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Altiparmak T, Nazliel B, Batur Caglayan H, Tokgoz N, Akyol Gurses A, Ucar M. Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECT) for the Evaluation of Cerebellar Infarcts. Neurologist 2022; 27:304-308. [PMID: 35051968 DOI: 10.1097/nrl.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates. MATERIALS AND METHODS We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study. RESULTS Patients with a pc-ASPECT score <7 were more likely to present with impaired consciousness ( P <0.001), multiple posterior circulation infarcts ( P <0.001), hydrocephalus ( P <0.001), lesions of the vermis ( P =0.028), and peduncle ( P =0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery ( P <0.05), and basilar artery stenosis ( P =0.005), ischemia in additional anatomical structures in the posterior circulation ( P <0.001) compared with those with a score ≥7. CONCLUSIONS Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis.
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Affiliation(s)
| | | | | | - Nil Tokgoz
- Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Murat Ucar
- Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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2
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Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10. Life (Basel) 2021; 11:life11121423. [PMID: 34947955 PMCID: PMC8703711 DOI: 10.3390/life11121423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion ("functional" BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0-0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0-0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33-16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16-3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.
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Hejazi ME, Malek Mahdavi A, Navarbaf Z, Tarzamni MK, Moradi R, Sadeghi A, Valizadeh H, Namvar L. Relationship between chest CT scan findings with SOFA score, CRP, comorbidity, and mortality in ICU patients with COVID-19. Int J Clin Pract 2021; 75:e14869. [PMID: 34525236 PMCID: PMC8646744 DOI: 10.1111/ijcp.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between chest computed tomography (CT) scan findings with sequential organ failure assessment (SOFA) score, C-reactive protein (CRP), comorbidity, and mortality in intensive care unit (ICU) patients with coronavirus disease 19 (COVID-19). METHOD Adult patients (≥18 years old) with COVID-19 who were consecutively admitted to the Imam-Reza Hospital, Tabriz, East-Azerbaijan Province, North-West of Iran between March 2020 and August 2020 were screened and total of 168 patients were included. Demographic, clinical, and mortality data were gathered. Severity of disease was evaluated using the SOFA score system. CRP levels were measured and chest CT scans were performed. RESULTS Most of patients had multifocal and bilateral ground glass opacity (GGO) pattern in chest CT scan. There were significant correlations between SOFA score on admission with multifocal and bilateral GGO (P = .010 and P = .011, respectively). Significant relationships were observed between unilateral and bilateral GGO patterns with CRP (P = .049 and P = .046, respectively). There was significant relationship between GGO patterns with comorbidities including overweight/obesity, heart failure, cardiovascular diseases, and malignancy (P < .05). No significant relationships were observed between chest CT scan results with mortality (P > .05). CONCLUSION Multifocal bilateral GGO was the most common pattern. Although chest CT scan characteristics were significantly related with SOFA score, CRP, and comorbidity in ICU patients with COVID-19, a relationship with mortality was not significant.
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Affiliation(s)
- Mohammad Esmaeil Hejazi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Aida Malek Mahdavi
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Zahra Navarbaf
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyMedical SchoolTabriz University of Medical SciencesTabrizIran
| | - Rozhin Moradi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
| | - Armin Sadeghi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Hamed Valizadeh
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Leila Namvar
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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Yamauchi K, Kumagae K, Goto K, Hagiwara R, Uchida Y, Harayama E, Tanaka S, Kuroyama S, Koyanagi Y, Arakawa S. Predictive Validity of the Scale for the Assessment and Rating of Ataxia for Medium-Term Functional Status in Acute Ataxic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105631. [PMID: 33508726 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105631] [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: 11/07/2020] [Revised: 01/09/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study examines the prognostic validity of the Scale for the Assessment and Rating of Ataxia for patients with acute stroke. MATERIALS AND METHODS We enrolled 120 patients with posterior circulation stroke having ischemic or hemorrhagic lesions with ataxia who had physical therapy. We recorded the clinical stroke features and obtained the scale for the assessment and rating of ataxia and National Institutes of Health Stroke Scale scores 7 days after admission and at discharge. Predictive factors for a 3-month modified Rankin Scale score of <3 were investigated. RESULTS During hospitalization, the Scale for the Assessment and Rating of Ataxia score decreased from 7.5 (interquartile range, 4.5-12.5) to 4.0 (interquartile range, 1.5-8.0) points, whereas the National Institutes of Health Stroke Scale score changed from 1 (interquartile range, 0-3) to 1 (interquartile range, 0-2) point. A significant correlation between functional outcome and the Scale for the Assessment and Rating of Ataxia scores 7 days after onset was observed. The cutoff value for the assessment and rating of ataxia for predicting favorable outcome (modified Rankin scale, 0-2) at 3 months post-onset was 14 points (0-40) at 7 days after onset. CONCLUSIONS The Scale for the Assessment and Rating of Ataxia scores showed good responsiveness to neurological changes in patients with acute ataxic stroke, could predict functional outcomes 3 months after onset on day 7, and could be a useful and reliable marker for patients with ataxic stroke.
