
• Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20(7): 864-70.
• Sulženko J, Kožnar B, Kučera D, Peisker T, Vaško P, Poledník I, et al. Direct transfer of acute stroke patients to angiography suites equipped with flat-detector computed tomography: literature review and initial singlecentre experience. Eur Heart J Suppl 2022; 30(24): 42-7.
• Pfaff JAR, Schönenberger S, Herweh C, Ulfert C, Nagel S, Ringleb PA, et al. Direct Transfer to Angio-Suite Versus Computed Tomography-Transit in Patients Receiving Mechanical Thrombectomy: A Randomized Trial. Stroke 2020; 51(9): 2630-38.
• Requena M, Olivé M, García-Tornel Á, Rodríguez-Villatoro N, Deck M, Juega J, et al. Time Matters: Adjusted Analysis of the Influence of Direct Transfer to Angiography-Suite Protocol in Functional Outcome. Stroke 2020; 51(6): 1766-71. Mendez B, Requena M, Aires A, Martins N, Boned S, Rubiera M, et al. Direct Transfer to Angio-Suite to Reduce Workflow Times and Increase Favorable Clinical Outcome. Stroke 2018; 49(11): 2723-27.
• Jahan R, Saver JL, Schwamm LH, Fonarow GC, Liang L, Matsouaka RA, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice. JAMA 2019; 322: 252-63.
• Kaditis DG, Zintzaras E, Sali D, Kotoulas G, Papadimitriou A, Hadjigeorgiou GM. Conjugate eye deviation as predictor of acute cortical and subcortical ischemic brain lesions. Clin Neurol Neurosurg 2016; 143: 80-5.
• Ringman JM, Saver JL, Woolson RF, Adams HP. Hemispheric asymmetry of gaze deviation and relationship to neglect in acute stroke. Neurology 2005; 65: 1661-62.
• Singer OC, Humpich MC, Laufs H, Lanfermann H, Steinmetz H, Neumann-Haefelin T. Conjugate eye deviation in acute stroke: incidence, hemispheric asymmetry, and lesion pattern. Stroke 2006; 37: 2726-32.
• Tijssen CC, Schulte BP, Leyten AC. Prognostic significance of conjugate eye deviation in stroke patients. Stroke 1991; 22: 200-2.
• Sato S, Koga M, Yamagami H, Okuda S, Okada Y, Kimura K, et al. Conjugate eye deviation in acute intracerebral hemorrhage: stroke acute management with urgent risk-factor assessment and improvement—ICH (SAMURAI-ICH) study. Stroke 2012; 43(11): 2898-03.