Etiology of bilateral cerebral infarction and influencing factors of short-term clinical outcome / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the etiology of bilateral cerebral infarction (BCI) and influencing factors of short-term clinical outcome.Methods:Patients with BCI admitted to the Department of Neurology, Xiangyang Central Hospital from January to July 2020 were enrolled retrospectively. According to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, the etiological classification was performed, including large artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined etiology (SOE), and stroke of undetermined etiology (SUE). According to the location of acute infarction showed on diffusion-weighted imaging, the patients were divided into anterior circulation group, posterior circulation group, and anterior + posterior circulation group. The demographic and baseline data of the three groups were compared. The short-term outcome was assessed by the modified Rankin Scale score at discharge. 0-2 was defined as good outcome, and >2 were defined as poor outcome. The clinical data of the good outcome group and the poor outcome group were compared. Multivariate logistic regression was used to analyze the independent influencing factor of short-term clinical outcome. Results:A total of 72 patients with BCI were enrolled, accounting for 9.4% of all acute cerebral infarction. Their age was 67.89±12.50 years. There were 41 males (56.9%). Twenty-three patient were in the anterior circulation group (32.0%), 25 were in the posterior circulation group (34.7%), and 24 were in the anterior + posterior circulation group (33.3%). The etiological types were SUE in 25 cases (34.7%), CE in 22 cases (30.6%), LAA in 14 cases (19.4%), SOE in 9 cases (12.5%), and SVO in 2 cases (2.8%). CE, SUE and SOE were the main etiologies in the anterior circulation group, and CE was the most common (43.5%). The proportion of CE was significantly higher than that in the posterior circulation group ( P=0.036), and there was no significant difference compared with the anterior + posterior circulation group. LAA, SUE and CE were the main etiologies in the posterior circulation group, and LAA was the most common (48.0%). The proportion of LAA was significantly higher than that in the anterior circulation group ( P<0.001) and the anterior + posterior circulation group ( P=0.002). SUE, CE and SOE were the main etiologies in the anterior + posterior circulation group, and SUE was most common (37.5%). However, there was no significant difference in the proportion of SUE between the anterior + posterior circulation group, the anterior circulation group and the posterior circulation group. Forty patients (55.6%) had poor short-term outcomes. The history of ischemic heart disease, fasting blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) score, large infarction (the largest infarct diameter >5 cm), the number of infarct distribution layers (6.6 mm/layer) and the proportion of LAA in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic analysis showed that higher baseline NIHSS score was an independent risk factor for poor outcome in patients with BCI (odds ratio 1.373, 95% confidence interval 1.014-1.859; P=0.041). Conclusions:BCI is not uncommon. Its main etiologies are SUE, CE and LAA. CE is the most common in the anterior circulation BCI, LAA is the most common in the posterior circulation BCI, and SUE is the most common in the anterior + posterior circulation BCI. The short-term poor outcome rate of BCI is higher, and the higher baseline NIHSS score is an independent risk factor for poor outcome of patients with BCI.