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Affiliation(s)
- Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Risa Hagiwara
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Yoshiko Uchida
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Sota Kuroyama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Yasuhiro Koyanagi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
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5
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Zhou LS, Li XQ, Zhou ZH, Chen HS. Effect of Argatroban Combined With Dual Antiplatelet Therapy on Early Neurological Deterioration in Acute Minor Posterior Circulation Ischemic Stroke. Clin Appl Thromb Hemost 2020; 26:1076029620904131. [PMID: 32013541 PMCID: PMC7288810 DOI: 10.1177/1076029620904131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is a lack of studies on anticoagulant plus antiplatelet therapy for acute ischemic stroke. The present study made a pilot effort to investigate the efficacy and safety of argatroban plus dual antiplatelet therapy (DAPT) in patients with acute posterior circulation ischemic stroke (PCIS). We retrospectively collected patients diagnosed with acute PCIS according to inclusion/exclusion criteria. According to treatment drugs, patients were divided into an argatroban plus DAPT group and a DAPT group. The primary efficacy end point was the proportion of early neurological deterioration (END). The primary safety outcome was symptomatic intracranial hemorrhage. All outcomes were compared between the 2 groups before and after propensity score matching (PSM). A total of 502 patients were enrolled in the study, including 35 patients with argatroban plus DAPT and 467 patients with DAPT. There was a higher National Institutes of Health Stroke Scale (NIHSS) score in the argatroban plus DAPT group than the DAPT group before PSM (3 vs 2, P = .017). Compared with the DAPT group, the argatroban plus DAPT group had no END (before PSM: 0% vs 6.2%, P = .250; after PSM: 0% vs 5.9%, P = .298). Argatroban plus DAPT yielded a significant decrease in the NIHSS score from baseline to 7 days after hospitalization, compared with that of the DAPT group before PSM (P = .032), but not after PSM (P = .369). No symptomatic intracranial hemorrhage was found in any patient. A short-term combination of argatroban with DAPT appears safe in acute minor PCIS.
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Affiliation(s)
- Ling-Shan Zhou
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Zhong-He Zhou
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
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6
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Meng PP, Zhang SC, Han C, Wang Q, Bai GT, Yue SW. The Occurrence Rate of Swallowing Disorders After Stroke Patients in Asia: A PRISMA-Compliant Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:105113. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/07/2023] Open
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7
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Zhu J, Chen C, Shi R, Li B. Correlations of CT scan with high-sensitivity C-reactive protein and D-dimer in patients with coronavirus disease 2019. Pak J Med Sci 2020; 36:1397-1401. [PMID: 32968416 PMCID: PMC7501002 DOI: 10.12669/pjms.36.6.2961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To study the correlations of CT scan with high-sensitivity C-reactive protein (hs-CRP) and D-dimer in patients with coronavirus disease 2019 (COVID-2019). METHODS From January to March 2020, COVID-19 patients were divided into two groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial version 7), with mild and ordinary cases as Group-1 and critical and severe cases as Group-2. The chest CT scan results, hs-CRP, D-dimmer levels of the two groups from admission to discharge were compared by the χ2 test or Fisher's exact test. The quantitative data were represented as mean ± standard deviation ( x ± s). Intergroup comparisons were performed by the independent samples t test, and the ineligible data were subjected to the nonparametric rank sum test. Binary logistic regression model was used for multivariate correlation analysis, using independent variables that were significant in univariate analysis. The correlations between the above indices were analyzed. RESULTS In Group-1, there were two cases of normal chest CT scan results, one case of fibrosis, and 25 cases of abnormalities during the first diagnosis, mainly manifested as single or scattered ground-glass shadows. After treatment, the CT scan results became normal. The chest CT scan of Group-2 showed abnormalities, including 21 cases of multiple ground-glass shadows, and six cases of multiple consolidations accompanied by ground-glass shadows, who were critically ill and died. In addition, there were 16 cases of multiple ground glass shadows with partial consolidation, and the CRP and D-dimer levels of Group-2 were significantly higher than those of Group-1. Chest CT scan results were significantly positively correlated with CRP and D-dimer levels (P<0.05). CONCLUSION The chest CT scan results of COVID-19 patients are characteristic, being correlated with CRP and D-dimer levels. D-dimer and CRP levels significantly increase in most severe and critical patients, which are closely related to their prognosis. The indices may play predictive roles in clinical treatment and prognosis evaluation.
