1
|
Koizumi H, Hoshi K, Yamamoto D, Asari Y, Kumabe T. Relationship between Stroke Events during Pachinko Play and Prognosis. J Stroke Cerebrovasc Dis 2017; 26:2971-2975. [PMID: 28939050 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/08/2017] [Accepted: 07/23/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND This study investigated whether pachinko play influences the outcome of stroke events, and identified the significant variables affecting outcomes. METHODS We reviewed the medical and imaging records of 2075 consecutive patients with stroke from January 2003 through June 2012. The remaining patients were divided into 2 groups, the pachinko players group (PP) and the non-pachinko players group (NPP). Background factors were recorded on admission. Multivariate logistic regression analysis was used to identify the factors significantly correlated with Glasgow Outcome Scale (GOS) score and risk of death at the time of discharge. RESULTS The PP group exhibited higher prevalence of hypertension and current smoking compared with the NPP group. However, no difference was found in outcomes between the PP and NPP groups. Multivariate analysis identified the dependent predictive variables for GOS as age (adjusted β = -.18, 95% confidence interval [CI]: -.22 to -.14, P <.001), Glasgow Coma Scale (GCS) score on admission (adjusted β = .64, 95% CI: .60 to .68, P <.001), and history of hypertension (adjusted β = -.06, 95% CI: -.10 to -.02, P = .007). Logistic regression analysis showed that age (odds ratio = 1.02, 95% CI: 1.01 to 1.04, P <.001) and GCS score on admission (odds ratio = .72, 95% CI: .69 to .75, P <.001) were significantly associated with death at the time of discharge. CONCLUSIONS Patients with stroke during playing pachinko have higher prevalence of hypertension and higher smoking rate, but pachinko play itself was not a critical factor determining the outcome of patients with stroke in our emergency center.
Collapse
Affiliation(s)
- Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Keika Hoshi
- Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| |
Collapse
|
2
|
Suthar NN, Patel KL, Saparia C, Parikh AP. Study of clinical and radiological profile and outcome in patients of intracranial hemorrhage. Ann Afr Med 2016; 15:69-77. [PMID: 27044730 PMCID: PMC5402816 DOI: 10.4103/1596-3519.176259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Incidence of intracerebral hemorrhage (ICH) is twice as high as in Western countries. Prognostic factors for predicting function outcome and mortality play a major role in determining the treatment outcome. METHODS A prospective study of male and female patients ≥12 years with primary nontraumatic intracranial hemorrhage were included. Hemorrhage caused by trauma, anticoagulant or thrombolytic drugs, brain tumor, saccular arterial aneurysm or vascular malformation were excluded. Functional outcome of patients was determined by modified Rankin's scale. Glasgow Coma Scale (GCS) score and ICH score were calculated for each patient. RESULTS Hypertension was present in 45 out of 49 patients (92%) with ICH of basal ganglia. Hypertension was significantly associated with worst clinical outcome. Mortality was high if the patient was comatose/stuporous compared to drowsy state (P < 0.0001). Mortality was found to be high when the size exceeded 30 cm3. High ICH score, low GCS score at the time of admission, presence of intraventricular hemorrhage, and midline shift were significantly associated with poor clinical outcome. CONCLUSIONS Intracranial hemorrhage can be deleterious if present with low GCS score, high ICH score, intraventricular extension, and midline shift.
Collapse
Affiliation(s)
- Nilay N Suthar
- Department of Internal Medicine, Sheth V.S. General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | | | | | | |
Collapse
|
3
|
Zhang H, Peng Y, Ju Z, Wang N, Xu T, Tong W, Zhang Y. Admission pulse pressure and short-term clinical outcome in patients with intracerebral and subarachnoid hemorrhage in Inner Mongolia, China. Neurol Res 2013; 33:285-9. [DOI: 10.1179/016164110x12759951866911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
4
|
Jiang YL, Liu XS, Chan DKY. Use of percutaneous endoscopic gastrostomy in stroke patients: Recent progress. Shijie Huaren Xiaohua Zazhi 2012; 20:2162-2166. [DOI: 10.11569/wcjd.v20.i23.2162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is much controversy over the use of percutaneous endoscopic gastrostomy (PEG) for management of dysphagia in stroke patients. An analysis of recent studies in this field indicates that appropriate timing of PEG in selected appropriate patients will provide therapeutic benefit.
