VOLNÝ, Ondřej, Petra CIMFLOVÁ and Robert MIKULIK. Ipsilateral Sinus Hypoplasia and Poor Leptomeningeal Collaterals as Midline Shift Predictors. Journal of Stroke & Cerebrovascular Diseases. Amsterdam: Elsevier Science BV, 2016, vol. 25, No 7, p. 1792-1796. ISSN 1052-3057. Available from: https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.004.
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Basic information
Original name Ipsilateral Sinus Hypoplasia and Poor Leptomeningeal Collaterals as Midline Shift Predictors
Authors VOLNÝ, Ondřej (203 Czech Republic, guarantor, belonging to the institution), Petra CIMFLOVÁ (203 Czech Republic, belonging to the institution) and Robert MIKULIK (203 Czech Republic).
Edition Journal of Stroke & Cerebrovascular Diseases, Amsterdam, Elsevier Science BV, 2016, 1052-3057.
Other information
Original language English
Type of outcome Article in a journal
Field of Study 30000 3. Medical and Health Sciences
Country of publisher Netherlands
Confidentiality degree is not subject to a state or trade secret
Impact factor Impact factor: 1.517
RIV identification code RIV/00216224:14110/16:00090112
Organization unit Faculty of Medicine
Doi http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.004
UT WoS 000378002800034
Keywords in English stroke; anterior circulation; dural sinuses; leptomeningeal collaterals; edema; midline shift
Tags EL OK
Tags International impact, Reviewed
Changed by Changed by: Ing. Mgr. Věra Pospíšilíková, učo 9005. Changed: 25/8/2016 11:36.
Abstract
Background: We explore the role of dural sinus morphology, leptomeningeal collaterals, and clot localization in the development of malignant brain edema in acute ischemic stroke in anterior circulation. Methods: This is a single-center retrospective study of consecutive stroke patients with acute occlusion (middle cerebral artery M1 +/- intracranial internal carotid artery) treated with intravenous thrombolysis (from November 2009 to November 2014). Admission computed tomography angiography data were evaluated for hypoplasia of dural sinuses, leptomeningeal collaterals, and clot location. Primary outcome was midline shift (<5 mm versus >= 5 mm) on follow-up computed tomography. Secondary outcomes were infarct volume and modified Rankin Scale score of 2 or lower at 90 days. Multivariate logistic regression was used. Results: Of 86 patients (49 females), 36 (42%) had poor collaterals, 26 (30%) had ipsilesional sinus hypoplasia, and 38 (44%) had proximal clots. A midline shift of 5 mm or higher was diagnosed in 14 patients (16%). Infarct volume was larger in the group with midline shift (median: 318 mL [interquartile range {IQR} = 260-350]) than in the group without midline shift (median: 44 mL [IQR = 28-60]) (P=.007). In multivariate analysis, poor leptomeningeal collaterals (odds ratio [OR]=.11, 95% confidence interval [CI]=.03-.44, P=.002 for good collaterals) and ipsilesional sinus hypoplasia (OR=6.43, 95% CI=1.5-46.1, P=.008) were independently associated with a midline shift of 5 mm or higher. Conclusion: Patients with poor leptomeningeal collaterals and ipsilesional hypoplasia of dural sinuses are more likely to develop midline shift.
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