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Affiliation(s)
- Jin Zhu
- Jin Zhu, Department of Intervention, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, P.R. China
| | - Cheng Chen
- Cheng Chen, Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, P.R. China
| | - Rongshu Shi
- Rongshu Shi, Department of Intervention, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, P.R. China
| | - Bangguo Li
- Bangguo Li, Department of Imaging, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, P. R. China
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8
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Zhao W, Ma P, Zhao W, Yang B, Zhang Y, Song J, Zhang P, Yue X. The Safety and Efficacy of Mechanical Thrombectomy in Posterior VS. Anterior Emergent Large Vessel Occlusion: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2020; 29:104545. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/22/2019] [Accepted: 11/17/2019] [Indexed: 01/19/2023] Open
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9
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Wang L, Li Y, Wang C, Guo W, Liu M. C-reactive Protein, Infection, and Outcome After Acute Ischemic Stroke: A Registry and Systematic Review. Curr Neurovasc Res 2020; 16:405-415. [PMID: 31738143 DOI: 10.2174/1567202616666191026122011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
Background:
A number of studies have explored the prognostic role of CRP in patients
with acute ischemic stroke, however, the results have been inconclusive. The aim of our study was
to investigate the impact of infection on the association between CRP and 3-month functional outcome
by performing a registry study and systematic review.
Methods:
Patients admitted within 24 hours of acute ischemic stroke onset and had CRP measured
within 24 hours after admission were included. Patients admitted between June 2016 and December
2018 in Chengdu Stoke Registry were enrolled. The PubMed database was searched up to July
2019 to identify eligible studies. Poor outcome was defined as modified Rankin Scale scores at
3-month more than 3.
Results:
Totally, 368 patients in the registry and 18 studies involving 15238 patients in the systematic
review were included. A statistically significant association between CRP values on admission
and 3-month poor outcome in patients without infection was found, both in our registry
(CRP per 1-mg/L increment, OR 1.04, 95% CI 1.01 to 1.07, p=0.008) and meta-analysis (CRP per
1-mg/dL increment, OR 1.66 [95% CI 1.37 to 2.01, p<0.001]). In patients with infection, CRP was
not associated with a 3-month poor outcome according to registry data (OR 1.00, 95% CI 0.99 to
1.01, p=0.663) and meta-analysis (OR 1.01, 95% CI 0.99 to 1.01, p=0.128).
Conclusion:
High CRP value was independently associated with a 3-month poor outcome after
stroke in patients without infection. Further studies are required to examine the value of infection
on CRP measures and long-term functional outcomes.
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Affiliation(s)
- Lu Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuxiao Li
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Changyi Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wen Guo
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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10
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Li H, Dai Y, Wu H, Luo L, Wei L, Zhou L, Lin Y, Wang Q, Lu Z. Predictors of Early Neurologic Deterioration in Acute Pontine Infarction. Stroke 2019; 51:637-640. [PMID: 31795900 DOI: 10.1161/strokeaha.119.027239] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The relationship between infarct dimensions and neurological progression in patients with acute pontine infarctions remains unclear. This study aimed to investigate the morphometric predictive value of magnetic resonance imaging for early neurological deterioration (END) in acute pontine infarction. Methods- We included all patients admitted to our department having an acute ischemic stroke in the pons. The ventrodorsal length multiplied by thickness was measured as parameters of infarct size. END was defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power, or ≥2 points in the total score within the first week after admission. Results- We enrolled 407 patients, and 114 (28.0%) patients were diagnosed with END. Adjusted logistic regression analyses showed the maximum length multiplied by thickness was independently associated with END (odds ratio, 4.580 [95% CI, 2.909-7.210]). The sensitivity, specificity, and area under the curve were 77.2%, 79.2%, and 0.843, respectively, in the receiver operating characteristic curve analysis of maximum length multiplied by thickness for predicting END. Conclusions- These results suggest that the maximum length multiplied by thickness may be a possible predictor in the evaluation of progression with isolated acute pontine infarction. The extent of the pontine infarction along the conduction tract may contribute to deterioration.
