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Predictors and outcomes of hemorrhagic stroke in reversible cerebral vasoconstriction syndrome.

Abstract：

BACKGROUND:Intracranial hemorrhage (ICH) is the most common neurologic complication of reversible cerebral vasoconstriction syndrome (RCVS). In this study, we compared hemorrhagic and non-hemorrhagic RCVS with an aim to evaluate the risk factors and short-term clinical outcomes of hemorrhagic lesions. METHODS:We used the Nationwide Readmissions Database 2016-2017 to identify all hospitalizations due to RCVS. Predictors and clinical outcomes of ICH were analyzed using logistic regression analysis. RESULTS:Among the total 1834 hospitalizations for RCVS during the study period (mean ± SD age:48.4 ± 15.6 years, female:75.8%), 768 (41.9%) had occurrence of ICH. Patients with ICH were more likely to be female (OR:2.72, 95% CI:1.86-3.97), have a history of hypertension (OR:1.63, 95% CI:1.20-2.22) and cocaine use (OR:3.11, 95% CI:1.49-6.51), and were less likely to have a history of diabetes (OR:0.52, 95% CI:0.32-0.84) and heart failure (OR:0.34, 95% CI:0.14-0.84). Hemorrhagic RCVS was associated with higher odds of cerebral edema (OR:10.71, 95% CI:5.75-19.97), new onset seizure (OR:2.24, 95% CI:1.08-4.61), respiratory failure (OR:2.40, 95% CI:1.37-4.22) and gastrostomy tube placement (OR:3.20, 95% CI:1.07-9.58). Patients with hemorrhagic lesions also had longer length of hospital stay (mean difference 5.5 days), higher hospital charges (mean difference $105,547), and a lower likelihood of discharge to home (OR:0.61, 95% CI:0.43-0.86). There was, however, no significant difference in the in-hospital mortality. CONCLUSIONS:ICH affects nearly 42% of patients with RCVS and is associated with increased rate of other neurologic complications and adverse discharge disposition, thus putting into question the prevailing conception that RCVS is generally a benign disorder with a self-limiting clinical course.

journal_name

J Neurol Sci

journal_title

Journal of the neurological sciences

authors

Garg A,Rocha M,Starr M,Ortega-Gutierrez S

doi

10.1016/j.jns.2021.117312

subject

Has Abstract

pub_date

2021-01-07 00:00:00

pages

117312

eissn

0022-510X

issn

1878-5883

pii

S0022-510X(21)00005-8

journal_volume

421

pub_type

杂志文章

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