RT Journal Article
SR Electronic
T1 Risk factors and clinical outcomes of basilar artery occlusion presenting with paroxysmal sympathetic hyperactivity as the initial manifestation: a prospective study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 892
OP 896
DO 10.1136/jnis-2023-020692
VO 16
IS 9
A1 Yin, Juntao
A1 Wang, Wan
A1 Wang, Yu
A1 Huo, Yichao
A1 Jia, Yanan
A1 Zhao, Peng
A1 Xu, Yingdong
A1 Li, Xiaoqiang
A1 Li, Guofeng
A1 Kong, Yongmei
A1 Wei, Yuqing
A1 Guo, Lixin
YR 2024
UL http://jnis.bmj.com/content/16/9/892.abstract
AB Background Paroxysmal sympathetic hyperactivity (PSH) has been linked to a worse clinical prognosis in patients with traumatic brain injury. We aimed to identify the risk factors and clinical features associated with basilar artery occlusion (BAO) presenting with PSH as the first clinical presentation.Methods This study recruited patients with acute BAO who received endovascular therapy (EVT) at two stroke centers in China. PSH Assessment Measure ≥8 was included in the PSH+ group, while those with a score below 8 were classified as the PSH− group. Clinical data and radiological findings were compared between the two groups. A binary logistic regression model was employed to identify independent risk factors for PSH.Results 101 participants were enrolled, of whom 19 (18.8%) presented with PSH as the initial manifestation of BAO. Worse prognosis (modified Rankin Scale score of 4–6) at day 90 occurred in 14 (73.7%) of the PSH+ patients and 42 (51.2%) of the PSH− patients (P=0.076). The 90-day mortality rate was higher in the PSH+ group with 12 (63.2%) participants, compared with 31 (37.8%) participants in the PSH− group (P=0.044). A significantly increased risk of PSH was found in patients with midbrain involvement (OR 6.53, 95% CI 1.56 to 27.30, P=0.01) and a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.15, 95% CI 1.01 to 1.31, P=0.037).Conclusions Patients with BAO presenting with PSH as the initial clinical manifestation experience a higher risk of 90-day mortality, despite undergoing EVT. Midbrain infarction and baseline NIHSS score may be significant risk factors for PSH following BAO.Data are available upon reasonable request.