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Affiliation(s)
- Haiyan Li
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Neurosurgery (H.L., Q.W.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yongqiang Dai
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Haotian Wu
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lingyun Luo
- Department of Neurology, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-Sen University, Meizhou, Guangdong, China (L.L.)
| | - Lei Wei
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Li Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, China (L.Z.)
| | - Yinyao Lin
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qiujing Wang
- Department of Neurosurgery (H.L., Q.W.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhengqi Lu
- From the Department of Neurology (H.L., Y.D., H.W., L.W., Y.L., Z.L.), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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11
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Chen H, Hu Q, Raza HK, Singh S, Rai P, Zhu J, Cui G, Ye X, Xu C, Jing J, Liu Y. An Analysis of Clinical Characteristics of Rare Bilateral Cerebral Peduncular Infarction. Front Neurol 2019; 10:1107. [PMID: 31708855 PMCID: PMC6823180 DOI: 10.3389/fneur.2019.01107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/02/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: To investigate the anatomical characteristics, clinical manifestations, and imaging features of bilateral cerebral peduncular infarction. Methods: A retrospective analysis was performed on 11 patients diagnosed with bilateral cerebral peduncular infarction in the Affiliated Hospital of Xuzhou Medical University from December 2014 to December 2018. Their clinical and imaging features were analyzed and summarized in combination with the relevant national and international literature. Results: Among all the patients, there were eight cases with a history of hypertension, four cases with a history of diabetes mellitus, and four cases with a history of smoking. Conscious disturbance was observed in nine cases, quadriplegia in seven cases, pseudobulbar paralysis in three cases, and ataxia in one case. Brain magnetic resonance (MR) scans of bilateral cerebral peduncles showed patchy abnormal shadows with a hypointense signal on T1-weighted imaging (T1WI) and apparent diffusion coefficient (ADC) and hyperintense signal on T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI). Computed tomography angiography (CTA) scans of head and neck showed severe stenosis or occlusion of vertebral artery, basilar artery, or posterior cerebral artery. All the patients received standardized treatment for cerebral infarction. Six patients died while five were left disabled. Conclusion: Bilateral cerebral peduncle infarction may be related to cerebral perfusion insufficiency caused by the stenosis or occlusion of vertebrobasilar artery and its branches. The main clinical manifestations are locked-in syndrome and persistent vegetative state. The specific imaging feature of "Mickey Mouse ear"-like infarction is associated with a poor prognosis.
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Affiliation(s)
- Hao Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qian Hu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hafiz Khuram Raza
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,School of International Education, Xuzhou Medical University, Xuzhou, China
| | - Sandeep Singh
- School of International Education, Xuzhou Medical University, Xuzhou, China
| | - Pabitra Rai
- School of International Education, Xuzhou Medical University, Xuzhou, China
| | - Jienan Zhu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xinchun Ye
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chuanying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia Jing
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Yonghai Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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12
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Kim SH, Kim JI, Lee JY, Park CI, Hong JY, Lee SS. Is spontaneous normalization of systolic blood pressure within 24 hours after ischemic stroke onset related with favorable outcomes? PLoS One 2019; 14:e0224293. [PMID: 31639163 PMCID: PMC6804986 DOI: 10.1371/journal.pone.0224293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background In acute ischemic stroke, blood pressure (BP) tends to rise initially and fall to a baseline level within 24–48 hours. Previous studies reported several different effects of BPs during acute ischemic stroke on clinical outcomes, which was partly due to the different time intervals from stroke onset to BP measurement. Methods All patients with acute ischemic stroke (onset ≤3 hours) who lived independently before the stroke, were consecutively enrolled for a 62-month period. BPs at 0, 12, and 24 hours after admission were collected. A favorable outcome was defined as a modified Rankin Scale (mRS) score 0–2 at discharge. For different standards of BP management, patients were grouped and analyzed according to intravenous (IV) tissue plasminogen activator (tPA) treatment and favorable outcome. Results Among the 446 enrolled patients, 227 patients underwent IV tPA treatment and 216 had mRS score 0–2 at discharge. Patients with favorable outcomes had lower initial NIH Stroke Scale (NIHSS) scores, less frequent progressive neurological deficits, and lower systolic BP (SBP) 12 and 24 hours after admission than patients with unfavorable outcomes, regardless of whether they underwent tPA treatment or not (p <0.05). The BP decreased over a period of 24 hours after admission. In logistic regression analysis, the independent variables associated with favorable outcome were the initial NIHSS score, a progressive neurological deficit, a previous stroke, and the SBP 24 hours after admission in the patients who underwent tPA treatment and the initial NIHSS score and a progressive neurological deficit in the patients who did not undergo tPA treatment (p <0.05). Conclusions The SBPs at 12 and 24 hours after admission were lower in acute stroke patients with favorable outcomes than in the other patients, regardless of whether the patients underwent tPA therapy and the SBP at 24 hours was an independent predictor of favorable outcomes among the patients who underwent tPA treatment.
