Akademik Veri Yönetim Sistemi
Uluslararası 6. Türkiye İnme Akademisi ve Kurslar Kongresi , İzmir, Türkiye, 6 - 09 Ekim 2022, cilt.28, ss.27-28
INTRODUCTION AND AIMS: The cerebellum is connected to the brain stem by three large pairs of cerebellar peduncles that contain afferent and efferent pathways. We aimed to evaluate the discharge and 6th-month prognosis of ischemic infarct locations of patients with acute ischemic stroke (vermian, hemispheric and peduncular).
METHODS: As a subgroup analysis of our 200 patients with cerebellar ischemic infarction pattern, univariate and multivariate analyses were performed to evaluate the prognosis according to ischemic infarct localizations.
RESULTS: When the location of the ischemic lesions of the cases in the cerebellar anatomy is examined as vermian, hemispheric, and peduncular regions, it should be noted that more than one region and right/left or bilateral can be affected at the same time. Of the patients, 184 had hemispheric (right hemisphere 126 patients, left hemisphere 113 patients), 47 had vermian (right vermian 30 patients, left vermian 24 patients), and 33 had peduncular ischemic infarction (right cerebellar peduncles 23, left cerebellar peduncle 16 patients) has been recorded (Table 1). It was observed that the localization of the ischemic infarct lesion in the cerebellum on the left peduncle had statistically significant effects in terms of increasing the NIHSS (Table 2) and mRS (Table 3) at discharge, 6th-month follow-up mRS (Table 4) and 6th-month survival (Table 5). Variables found to be p<0.10 as a result of univariate statistical analyzes were included in the multinomial logistic regression model, considering that they may be effective in predicting prognosis in terms of discharge mRS. According to the retrospective stepwise elimination method, the presence of left cerebellar peduncle ischemia was observed as an important factor in differentiating the cases with mRS 0 from the cases with mRS 1-2-3, mRS 4-5, and mRS 6 in terms of discharge mRS (Table 6). The localization of the ischemic infarct lesion only on the left side of the peduncle had significant effects in terms of increased NIHSS and mRS at discharge. 6th-month follow-up mRS revealed impaired ambulation and decreased the 6th-month survival rates (p<0.05).
DISCUSSION AND CONCLUSION: The peduncles' synaptic, axonal, or myelin damage may be related to more limited clinical improvement. The absence of a recurrent microcompartment system in the peduncles, as present in the hemisphere and vermis, may lead to decreased plasticity during the healing process. Damage to the left cerebellar peduncle as seen in previous multiple sclerosis and glioma studies may cause disability in clinical status. The left superior cerebellar peduncle may cause permanent ambulatory disorders, leading to proprioception and ataxic gait loss. Functional and tractography neuroimaging studies are needed to confirm and settle this issue.