Abstract：
BACKGROUND: Paroxysmal sympathetic hyperactivity (PSH) has been linked to a worse clinical prognosis in patients with traumatic brain injury. We aimed to identify the risk factors and clinical features associated with basilar artery occlusion (BAO) presenting with PSH as the first clinical presentation.
METHODS: This study recruited patients with acute BAO who received endovascular therapy (EVT) at two stroke centers in China. PSH Assessment Measure ≥8 was included in the PSH+ group, while those with a score below 8 were classified as the PSH- group. Clinical data and radiological findings were compared between the two groups. A binary logistic regression model was employed to identify independent risk factors for PSH.
RESULTS: 101 participants were enrolled, of whom 19 (18.8%) presented with PSH as the initial manifestation of BAO. Worse prognosis (modified Rankin Scale score of 4-6) at day 90 occurred in 14 (73.7%) of the PSH+ patients and 42 (51.2%) of the PSH- patients (P=0.076). The 90-day mortality rate was higher in the PSH+ group with 12 (63.2%) participants, compared with 31 (37.8%) participants in the PSH- group (P=0.044). A significantly increased risk of PSH was found in patients with midbrain involvement (OR 6.53, 95% CI 1.56 to 27.30, P=0.01) and a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.15, 95% CI 1.01 to 1.31, P=0.037).
CONCLUSIONS: Patients with BAO presenting with PSH as the initial clinical manifestation experience a higher risk of 90-day mortality, despite undergoing EVT. Midbrain infarction and baseline NIHSS score may be significant risk factors for PSH following BAO.
METHODS: This study recruited patients with acute BAO who received endovascular therapy (EVT) at two stroke centers in China. PSH Assessment Measure ≥8 was included in the PSH+ group, while those with a score below 8 were classified as the PSH- group. Clinical data and radiological findings were compared between the two groups. A binary logistic regression model was employed to identify independent risk factors for PSH.
RESULTS: 101 participants were enrolled, of whom 19 (18.8%) presented with PSH as the initial manifestation of BAO. Worse prognosis (modified Rankin Scale score of 4-6) at day 90 occurred in 14 (73.7%) of the PSH+ patients and 42 (51.2%) of the PSH- patients (P=0.076). The 90-day mortality rate was higher in the PSH+ group with 12 (63.2%) participants, compared with 31 (37.8%) participants in the PSH- group (P=0.044). A significantly increased risk of PSH was found in patients with midbrain involvement (OR 6.53, 95% CI 1.56 to 27.30, P=0.01) and a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.15, 95% CI 1.01 to 1.31, P=0.037).
CONCLUSIONS: Patients with BAO presenting with PSH as the initial clinical manifestation experience a higher risk of 90-day mortality, despite undergoing EVT. Midbrain infarction and baseline NIHSS score may be significant risk factors for PSH following BAO.
摘要：
背景：阵发性交感神经过度活动（PSH）与创伤性脑损伤患者的临床预后较差有关。我们旨在确定与以PSH为首次临床表现的基底动脉闭塞（BAO）相关的危险因素和临床特征。
方法：本研究招募了在中国两个卒中中心接受血管内治疗（EVT）的急性BAO患者。PSH+组包括PSH评估措施≥8，而那些得分低于8分的被归类为PSH-组。比较两组的临床资料和影像学检查结果。采用二元Logistic回归模型确定PSH的独立危险因素。
结果：101名参与者被登记，其中19人（18.8%）以PSH为BAO的初始表现。在第90天，不良预后（改良的Rankin量表评分为4-6）发生在14例（73.7％）PSH患者和42例（51.2％）PSH患者中（P=0.076）。PSH+组的90天死亡率更高，有12名（63.2%）参与者，与PSH组31名（37.8%）参与者相比（P=0.044）。在中脑受累（OR6.53，95％CI1.56至27.30，P=0.01）和高基线美国国立卫生研究院卒中量表（NIHSS）评分（OR1.15，95％CI1.01至1.31，P=0.037）的患者中，PSH的风险显着增加。
结论：以PSH为初始临床表现的BAO患者90天死亡的风险更高，尽管接受了EVT。中脑梗死和基线NIHSS评分可能是BAO后PSH的重要危险因素。
方法：本研究招募了在中国两个卒中中心接受血管内治疗（EVT）的急性BAO患者。PSH+组包括PSH评估措施≥8，而那些得分低于8分的被归类为PSH-组。比较两组的临床资料和影像学检查结果。采用二元Logistic回归模型确定PSH的独立危险因素。
结果：101名参与者被登记，其中19人（18.8%）以PSH为BAO的初始表现。在第90天，不良预后（改良的Rankin量表评分为4-6）发生在14例（73.7％）PSH患者和42例（51.2％）PSH患者中（P=0.076）。PSH+组的90天死亡率更高，有12名（63.2%）参与者，与PSH组31名（37.8%）参与者相比（P=0.044）。在中脑受累（OR6.53，95％CI1.56至27.30，P=0.01）和高基线美国国立卫生研究院卒中量表（NIHSS）评分（OR1.15，95％CI1.01至1.31，P=0.037）的患者中，PSH的风险显着增加。
结论：以PSH为初始临床表现的BAO患者90天死亡的风险更高，尽管接受了EVT。中脑梗死和基线NIHSS评分可能是BAO后PSH的重要危险因素。