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Affiliation(s)
- Seo Hyun Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
- * E-mail:
| | - Ji In Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Ji-Yong Lee
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Chan Ik Park
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Sung-Soo Lee
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
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Schneck MJ. Current Stroke Scales May Be Partly Responsible for Worse Outcomes in Posterior Circulation Stroke. Stroke 2018; 49:2565-2566. [DOI: 10.1161/strokeaha.118.023201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael J. Schneck
- From the Departments of Neurology and Neurosurgery, Stritch School of Medicine, Loyola University Chicago, IL
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Zhao FL, Mi DH, Zhang CQ, Song QH, Liu HS, Dai HL, Liu ZM, Ge CQ, Wang YJ, Liu LP, Guo L. A cohort study of isolated brainstem infarction based on head MR imaging and clinical findings. J Int Med Res 2018; 46:4974-4984. [PMID: 30246581 PMCID: PMC6300943 DOI: 10.1177/0300060518788253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The prognosis of patients with isolated brainstem infarction (BSI) differs on an individual patient basis. This study was undertaken to analyze the influences of different imaging and clinical features with the prognosis of patients with BSI. Methods The study population was derived from a multicenter study of intracranial atherosclerosis in China. In the present study, 300 patients were selected who had experienced non-cardiogenic brain stem infarction within the prior 7 days. Evaluations included clinical characteristics, location and size of the brainstem infarction, and whether the infarction was located in multiple perforating branches of the brainstem. Poor prognosis was defined as the presence of disability within 1 year from the onset of disease. Results In total, 281 patients were followed up at 1 year post-infarction. Of these 281 patients, 84 (29.9%) exhibited disability at 1 year; these patients showed a median National Institutes of Health Stroke Scale score of 6 on admission. Multiple logistic regression analysis showed that patients with BSI located in the territory of multiple perforating arteries, who were discharged without administration of statins, showed a poor 1-year prognosis. Conclusion Isolated BSI involving multiple perforating arteries, without statin medication at discharge, indicated poor prognosis for patients with BSI.
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Affiliation(s)
- Feng-Li Zhao
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China.,3 Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dong-Hua Mi
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chang-Qing Zhang
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi-Han Song
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China
| | - Hong-Shun Liu
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China
| | - Hai-Lin Dai
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China
| | - Zhi-Min Liu
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China
| | - Chang-Qing Ge
- 1 Department of Neurology, The Second Hospital of Baoding, Baoding, Hebei, China
| | - Yong-Jun Wang
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Guo
- 3 Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Choi SW, Han N, Jung SH, Kim HD, Eom MJ, Bae HW. Evaluation of Ataxia in Mild Ischemic Stroke Patients Using the Scale for the Assessment and Rating of Ataxia (SARA). Ann Rehabil Med 2018; 42:375-383. [PMID: 29961735 PMCID: PMC6058584 DOI: 10.5535/arm.2018.42.3.375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To demonstrate the utility of Scale for the Assessment and Rating of Ataxia (SARA) for evaluation of posterior circulation-related features in patients with mild stroke. Methods Forty-five subjects, diagnosed with acute infarction in the cerebellum, basis pontis, thalamus, corona radiata, posterior limb of internal capsule, and their National Institutes of Health Stroke Scale (NIHSS) scores ≤5 were enrolled. SARA scores were graded by the cut-off value of severity in dependency of activities of daily living (ADL). SARA, Berg Balance Scale (BBS), Timed Up-and-Go (TUG), and Trunk Control Test (TCT) were correlated in regression analysis with the modified Rankin Scale (mRS) at discharge. Correlation between SARA and other tools was analyzed. Patients were divided based on mRS at admission (group A, mRS 0–2; group B, mRS 3–5). Scores between the two groups were compared. Results Among the subjects, 48.9% (22/45) scored above 5.5 on SARA, and even 11.1% (5/45) scored higher than 14.25, which is the cut-off value of ‘severe dependency’ in ADL. SARA showed significant value for prediction of mRS at discharge. SARA was correlated with BBS (r=-0.946, p<0.001), TUG (r=-0.584, p<0.001), and TCT (r=-0.799, p<0.001). The SARA, BBS, TUG, and TCT scores between were lower in group B than in group A patients. SARA as well as BBS, TUG, and TCT reflect the functional severity of all patients. Conclusion SARA is a complementary tool for evaluation of the severity of ataxia in mild stroke patients with features of posterior circulation.
