Early neurological deterioration (END) has been described asworsening in neurological function during the first days of acutecerebral ischemia (ACI). The prevalence of END varies in different studies according to thedefinition used for END detection. Prevalence of END occurred in20–38% of patients presenting with acute ischemic stroke (AIS). Recent studies have shown that END is an independent predictor ofpoor outcomes in the setting of AIS
TIẾN TRIỂN XẤU SAU ĐIỀU TRỊ CẤP TS.BS NGUYỄN HUY THẮNG TRƯỜNG ĐẠI HỌC Y KHOA PHẠM NGỌC THẠCH Sau Điều Trị Cấp Early neurological deterioration (END) Early neurological deterioration (END) has been described as worsening in neurological function during the first days of acute cerebral ischemia (ACI) The prevalence of END varies in different studies according to the definition used for END detection Prevalence of END occurred in 20–38% of patients presenting with acute ischemic stroke (AIS) Recent studies have shown that END is an independent predictor of poor outcomes in the setting of AIS Causes Stroke in progress Hemorrhagic Arterial transformation reoccusion Hemodynamic steal Stroke in Progression Concept of Perfusion-Diffusion Mismatch Điều Trị Tái Tưới Máu Tái Thông Không Tái Thông Recanalization rates with large arteries Lansberg, Stroke 2011 Intra-Arterial Thrombolysis and 1st Generation Devices PROACT-2 Control PROACT-2 Pro-UK MERCI Multi MERCI Penumbra N 59 121 151 164 125 Age 64 64 67 68 64 NIHSS 17 17 20 19 18 Time to groin punc NA NA 4.3H 4.3H 4.3H TIMI 2-3 18% 66% 46% 55% 82% 90-day mRS 0-2 25% 40% 28% 36% 25% 90-day Mortality 27% 25% 44% 34% 33% sICH 2% 10% 8% 10% 11% PROACT-2: Furlan, JAMA 1999 MERCI: Smith, Stroke 2005 Multi-MERCI: Smith, Stroke 2009 Penumbra Pivotal Trial, Stroke 2009 More Promising results from studies of stent-retrievers … SWIFT SWIFT Solitaire TREVO Trevo N 58 88 Age 67 67 NIHSS 18 19 Time to groin puncture 4.9H 4.6H TICI 2-3 NA 86% TIMI 2-3 69% NA 90d mRS 0-2 58% 40% 90d Mortality 17% 33% sICH 2% 7% SWIFT, Lancet 2012 TREVO 2, Lancet 2012 TREVO Anterior Cerebral Artery collaterals Infarct Core Ischemic Penumbra Posterior Cerebral Artery collaterals Tìm nguyên nhân ??? Siêu âm ĐM cảnh cột sống: Mảng xơ vữa nhỏ phình cảnh bên Không ghi nhận tắc hẹp có ý nghĩa Siêu âm xuyên sọ: hình ảnh tắc M1 MCA không thay đổi CT Scan không ghi nhận xuất huyết Sáng ngày thứ BN nằm li bì, ngủ gà Khám thần kinh: NIHSS-8 • Sức tay T: 3/5 • Sức chân T: 3/5 Không tìm câu trả lời ??? Người nhà bệnh nhân giúp bạn ! BN thay đổi tư nhiều lúc ngủ Ngáy lớn Có ngưng thở ngắn TCD monitoring of both MCAs during breath holding R MCA Steal response Normal response L MCA SM = (MFVm - MFVb)/MFVb] x 100 CT perfusion Reversed Robin Hood syndrome Stroke 2007 Nov; 38(11):3045-8 Normocapnia CBF Constant CBF Constant CBF Constant Hypercapnia CBF decrease Stroke 2009;40:2738-2742 • Consecutive patients with symptoms of acute cerebral ischemia admitted within 48 hours from symptom onset to our hospital were prospectively evaluated • Patients with known causes of neurological deterioration, including reocclusion, continuing embolization,edema with mass effect, and hemorrhagic transformation were excluded from the study Stroke 2009;40:2738-2742 Stroke 2009;40:2738-2742 BN chẩn đoán xác định “sleep apnea” test khảo sát giấc ngủ BN định thở CPAP sau BN tương tự KẾT LUẬN Tiến triển xấu giai đoạn cấp thường gặp LS Việc theo dỏi sát tìm nguyên nhân sớm giúp ích cho bệnh nhân HCM City Stroke Conference 14-15/ 10 /2017 Andrew Demchuk Henry Ma Craig Anderson Lawrence Wong Nijasri Suwewala Artemio A Roxas Bernard Chan Piere Jallon .. .Sau Điều Trị Cấp Early neurological deterioration (END) Early neurological deterioration (END) has been... reoccusion Hemodynamic steal Stroke in Progression Concept of Perfusion-Diffusion Mismatch Điều Trị Tái Tưới Máu Tái Thông Không Tái Thông Recanalization rates with large arteries Lansberg,