Collapse
|
5
|
Management of non-traumatic intraventricular hemorrhage. Neurosurg Rev 2012; 35:485-94; discussion 494-5. [PMID: 22732889 DOI: 10.1007/s10143-012-0399-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/03/2012] [Indexed: 01/15/2023]
Abstract
Intraventricular hemorrhage (IVH) is defined as the eruption of blood in the cerebral ventricular system and is mostly secondary to spontaneous intracerebral hemorrhage and aneurysmal and arteriovenous malformation rupture. IVH is a proven risk factor of increased mortality and poor functional outcome. Its seriousness is correlated not only with the amount of blood but also with the involvement of the third and fourth ventricles. There are four mechanisms that explain the pathophysiology of this event: acute obstructive hydrocephalus, the mass effect exerted by the blood clot, the toxicity of blood-breaking products on the adjacent brain parenchyma, and, lastly, the development of a chronic hydrocephalus. It is thus obvious that the clearance of blood from the ventricles should be a therapeutic goal. In cases of acute hydrocephalus, external ventricular drainage is a mandatory step, but proven often insufficient. The concomitant use of intraventricular fibrinolytics such as recombinant tissue plasminogen activator or urokinase seems to be beneficial at least in the context of spontaneous intracerebral hemorrhage, in which their use is now accepted but not yet validated by a randomized trial. Given the potential neurotoxicity of these agents, further research is needed in order to identify the best treatment for intraventricular fibrinolysis (IVF). The endoscopic retrieval of intraventricular blood was also described recently and seems to be as efficient as IVF, but its use is limited to specialized centers. IVH represents a therapeutic challenge for neurosurgeons, neurologists, and intensivists. Thus, a better understanding of this dramatic event will help in better tailoring the treatment strategies.
Collapse
|
6
|
Keong LH, Ghani ARI, Awang MS, Sayuthi S, Idris B, Abdullah JM. The role of a high augmentation index in spontaneous intracerebral hemorrhage to prognosticate mortality. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:375-9. [PMID: 21725785 DOI: 10.1007/978-3-7091-0693-8_63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The aim of the study was to determine the prognostic value of a high augmentation index, which was a surrogate marker of arterial stiffness in patients with spontaneous intracerebral hemorrhage. The outcome was divided into two groups in which the following data were collected in a computer running SphygmoCor CvMS software version 8.2. Logistic regression analysis was carried out among significant variables to identify an independent predictor of 6-month outcome and mortality. Sixty patients were recruited into the study. Admission Glasgow Coma Scale score (OR, 0.7; 95% CI, 0.450-0.971; P=0.035), total white cell count (OR, 1.2; 95% CI, 1.028-1.453; P=0.023) and hematoma volume (OR, 1.1; 95% CI, 1.024-1.204; P=0.011) were found to be statistically significant for identifying poor 6-month outcome in multivariate analysis. Factors independently associated with mortality were a high augmentation index (OR, 8.6; 95% CI, 1.794-40.940; P=0.007) and midline shift (OR, 7.5; 95% CI, 1.809-31.004; P=0.005). Admission Glasgow Coma Scale score, total white cell count and hematoma volume were significant predictors for poor 6-month outcome, and a high augmentation index and midline shift were predictors for 6-month mortality in this study.
Collapse
Affiliation(s)
- Lee Hock Keong
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Jalan Sultanah Zainab 2, Kubang Kerian, Kota Bharu, 16150, Kelantan, Malaysia
| | | | | | | | | | | |
Collapse
|
7
|
Lee HK, Ghani ARI, Awang MS, Sayuthi S, Idris B, Abdullah JM. Role of High Augmentation Index in Spontaneous Intracerebral Haemorrhage. Asian J Surg 2010; 33:42-50. [DOI: 10.1016/s1015-9584(10)60008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2010] [Indexed: 10/19/2022] Open
|
8
|
Jaffe J, AlKhawam L, Du H, Tobin K, O'Leary J, Pollock G, Batjer HH, Awad IA. OUTCOME PREDICTORS AND SPECTRUM OF TREATMENT ELIGIBILITY WITH PROSPECTIVE PROTOCOLIZED MANAGEMENT OF INTRACEREBRAL HEMORRHAGE. Neurosurgery 2009; 64:436-45; discussion 445-6. [DOI: 10.1227/01.neu.0000330402.20883.1b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Risk predictors, spectrum of treatment eligibility, and range of expected outcomes have not been validated in consecutive series including all cases of intracerebral hemorrhage (ICH) subjected to a prospective management protocol based on current guidelines.
METHODS
Eighty-six cases of ICH were prospectively identified in conjunction with screening for a clinical trial during an 18-month period. All patients were subjected to protocolized management based on published “best practice” guidelines for ICH. Medical records were reviewed by trained researchers, and outcomes were assessed at various time points including latest follow-up (range, 0–24 months; mean, 3.97 months). Initial assessment parameters, treatment eligibility, and outcomes were based on standardized criteria.