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Affiliation(s)
- Sung Won Choi
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nami Han
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Hoon Jung
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Dong Kim
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi Ja Eom
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Woo Bae
- Department of Physical Medicine and Rehabilitation, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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16
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Ren H, Han L, Liu H, Wang L, Liu X, Gao Y. Decreased Lymphocyte-to-Monocyte Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Treated with Thrombolysis. Med Sci Monit 2017; 23:5826-5833. [PMID: 29220346 PMCID: PMC5731214 DOI: 10.12659/msm.907919] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Our previous study found that lower lymphocyte-to-monocyte ratio (LMR) is an independent risk factor of clinical outcome of acute ischemic stroke (AIS). However, whether lower LMR is independently associated with adverse prognosis of AIS treated with thrombolysis has not been determined. In this study, we explored the relationship between LMR and prognosis of AIS treated with thrombolysis. Material/Methods We retrospectively enrolled 108 patients treated with thrombolysis. LMR was calculated according to lymphocyte count and monocyte count on admission. Patients were classified into 3 groups according to LMR values on admission (group 1 LMR >4.34, group 2 LMR 2.79 to 4.34, group 3 LMR <2.79). Neurologic impairment was estimated by use of the National Institute of Health Stroke Scale. Clinical prognosis at 3 months was assessed by modified Rankin Scale. The relationship between LMR and neurologic impairment was analyzed by Spearman rank correlation. Receiver operating characteristic curve (ROC) was used to evaluate the ability of LMR to predict outcome. Results Patients in group 3 had lower lymphocyte counts and LMR values and higher monocyte counts (P<0.001). LMR value was negatively correlated with the degree of neurologic impairment (r=−0.372, P<0.001). The ROC suggested a moderate sensitivity (71.6%) and specificity (80.5%) of LMR for predicting prognosis with an optimal cut-off point at 3.48. Higher LMR value was an independent protective factor against adverse prognosis (odds ratio 0.683, 95% confidence interval 0.490−0.952, P=0.024). Conclusions A lower LMR value is an independent predictor of poor prognosis of AIS treated with thrombolytic therapy.
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Affiliation(s)
- Hao Ren
- Department of Neurology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Lin Han
- Department of Neurology, Hengshui Hospital of Traditional Chinese Medicine, Hengshui, Hebei, China (mainland)
| | - Hongbin Liu
- Department of Neurology, Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, China (mainland)
| | - Lin Wang
- Department of Neurology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Xiao Liu
- Department of Neurology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
| | - Yanjun Gao
- Department of Neurology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China (mainland)
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Pula JH, Yuen CA. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2:210-220. [PMID: 29507782 PMCID: PMC5829892 DOI: 10.1136/svn-2017-000079] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/05/2023] Open
Abstract
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
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Affiliation(s)
- John H Pula
- Department of Neurology, NorthShore University HealthSystem, Chicago, Illinois, USA
| | - Carlen A Yuen
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Zhang C, Wang Y, Zhao X, Liu L, Wang C, Pu Y, Zou X, Pan Y, Wong KS, Wang Y. Prediction of Recurrent Stroke or Transient Ischemic Attack After Noncardiogenic Posterior Circulation Ischemic Stroke. Stroke 2017. [PMID: 28626054 DOI: 10.1161/strokeaha.116.016285] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. METHODS We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms <7 days. Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS. RESULTS A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69-10.2; P=0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55-42.5; P<0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00-62.6; P=0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25-23.3; P=0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09-8.58; P=0.03) as independent predictors of recurrent IS or TIA. CONCLUSIONS Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible.
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Affiliation(s)
- Changqing Zhang
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Yilong Wang
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Xingquan Zhao
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Liping Liu
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - ChunXue Wang
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Yuehua Pu
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Xinying Zou
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Yuesong Pan
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Ka Sing Wong
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, China (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing (C.Z., Yilong Wang, X.Z., L.L., C.W., Y.P., X.Z., Y.P., Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Yongjun Wang); and Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China (K.S.W.).
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Sand KM, Naess H, Nilsen RM, Thomassen L, Hoff JM. Less thrombolysis in posterior circulation infarction-a necessary evil? Acta Neurol Scand 2017; 135:546-552. [PMID: 27380826 DOI: 10.1111/ane.12627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with posterior circulation infarction (PCI) have more subtle symptoms than anterior circulation infarction (ACI) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry. METHODS All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006-2013 were included (n=686). Patients with ACI (n=1758) were used for comparison. RESULTS Patients with PCI were younger (68.2 vs 71.8, P<.001), had longer median time from symptom onset to admission (3.8 hours vs 2.2 hours, P<.001), and were less likely to arrive at hospital within 4.5 hours from symptom onset (56.2% vs 72.5%, P<.001, ictus known). Patients with PCI scored lower on baseline National Institute of Health Stroke Scale (NIHSS) total score (3.2 vs 6.3, P<.001), and lower or equally on all items of NIHSS, except for ataxia in two limbs. Patients with PCI were less likely to receive i.v. thrombolytic treatment (9.9% vs 21.5%, OR 0.66, CI 0.47-0.94). On day 7, patients with PCI scored lower on NIHSS (2.8 vs 4.9, P<.001), modified Rankin Scale (2.0 vs 2.3, P<.001), and higher on Barthel Index (84.5 vs 76.0, P<.001). CONCLUSIONS Our study is, to our knowledge, the largest series reporting comprehensively on PCI verified by diffusion-weighted imaging. PCI patients are younger than ACI and have better outcome. PCI and ACI are equally investigated in the acute setting, but thrombolysis rates remain 50% lower in PCI.
