Abstract：
BACKGROUND: Addressing the need to uniformly classify arteriopathies among patients with arterial ischemic stroke (AIS) due to tubercular meningitis (TBM), we used the Childhood AIS Standardised Classification and Diagnostic Evaluation (CASCADE) criteria.
METHODS: This tri-centric prospective study included children aged 0.5-12 years with TBM and AIS. Magnetic resonance angiographies (MRAs) were done during admission and repeated 3 and 12 months after discharge. Arteriopathies were classified according to the primary CASCADE criteria. We used the modified Pediatric Alberta Stroke Programme Early Computed Tomography Score as an ordinal measure of infarct volume. The severity of arteriopathies was graded using the focal cerebral arteriopathy severity score (FCASS). The final outcomes were measured at the 12-month follow-up visit using the Pediatric Stroke Outcome Measure (PSOM).
RESULTS: Out of 55 patients, 64% had MRA-evidenced arteriopathies and 84% had multiple infarcts. The middle cerebral (46%) and internal carotid arteries (22%) were most commonly affected. The basal ganglia (70%) and the cerebral cortex (61%) were most commonly infarcted. CASCADE categories included 3b (40%), 1d (38%), 2b (16%), 2c (5%), progressive (32%), and stable (44%) arteriopathies. Younger age, hypertrophic pachymeningitis, cortical infarcts, recurrent strokes, progressive arteriopathies, EEG abnormalities, and mortality were significantly higher among patients with MRA-proven arteriopathies. Patients with progressive arteriopathies had a significantly higher prevalence of hypertrophic pachymeningitis, cortical infarcts, and recurrent strokes. FCASS correlated positively with outcomes measured by the Pediatric Stroke Outcome Measure and modified Pediatric Alberta Stroke Programme Early Computed Tomography Score.
CONCLUSIONS: The CASCADE classification clarified the arteriopathy patterns, enabling us to correlate them with the characteristics of the infarcts. FCASS is useful to grade the arteriopathy severity and progression in TBM.
METHODS: This tri-centric prospective study included children aged 0.5-12 years with TBM and AIS. Magnetic resonance angiographies (MRAs) were done during admission and repeated 3 and 12 months after discharge. Arteriopathies were classified according to the primary CASCADE criteria. We used the modified Pediatric Alberta Stroke Programme Early Computed Tomography Score as an ordinal measure of infarct volume. The severity of arteriopathies was graded using the focal cerebral arteriopathy severity score (FCASS). The final outcomes were measured at the 12-month follow-up visit using the Pediatric Stroke Outcome Measure (PSOM).
RESULTS: Out of 55 patients, 64% had MRA-evidenced arteriopathies and 84% had multiple infarcts. The middle cerebral (46%) and internal carotid arteries (22%) were most commonly affected. The basal ganglia (70%) and the cerebral cortex (61%) were most commonly infarcted. CASCADE categories included 3b (40%), 1d (38%), 2b (16%), 2c (5%), progressive (32%), and stable (44%) arteriopathies. Younger age, hypertrophic pachymeningitis, cortical infarcts, recurrent strokes, progressive arteriopathies, EEG abnormalities, and mortality were significantly higher among patients with MRA-proven arteriopathies. Patients with progressive arteriopathies had a significantly higher prevalence of hypertrophic pachymeningitis, cortical infarcts, and recurrent strokes. FCASS correlated positively with outcomes measured by the Pediatric Stroke Outcome Measure and modified Pediatric Alberta Stroke Programme Early Computed Tomography Score.
CONCLUSIONS: The CASCADE classification clarified the arteriopathy patterns, enabling us to correlate them with the characteristics of the infarcts. FCASS is useful to grade the arteriopathy severity and progression in TBM.
摘要：
背景：解决对结核性脑膜炎（TBM）引起的动脉缺血性卒中（AIS）患者的动脉病变进行统一分类的需要，我们使用儿童AIS标准化分类和诊断评估(CASCADE)标准.
方法：这项三中心前瞻性研究包括年龄在0.5-12岁的TBM和AIS儿童。入院期间进行磁共振血管造影（MRA），并在出院后3和12个月重复。根据主要CASCADE标准对动脉病变进行分类。我们使用改良的小儿Alberta卒中计划早期计算机断层扫描评分作为梗死体积的顺序测量。使用局灶性脑动脉病严重程度评分（FCASS）对动脉病的严重程度进行分级。在12个月的随访中使用小儿卒中结果测量(PSOM)测量最终结果。
结果：在55名患者中，64%有MRA证实的动脉病变，84%有多发性梗塞。中脑（46％）和颈内动脉（22％）最常见。最常见的是基底神经节（70％）和大脑皮层（61％）。级联类别包括3b(40%)，1d（38%），2b（16%），2c（5%），进步（32%），和稳定的（44%）动脉病变。年龄更小,肥厚性硬脑膜炎,皮层梗塞,复发性中风,进行性动脉病变,脑电图异常，MRA证实的动脉病变患者的死亡率明显较高.进行性动脉病变患者的肥厚性硬脑膜炎患病率明显较高，皮层梗塞,和复发性中风。FCASS与通过小儿卒中结果测量和改良小儿Alberta卒中计划早期计算机断层扫描评分测量的结果呈正相关。
结论：CASCADE分类阐明了动脉病变的类型，使我们能够将它们与梗塞的特征联系起来。FCASS可用于对TBM中动脉病的严重程度和进展进行分级。
方法：这项三中心前瞻性研究包括年龄在0.5-12岁的TBM和AIS儿童。入院期间进行磁共振血管造影（MRA），并在出院后3和12个月重复。根据主要CASCADE标准对动脉病变进行分类。我们使用改良的小儿Alberta卒中计划早期计算机断层扫描评分作为梗死体积的顺序测量。使用局灶性脑动脉病严重程度评分（FCASS）对动脉病的严重程度进行分级。在12个月的随访中使用小儿卒中结果测量(PSOM)测量最终结果。
结果：在55名患者中，64%有MRA证实的动脉病变，84%有多发性梗塞。中脑（46％）和颈内动脉（22％）最常见。最常见的是基底神经节（70％）和大脑皮层（61％）。级联类别包括3b(40%)，1d（38%），2b（16%），2c（5%），进步（32%），和稳定的（44%）动脉病变。年龄更小,肥厚性硬脑膜炎,皮层梗塞,复发性中风,进行性动脉病变,脑电图异常，MRA证实的动脉病变患者的死亡率明显较高.进行性动脉病变患者的肥厚性硬脑膜炎患病率明显较高，皮层梗塞,和复发性中风。FCASS与通过小儿卒中结果测量和改良小儿Alberta卒中计划早期计算机断层扫描评分测量的结果呈正相关。
结论：CASCADE分类阐明了动脉病变的类型，使我们能够将它们与梗塞的特征联系起来。FCASS可用于对TBM中动脉病的严重程度和进展进行分级。
