背景:关于在急诊室(AISER)诊断的急性缺血性中风和中风变色龙(SC)之间的临床/放射学差异的数据很少。我们旨在描述在智利综合中风中心观察到的差异。
方法:在2014年12月至2023年10月期间接受ClínicaAlemanaER的缺血性卒中综合征患者的前瞻性观察性研究。
结果:纳入1197例患者;其中63例(5.2%,95CI4.1-6.6)是SC;这些都是年轻的(p<0.001),高血压频率较低(p=0.03),收缩压(SBP)也较低(p<0.001),舒张压(DBP)(p=0.011),和NIHSS(p<0.001)。在临床上,他们表现出不太频繁的凝视(p=0.008)和校园检查改变(p=0.03),面部(p<0.001)和四肢无力(左臂(p=0.004),右臂(p=0.041),左腿(p=0.001),右腿P=0.0029),感觉异常(p<0.001),构音障碍(p<0.001)。神经放射学评估包括不太频繁的大血管闭塞(p=0.01),和中风位置(p=0.005);它们的病因也不同(p<0.001)。脑干中风(p&lt;0.001)和消失/注意力不集中症状(p&lt;0.001)仅在AISER中可见。在多变量分析中,年龄较小(OR:0.945;95%CI0.93-0.96),DBP(OR:0.97;95%CI,0.95-0.99),面部无力(OR:0.39;CI95%0.19-0.78),感觉异常(OR:0.16.18;95%CI,0.05-0.4),幕下位置(OR:0.36;95%CI,0.15-0.78),后循环受累(OR:3.02;95%CI,1.45-6.3),心源性栓塞(OR:3.5;95%CI,1.56-7.99)和未确定(OR:2.42;95%CI,1.22-4.7;95%)病因,仍然具有统计学意义。逐步分析,仅包括患者到达急诊室时出现的临床因素,证明年龄(OR:0.95;95%CI0.94-0.97),DBP(OR:0.97;95%CI,0.95-0.99),房颤的存在(OR:2.22;95%CI,1.04-4.75,NIHSS(OR:0.88;95%CI,0.71-0.89)和NIHSS的存在为1。意识水平(OR:5.66;CI95%1.8-16.9),1.意识水平问题(OR:3.023;95%CI,1.35-6.8),面部无力(OR:0.3;CI95%0.17-0.8)和敏感异常(OR:0.27;95%CI,0.1-0.72)仍有统计学意义.
结论:SC与AISER相比具有临床和放射学差异。另一个相关发现是房颤患者的任何神经系统症状,即使在DWI阴性的情况下,也应将其视为卒中发作,直至完全排除.
BACKGROUND: Scarce data exist about clinical/radiological differences between acute ischemic strokes diagnosed in the emergency room (AISER) and stroke chameleons (SCs). We aimed at describing the differences observed in a comprehensive stroke center in Chile.
METHODS: Prospective observational
study of patients with ischemic stroke syndromes admitted to the emergency room (ER) of Clínica Alemana between December 2014 and October 2023.
RESULTS: 1,197 patients were included; of these 63 (5.2%, 95% CI: 4.1-6.6) were SC; these were younger (p < 0.001), less frequently hypertensive (p = 0.03), and they also had lower systolic (SBP) (p < 0.001), diastolic blood pressures (DBP) (p = 0.011), and NIHSS (p < 0.001). Clinically, they presented less frequently gaze (p = 0.008) and campimetry alterations (p = 0.03), facial (p < 0.001) and limb weakness (left arm [p = 0.004], right arm (p = 0.041), left leg (p = 0.001), right leg p = 0.0029), sensory abnormalities (p < 0.001), and dysarthria (p < 0.001). Neuroradiological evaluations included less frequently large vessel occlusions (p = 0.01) and other stroke locations (p = 0.005); they also differed in their etiologies (p < 0.001). Brainstem strokes (p < 0.001) and extinction/inattention symptoms (p < 0.001) were only seen in AISER. In multivariate analysis, younger age (OR: 0.945; 95% CI: 0.93-0.96), DBP (OR: 0.97; 95% CI, 0.95-0.99), facial weakness (OR: 0.39; 95% CI: 0.19-0.78), sensory abnormities (OR: 0.16.18; 95% CI, 0.05-0.4), infratentorial location (OR: 0.36; 95% CI, 0.15-0.78), posterior circulation involvement (OR: 3.02; 95% CI, 1.45-6.3), cardioembolic (OR: 3.5; 95% CI, 1.56-7.99), and undetermined (OR: 2.42; 95% CI, 1.22-4.7; 95%) etiologies, remained statistically significant. A stepwise analysis including only clinical elements present on the patient\'s arrival to the ER, demonstrates that age (OR: 0.95; 95% CI: 0.94-0.97), DBP (OR: 0.97; 95% CI, 0.95-0.99), the presence of atrial fibrillation (OR: 2.22; 95% CI, 1.04-4.75, NIHSS (OR: 0.88; 95% CI, 0.71-0.89) and the presence in NIHSS of 1a level of consciousness (OR: 5.66; CI: 95% 1.8-16.9), 1b level of consciousness questions (OR: 3.023; 95% CI, 1.35-6.8), facial weakness (OR: 0.3; CI: 95% 0.17-0.8), and sensory abnormalities (OR: 0.27; 95% CI, 0.1-0.72) remained statistically significant.
CONCLUSIONS: SC had clinical and radiological differences compared to AISER. An additional relevant finding is that neurological symptoms in a patient with atrial fibrillation, even with a negative diffusion-weighted imaging, should be carefully evaluated as a potential stroke until other causes are satisfactorily ruled out.