Stroke 2013 July-6

 

The relatively good outcome of cerebellum-brainstem ischemic strokes.

Eur Neurol. 2013;69(1):8-13.

Korn-Lubetzki I, Molshatzki N, Benderly M, Steiner I; NASIS Investigators.

Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel. ikl @ cc.huji.ac.il

Abstract

BACKGROUND: Our clinical experience suggests that the outcome of cerebellum-brainstem ischemic strokes is better than that of hemispheric ischemic strokes.

METHODS: Within the setting of 2 national Israeli prospective stroke surveys, we analyzed risk factors, etiology, severity at presentation, and prognosis of first ischemic cerebellum-brainstem stroke (259 patients), comparing with strokes within the anterior circulation (1,029 patients).

RESULTS: Patients with cerebellum-brainstem strokes were younger and had less frequently atrial fibrillation and congestive heart failure. Cardioembolic etiology was significantly less prevalent (p < 0.001). Severity at presentation was milder (p < 0.001). At discharge, worsening of the modified Rankin Scale was present in a smaller number of patients (p < 0.001); more returned to their home (p < 0.001). Six-month and 1-year mortality were lower (p < 0.001 for both). Adjusted logistic regression models showed that patients with cerebellum-brainstem strokes had 50% smaller chances of dying (OR 0.55; 95% CI 0.31-0.98) and a smaller chance of worsening of the modified Rankin Scale at discharge (OR 0.61; 95% CI 0.46-0.82).

CONCLUSIONS: Cerebellum-brainstem strokes are less frequently cardioembolic, have a less severe presentation, and carry a better immediate and long-term prognosis. Copyright © 2012 S. Karger AG, Basel.

PMID: 23146821

Comments:  Our study can help the physicians dealing with cerebellum brainstem ischemic strokes. They can use our findings in order to reassure patients for their future prognosis. Moreover the fact that these strokes are less cardioembolic can support the decision that extensive cardiac workup can be done, if necessary, after discharge and not necessary while hospitalized.

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