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Affiliation(s)
- K. M. Sand
- Department of Neurology; Institute for Clinical Medicine; University of Bergen; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
| | - R. M. Nilsen
- Centre for Clinical Research; Haukeland University Hospital; Bergen Norway
| | - L. Thomassen
- Department of Neurology; Institute for Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. M. Hoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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Bustamante A, Simats A, Vilar-Bergua A, García-Berrocoso T, Montaner J. Blood/Brain Biomarkers of Inflammation After Stroke and Their Association With Outcome: From C-Reactive Protein to Damage-Associated Molecular Patterns. Neurotherapeutics 2016; 13:671-684. [PMID: 27538777 PMCID: PMC5081112 DOI: 10.1007/s13311-016-0470-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stroke represents one of the most important causes of disability and death in developed countries. However, there is a lack of prognostic tools in clinical practice to monitor the neurological condition and predict the final outcome. Blood biomarkers have been proposed and studied in this indication; however, no biomarker is currently used in clinical practice. The stroke-related neuroinflammatory processes have been associated with a poor outcome in stroke, as well as with poststroke complications. In this review, we focus on the most studied blood biomarkers of this inflammatory processes, cytokines, and C-reactive protein, evaluating its association with outcome and complications in stroke through the literature, and performing a systematic review on the association of C-reactive protein and functional outcome after stroke. Globally, we identified uncertainty with regard to the association of the evaluated biomarkers with stroke outcome, with little added value on top of clinical predictors such as age or stroke severity, which makes its implementation unlikely in clinical practice for global outcome prediction. Regarding poststroke complications, despite being more practical scenarios in which to make medical decisions following a biomarker prediction, not many studies have been performed, although there are now some candidates for prediction of poststroke infections. Finally, as potential new candidates, we reviewed the pathophysiological actions of damage-associated molecular patterns as triggers of the neuroinflammatory cascade of stroke, and their possible use as biomarkers.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alba Simats
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Andrea Vilar-Bergua
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain.
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Mayasi Y, Helenius J, Goddeau RP, Moonis M, Henninger N. Time to Presentation Is Associated with Clinical Outcome in Hemispheric Stroke Patients Deemed Ineligible for Recanalization Therapy. J Stroke Cerebrovasc Dis 2016; 25:2373-9. [PMID: 27315744 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Delayed thrombolysis adversely impacts functional outcome after stroke. Therefore, great efforts are undertaken to reduce delay in patient presentation and initiate treatment as quickly as possible. However, little is known regarding the impact of time to presentation (TTP) on outcome in patients who are ineligible for acute stroke therapy. Thus, we sought to determine whether the TTP is associated with the 90-day outcome irrespective of eligibility for acute recanalization therapy. METHODS We retrospectively analyzed 258 consecutive acute ischemic stroke patients evaluated between January 2013 and February 2014. Multivariable logistic regression was used to determine whether a greater TTP is independently associated with a poor 90-day outcome defined as a modified Rankin scale (mRS) score of 3-6. RESULTS In the unadjusted analyses, the TTP was inversely correlated with transfer from an acute facility (r = -.126, P = .043), cardioembolic stroke etiology (r = -.146, P = .019), and acute recanalization therapy (r = .-412, P < .001). Conversely, a longer TTP was correlated with a worse 90-day mRS score (r = .127, P = .045). After adjustment, the TTP (P = .019), age (P < .001), female sex (P = .001), National Institutes of Health Stroke Scale score (P < .001), preadmission mRS score (P = .001), atrial fibrillation (P < .001), and infarct volume (P < .001) were independently associated with a poor 90-day outcome. Importantly, a longer TTP (odds ratio 1.016, 95% confidence interval 1.001-1.032, P = .036) remained independently associated with the 90-day outcome when we restricted the analyses to patients ineligible for acute intravenous and endovascular recanalization therapies. CONCLUSIONS Each hour delay in the TTP decreased chances for good outcome by approximately 2% independent of patient eligibility for acute recanalization therapies.