RESULTS
In accordance with past literature, mortality and functional outcomes were significantly worse in older patients, those with a larger ICH volume, and worse Glasgow Coma Scale scores, in univariate and multivariate models. The presence and severity of associated intraventricular hemorrhage also correlated with mortality and outcome. Significantly lower mortality (P = 0.024) and better functional outcomes (P = 0.018) were achieved at 30 days in patients with an ICH volume of less than 30 cm3 in this series than in previously published community-based historical controls without protocolized care. A tight correspondence between treatment eligibility and treatment administered was found.
CONCLUSION
Previous estimates of poorer outcome in patients with ICH might not apply to contemporary management protocols, especially in patients with a smaller ICH volume. Outcome ranges in various risk categories and modeling of treatment eligibility will help project more realistic prognostication and assist with the design of future trials.
Collapse
Affiliation(s)
- Jennifer Jaffe
- Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Lora AlKhawam
- Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Hongyan Du
- Center for Outcomes Research and Education, NorthShore University HealthSystem, Evanston, Illinois
| | - Kristen Tobin
- Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Judith O'Leary
- Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Glen Pollock
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - H. Hunt Batjer
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Issam A. Awad
- Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
9
|
Braga P, Ibarra A, Rega I, Ketzoian C, Pebet M, Servente L, Benzano D. Prediction of early mortality after acute stroke. J Stroke Cerebrovasc Dis 2007; 11:15-22. [PMID: 17903850 DOI: 10.1053/jscd.2002.123970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2001] [Indexed: 11/11/2022] Open
Abstract
The purpose of this trial was to identify clinical factors and evaluation studies with significant value as mortality predictors in patients suffering an acute stroke. One hundred forty-eight consecutive patients hospitalized at the Hospital de Clínicas, Montevideo, with a clinical diagnosis of stroke were studied: 85 had ischemic strokes and 63 presented with intracerebral hemorrhages. The potentially predictive variables (past medical history, clinical assessment, neuroimaging, biochemical analysis) were evaluated within the first 24 hours of admission; patient follow-up was performed until they left the hospital or died. The modified National Institutes of Health Stoke Scale (NIHSS) was used to assess neurologic impairment. Three variables were identified as early mortality predictors in this population: (1) Glasgow Coma Scale score < or = 11 on admission (R = 0.19); (2) severe mass effect, defined as the presence of ventricular shift across the midline and/or enlargement of contralateral ventricle in early computed tomography (CT) scan (R = 0.26); and (3) modified NIHSS quotient score > or = 0.26 on admission (R = 0.27). We conclude that modified NIHSS was the most consistent instrument for an early identification of patients at high mortality risk, even before confirmatory evidence of the stroke's nature was obtained. A cutoff of 0.26 on NIHSS quotient score on admission was identified as the most significant predictive value.
Collapse
Affiliation(s)
- Patricia Braga
- Neuroepidemiology Section, Neurology Institute, Hospital de Clínicas, School of Medicine, University of the Republic, Montevideo, Uruguay
| | | | | | | | | | | | | |
Collapse
|
10
|
Ariesen MJ, Algra A, van der Worp HB, Rinkel GJE. Applicability and relevance of models that predict short term outcome after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 2005; 76:839-44. [PMID: 15897508 PMCID: PMC1739684 DOI: 10.1136/jnnp.2004.048223] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Several models for prediction of short term outcome after intracerebral haemorrhage (ICH) have been published, however, these are rarely used in clinical practice for treatment decisions. This study was conducted to identify current models for prediction of short term outcome after ICH and to evaluate their clinical applicability and relevance in treatment decisions. METHODS MEDLINE was searched from 1966 to June 2003 and studies were included if they met predefined criteria. Regression coefficients of multivariate models were extracted. Two neurologists independently evaluated the models for applicability in clinical practice. To assess clinical relevance and accuracy of each model, in a validation series of 122 patients the proportion with a >or=95% probability of death or poor outcome and the actual 30 day case fatality in these patients were calculated. Receiver operator characteristic (ROC) curves were computed for assessment of discriminatory power. RESULTS A total of 18 prognostic models were identified, of which 14 appeared easy to apply. In the validation series, the proportion of patients with a >or=95% probability of death or poor outcome ranged from 0% to 43% (median 23%). The 30 day case fatality in these patients ranged from 75% to 100% (median 93%). The area under the ROC curves ranged from 0.81 to 0.90. CONCLUSIONS Most models are easy to apply and can generate a high probability of death or poor outcome. However, only a small proportion of patients have such a high probability, and 30 day case fatality is not always correctly predicted. Therefore, current models have limited relevance in triage, but can be used to estimate the chances of survival of individual patients.
