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Abstract(s)
Introdução: O Acidente Vascular Cerebral (AVC) faz parte de um leque de doenças
cardiovasculares que no seu conjunto, integram a principal causa de mortalidade em
Portugal e na Europa (1). A hemorragia intraparenquimatosa apresenta ainda uma
mortalidade significativa sendo que a sua abordagem não sofreu avanços significativos.
Cada caso deve ser avaliado individualmente de modo a obter uma intervenção adequada
em todos os fatores relacionados com o evento, obtendo assim o melhor prognóstico
possível. Assim, este estudo tem como objetivo estudar a relação entre o volume de
hemorragia intraparenquimatosa aguda na tomografia computadorizada crânioencefálica (TC-CE) de apresentação e a área final de lesão na TC-CE de controlo, já sem
hemorragia. Tem também um objetivo secundário, estudar a relação do volume
reabsorvido, e a percentagem deste com várias outras variáveis explicitadas na secção
dos métodos, assim como o seu impacto no prognóstico destes doentes.
Métodos: Estudo de investigação retrospetivo. Recolheram-se dados dos processos
clínicos armazenados no Sclinico de doentes hospitalizados na unidade de AVC do
Hospital Universitário Cova da Beira entre janeiro de 2008 e abril de 2012. Foram
excluídos os doentes que não apresentavam hemorragia intraparenquimatosa ou que não
apresentavam um exame de imagem de seguimento. A análise estatística destes dados
foi feita no SPSS.
Resultados: De 146 doentes com diagnóstico de AVC hemorrágico nestas datas, apenas
50 apresentavam todas as condições para serem incluídos no estudo. Há uma clara
relação entre o volume de hemorragia inicial medido na TC-CE e o volume de lesão final,
sendo que o volume de lesão inicial explica cerca de 35,6% da variância do volume de
lesão final (p-value < 0,001). As variáveis secundárias que contribuem para o volume de
lesão final na TC-CE são a afetação intraventricular, o volume de edema na lesão inicial,
a toma de antiagregantes, a contagem de plaquetas à admissão, a topografia da lesão e a
história pessoal de eventos cardiovasculares prévios e dislipidemias. Em relação à
sobrevivência no 1º ano após o evento agudo e independência para as atividades de vida
diária (AVD), apenas a topografia da lesão inicial apresentou uma relação
estatisticamente significativa (p-value 0,034 para independência AVD e p-value 0,032
para sobrevivência 1º ano após evento agudo).
Discussão: Este estudo estabelece uma clara relação entre o volume de hemorragia
intraparenquimatosa inicial e o volume da lesão final na TC-CE, quanto mais elevado o primeiro, mais elevado irá ser o volume de lesão final, e ainda destaca outras variáveis a
considerar para este volume final, como a influência do volume do edema perihematoma, a toma habitual de antiagregantes, a expansão intraventricular do
hematoma, a ocorrência de eventos cardiovasculares prévios, o diagnóstico de
dislipidemias, a topografia da lesão e a contagem de plaquetas à admissão. Os fatores de
prognóstico estudados apenas sofreram maior influência pela topografia da lesão, sendo
que lesões na fossa posterior estão associadas a piores outcomes.
Introduction: Stroke is part of a spectrum of cardiovascular diseases that in their total, integrate the main mortality cause in Portugal and in Europe. Intracerebral hemorrhage (ICH) still presents a significant mortality that could be explained by the lack of breakthrough developments in its management. Each case must be managed individually in order to obtain an adequate intervention of every factor contributing to the acute event, so that the best outcomes are achieved. This work aims to study the relationship between the acute ICH initial volume and the final lesion volume on the following head CT scan, where the bleeding has been reabsorbed. It also aims to study the relationship between the absorbed volume and its percentage and many other variables explicit in the methods section, as well as their impact in these patients’ prognosis. Methods: Retrospective investigation work. Data from clinical processes stored in Sclinico of patients hospitalised in the Hospital Universitário Cova da Beira’s stroke unit between January 2008 and April 2012 was extracted. Patients who didn’t present with ICH or didn’t have a following CT scan were excluded. The statistical analysis was done in SPSS. Results: Of 146 patients hospitalised in that unit with an ICH diagnosis, only 50 patients presented all the characteristics to be included in this study. There is a clear relationship between the initial lesion volume and the final lesion volume, and this initial lesion contributes around 35,6% of the final lesion variance (p-value <0,001). The secondary variables that contribute to the final lesion volume on head CT are intraventricular expansion, perilesional oedema, antiplatelets agents regime prior to the acute event, platelets counts on presentation, ICH site and personal history of previous cardiovascular events and dyslipidemias. Only ICH site has shown a significant contribution to outcomes such as daily activities independency (p-value 0,034) and survival in the first year following the acute event (p-value 0,032). Discussion: This work establishes a clear relationship between the initial ICH volume and the final lesion volume on head-CT, in which a greater initial volume will imply a greater final lesion volume. In addition, it also highlights the contribution of other variables such as the perilesional oedema, the antiplatelet regime prior to the event, the intraventricular expansion, the occurrence of previous cardiovascular events, prior dyslipidemia diagnosis, the ICH site and platelets count at admission. Only the ICH site has significantly contributed to the outcomes studied in this work, whither posterior fossa lesions were associated with worse outcomes.
Introduction: Stroke is part of a spectrum of cardiovascular diseases that in their total, integrate the main mortality cause in Portugal and in Europe. Intracerebral hemorrhage (ICH) still presents a significant mortality that could be explained by the lack of breakthrough developments in its management. Each case must be managed individually in order to obtain an adequate intervention of every factor contributing to the acute event, so that the best outcomes are achieved. This work aims to study the relationship between the acute ICH initial volume and the final lesion volume on the following head CT scan, where the bleeding has been reabsorbed. It also aims to study the relationship between the absorbed volume and its percentage and many other variables explicit in the methods section, as well as their impact in these patients’ prognosis. Methods: Retrospective investigation work. Data from clinical processes stored in Sclinico of patients hospitalised in the Hospital Universitário Cova da Beira’s stroke unit between January 2008 and April 2012 was extracted. Patients who didn’t present with ICH or didn’t have a following CT scan were excluded. The statistical analysis was done in SPSS. Results: Of 146 patients hospitalised in that unit with an ICH diagnosis, only 50 patients presented all the characteristics to be included in this study. There is a clear relationship between the initial lesion volume and the final lesion volume, and this initial lesion contributes around 35,6% of the final lesion variance (p-value <0,001). The secondary variables that contribute to the final lesion volume on head CT are intraventricular expansion, perilesional oedema, antiplatelets agents regime prior to the acute event, platelets counts on presentation, ICH site and personal history of previous cardiovascular events and dyslipidemias. Only ICH site has shown a significant contribution to outcomes such as daily activities independency (p-value 0,034) and survival in the first year following the acute event (p-value 0,032). Discussion: This work establishes a clear relationship between the initial ICH volume and the final lesion volume on head-CT, in which a greater initial volume will imply a greater final lesion volume. In addition, it also highlights the contribution of other variables such as the perilesional oedema, the antiplatelet regime prior to the event, the intraventricular expansion, the occurrence of previous cardiovascular events, prior dyslipidemia diagnosis, the ICH site and platelets count at admission. Only the ICH site has significantly contributed to the outcomes studied in this work, whither posterior fossa lesions were associated with worse outcomes.
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Keywords
Avc Avchemorrágico Neurologia Tc Volumes