Early prediction of stroke severity. Role of the erythrocyte sedimentation rate

BACKGROUND AND PURPOSE

Early predictors of functional outcome after stroke are necessary for better planning of treatment and care.

METHODS

We evaluated prospectively early clinical predictors of short-term functional outcome in a group of patients with ischemic cerebral infarction and explored whether the intensity of the acute-phase response provided further information concerning the short-term functional outcome. We evaluated a group of 208 ischemic stroke patients using the Mathew scale at entry. All patients had neuroimaging studies and routine blood tests, including erythrocyte sedimentation rate (ESR), within 72 hours from clinical onset. At discharge, functional outcome was graded according to a Stroke Outcome Scale.

RESULTS

Larger infarcts, more embolic infarcts, and fewer lacunar infarcts were observed in the poor-outcome group. Vascular risk factors, radiological findings not related to the index stroke, time to admission, and treatment were similar in the two outcome groups. Variables with statistically significant differences between outcome groups included the following: age > 65 years, female sex, admission Mathew score < 75, worsening at clinical presentation, infarct volume > 6 cm3, complicating infections, fasting glucose > 110 mg, nonfasting glucose > 130 mg, and elevated ESR. With stepwise logistic regression analysis, Mathew score on admission, infarct volume, mode of clinical presentation, and ESR remained in the predictive model of stroke outcome, with a sensitivity and specificity of 89.91% and 85.71%, respectively. After removing the computed tomographic information from the model the same variables remained, with a sensitivity and specificity of 83.05% and 94.29%, respectively.

CONCLUSIONS

Infarct size and clinical severity on admission are the stronger predictors of short-term functional outcome. Mode of clinical presentation, clinical evolution during the first day of stroke, and ESR are also independent predictors of short-term stroke outcome. These findings might be indicative of an inadequate collateral profile and/or a more pronounced prothrombotic state.

[Wolfram's syndrome: correlation of clinical signs and neurological images]

Wolfram's syndrome is defined by the association of diabetes mellitus, diabetes insipidus, optic atrophy and nerve deafness. Other neurological anomalies, such as ataxia, nystagmus, tonic pupil, dizziness, dysarthria, dysphagia and epilepsy are rarely described and tend to appear later than the primary manifestations. We describe a patient with Wolfram's syndrome whose magnetic resonance image (MRI) of the head showed brainstem and cerebellar atrophy years before the appearance of clinical signs of brainstem disfunction. We conclude that alterations in MRI precede neurological symptoms by several years in Wolfram's syndrome.

[Limb shaking and loss of consciousness: a carotid-basilar artery syndrome]

We describe the brain MRI and cerebral blood flow characteristics in a patient with hypertension, severe bilateral carotid artery disease and moderate vertebrobasilar atheromatosis. When standing, the patient experienced short repetitive episodes of loss of consciousness and involuntary shaking of the lower extremities. We believe that, in this patient, the combination of bilateral perfusion insufficiency through the carotid artery, the local effects of atheromatosis of the penetrating branches arising from the basilar artery and the systemic effects of orthostatic hypotension may have caused ischemic lesions in the terminal zones of the paramedian branches of the basilar artery.

Laparoscopic ventral hernia repair

Laparoscopic repair of ventral hernia can be done with advanced training. We present a case report with intraoperative photographs and description of the surgical technique.

Reduced variation of the diurnal curve after the subscleral scheie procedure for primary open-angle glaucoma

We report the results of a one-year prospective study of the maximum intraocular pressure and the range of the oscillations of the diurnal curve after a subscleral Scheie procedure in 21 eyes (13 patients) with chronic primary open-angle glaucoma. Pressure curves were recorded preoperatively, during the immediate postsurgical period, at one month postoperatively, and every three months thereafter up to one year after surgery. Our results showed that this procedure reduced the maximum intraocular pressure and the oscillations of the diurnal curve (P < .001). This effect was maximum during the immediate postoperative period and decreased one month after surgery (P < .001).

Atonic pupil: an unusual complication of cataract surgery

Eight cases of atonic pupil, an unusual complication following cataract surgery, are presented. Six of the eyes involved had intracapsular cataract extraction and anterior chamber intraocular lens implantation; one case underwent extracapsular cataract extraction with a posterior chamber intraocular lens implantation; the other had an extracapsular procedure with no implant. The etiology is unknown, but we believe the most likely one is that the sodium hyaluronate used in all these patients caused a temporary reduction of the iris blood supply by mechanical factors or by a vasoconstriction induced by some toxicity of the material that produced a lesion on the iris sphincter.

Pressure-curve variations after trabeculectomy for chronic primary open-angle glaucoma

We report the results of a 5-year study of the influence of trabeculectomy on the maximum intraocular pressure (IOP) and the amplitude of its diurnal oscillation in 26 eyes (14 patients) with open-angle glaucoma. Pressure-curves were recorded before surgery and at 1 year and 5 years after surgery. The latter two pressure-curves demonstrated that trabeculectomy significantly reduced both the maximum IOP and the amplitude of the oscillations below preoperative values.

GC subtyping and HIV infection in a Spanish population: no evidence of an association between GC subtypes and AIDS

Group-specific component (GC) subtyping was performed by isoelectric focusing in 318 Spanish drug users at risk for infection or infected by HIV (85 HIV seronegatives, 111 HIV seropositives without symptoms, 89 seropositives with symptoms, 33 AIDS patients) and 187 healthy individuals. There was no significant association between GC subtypes and susceptibility to HIV infection and/or progression to AIDS.

Nonsuture surgery under microscopic control for basal cell carcinoma

Nonsuture surgery under microscopic control consists of conservative surgical excision of the tumor leaving the wound open and allowing it to granulate. Using fresh tissue technique, the lesion is cut in multiple horizontal sections from the depth up and examined under the microscope. In this form, a simple office procedure, removal is complete with minimum destruction of normal tissue. Cosmetic results are excellent.