Collapse
Affiliation(s)
- M J Ariesen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 06.131, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | | | | | | |
Collapse
|
11
|
Diamond P, Gale S, Stewart K. Primary intracerebral haemorrhage--clinical and radiologic predictors of survival and functional outcome. Disabil Rehabil 2003; 25:689-98. [PMID: 12791554 DOI: 10.1080/0963828031000090470] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Primary intracerebral haemorrhage (ICH) is a common and devastating disorder that often results in long-term disability. This review examines the literature on predictors of survival and long-term functional outcome after ICH. METHOD Medical literature review. RESULTS Numerous clinical and radiologic variables have been shown to be associated with survival and functional recovery following ICH. These include patient age and gender, lesion size and location, initial level of consciousness, presence of intraventricular haemorrhage, hydrocephalus, and mass effect. Studies have employed a variety of outcome measures including survival and functional recovery. CONCLUSIONS Clinical and radiologic findings following ICH may assist rehabilitation specialists as they develop treatment goals, anticipate long-term patient care needs, and educate and train caregivers.
Collapse
Affiliation(s)
- Paul Diamond
- Division of Neurorehabilitation, Department of Physical Medicine and Rehabilitation, University of Virginia Health System, 545 Ray C. Hunt Drive, Suite 240, PO Box 801004, Charlottesville, VA 22908-1004, USA.
| | | | | |
Collapse
|
12
|
Nilsson OG, Lindgren A, Brandt L, Säveland H. Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population. J Neurosurg 2002; 97:531-6. [PMID: 12296635 DOI: 10.3171/jns.2002.97.3.0531] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Predictors of early (30-day) and long-term (1-year) mortality rates after primary intracerebral hemorrhage (ICH) were studied in a large population in southern Sweden.
Methods. All cases of primary ICH, verified using computerized tomography (CT) scanning or autopsy study, were prospectively registered at the 12 hospitals covering a defined population of 1.14 million during the calendar year 1996. Mortality was analyzed in relation to CT findings (hematoma location and volume and ventricular extension) and clinical parameters (patient age and sex, level of consciousness on admission, and history of preictal risk factors) by using univariate and multivariate statistical methods.
Three hundred forty-one cases of primary ICH were detected. The overall mortality rate was 36% at the 30-day and 47% at the 1-year follow up. Multivariate analysis revealed that initial level of consciousness, hematoma volume, and a history of heart disease were independent predictors of death at 30 days postictus. One year after bleeding, independent predictors of mortality were the initial level of consciousness, patient age, and hematoma location.
Conclusions. Primary ICH remains a stroke subtype associated with a high mortality rate and for which the level of consciousness on admission is the strongest predictor of fatal outcome both at 30 days and during the 1st year after bleeding. A preictal history of heart disease increased the 30-day mortality rate.
Collapse
Affiliation(s)
- Ola G Nilsson
- Department of Neurosurgery, Lund University Hospital, Sweden.
| | | | | | | |
Collapse
|
13
|
Liliang PC, Liang CL, Lu CH, Chang HW, Cheng CH, Lee TC, Chen HJ. Hypertensive caudate hemorrhage prognostic predictor, outcome, and role of external ventricular drainage. Stroke 2001; 32:1195-200. [PMID: 11340233 DOI: 10.1161/01.str.32.5.1195] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the present study was to analyze the outcome and outcome predictors of caudate hemorrhage and role of external ventricular drainage in acute hydrocephalus. METHODS Clinical data from 36 consecutive patients with hypertensive caudate hemorrhage was used in the present study. Age, gender, volume of parenchymal hematoma, hematoma in the internal capsule, initial Glasgow Coma Scale (GCS), hydrocephalus, severity of intraventricular hemorrhage, and hemorrhagic dilatation of the fourth ventricle were analyzed for effect on outcome. Effect of external ventricle drainage for hydrocephalus was evaluated by comparing preoperative and postoperative GCS scores. RESULTS By univariate analyses, poor outcome was associated with a poor initial GCS score (P=0.016), hydrocephalus (P<0.001), intraventricular hemorrhage severity (P<0.01), and hemorrhagic dilatation of the fourth ventricle (P=0.02). By multivariate analysis, stepwise logistic regression revealed that hydrocephalus was the only independent prognostic factor for poor outcome (P<0.001). Postoperative 48-hour GCS score was better than the preoperative score by use of paired-sample t test (P<0.001). CONCLUSIONS Hydrocephalus is the most important predictor of poor outcome. External ventricular drainage response for hydrocephalus was good in the present study, whereas an early decision should be made regarding preoperative neurological condition.
Collapse
Affiliation(s)
- P C Liliang
- Departments of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niaosung Hsiang, Kaohsiung Hsien, Taiwan
| | | | | | | | | | | | | |
Collapse
|