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Affiliation(s)
- Yunis Mayasi
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Johanna Helenius
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard P Goddeau
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Majaz Moonis
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
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Henninger N, Goddeau RP, Karmarkar A, Helenius J, McManus DD. Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes. Stroke 2016; 47:1486-92. [PMID: 27217503 DOI: 10.1161/strokeaha.116.012865] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Patients with a cardioembolic stroke (CES) have worse outcomes than stroke patients with other causes of stroke. Among patients with CES, atrial fibrillation (AF) is a common comorbidity. Mounting data indicate that AF may be related to stroke pathogenesis beyond acute cerebral thromboembolism. We sought to determine whether AF represents an independent risk factor for stroke severity and outcome among patients with CES. METHODS We retrospectively analyzed patients with acute hemispheric CES included in an academic medical center's stroke registry. CES was determined using the Causative Classification System of ischemic stroke. Multivariable logistic regression was used to determine whether AF was associated with 90-day outcome functional status. RESULTS Our cohort included 140 patients. Of these, 52 had prevalent AF and 28 had incident AF diagnosed during their index hospitalization or within 90 days of hospital discharge. After adjustment for potential confounders or mediators, any AF (odds ratio, 2.51; 95% confidence interval, 1.03-6.33; P=0.049), infarct volume (odds ratio, 1.03; 95% confidence interval, 1.01-1.06; P=0.005), preadmission modified Rankin Scale score (odds ratio, 2.58; 95% confidence interval, 1.66-4.01; P<0.001), and admission National Institutes of Health Stroke Scale score (odds ratio, 1.17; 95% confidence interval, 1.08-1.28; P<0.001) remained associated with an unfavorable 90-day outcome (modified Rankin Scale score, 2-6). CONCLUSIONS AF is associated with an unfavorable 90-day outcome among patients with a CES independent of established risk factors and initial stroke severity. This suggests that AF-specific mechanisms affect CES severity and functional status after CES. If confirmed in future studies, further investigation into the underlying pathophysiological mechanisms may provide novel avenues to AF detection and treatment.
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Affiliation(s)
- Nils Henninger
- From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester.
| | - Richard P Goddeau
- From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester
| | - Ameeta Karmarkar
- From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester
| | - Johanna Helenius
- From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester
| | - David D McManus
- From the Departments of Neurology (N.H., R.P.G., J.H.), Psychiatry (N.H.), and Internal Medicine (A.K.) and Division of Cardiology, Department of Internal Medicine (D.D.M.), University of Massachusetts Medical School, Worcester
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Bacigaluppi S, Gatto F, Anania P, Bragazzi NL, Rossi DC, Benvegnu G, Nazzari E, Spaziante R, Giusti M, Ferone D, Zona G. Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center. Endocrine 2016; 51:524-33. [PMID: 25982150 DOI: 10.1007/s12020-015-0619-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
First-line treatment of patients with growth hormone secreting adenomas is surgical resection. Disease control can be obtained by surgery (one or multiple steps), in case followed by medical treatment or adjuvant radiation therapy (radiosurgery or radiotherapy). The impact of pre-surgical treatment with somatostatin analogs (SSAs) on surgical outcome is still controversial. The aim of this study is to retrospectively evaluate the impact of SSA pre-treatment on biochemical outcome and post-surgical hypopituitarism in a consecutive surgical series from a single referral centre, with data covering 17 years' experience and to investigate the possible predictive value of early postoperative insulin-like factor 1 (IGF-I) on long-term biochemical control. Data from 68 acromegalic patients were revised. Endocrinological long-term follow-up (minimum 6 months) was available for 57 patients. Eighty-eight percent of patients received a single-step surgical treatment (single surgery, with or without adjuvant medical therapy). The remaining 12% underwent a multi-step strategy: redo-surgery (three macroadenomas) and/or radiation (four macro- and two microadenomas). Pre-surgical SSA treatment was performed in 77.9% and resulted in a significant lowering of basal IGF-I values (p = 0.0001). Early post-surgical IGF-I was significantly lower in patients biochemically controlled with single surgery alone (p = 0.016) and after overall treatment strategies (p = 0.005). Normalization of GH and IGF-I was obtained in 56.1%, and normalization of either one of them in 27.8% of patients. No major surgery-related complications occurred. Post-treatment hypopituitarism occurred in 11.9% and was lower in SSA pre-treated patients. Our results well compare with other recently published series. Very early post-surgical IGF-I improvement might be a useful predictor for biochemical disease control. Moreover, our results suggest that pre-surgical treatment with somatostatin analogs seems to prevent hypopituitarism.
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Affiliation(s)
- Susanna Bacigaluppi
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Federico Gatto
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Pasquale Anania
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Diego Criminelli Rossi
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Giulia Benvegnu
- Anaesthesiology, Department of Emergency (DEA), IRCCS San Martino-IST, Genova, Italy
| | - Elena Nazzari
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
| | - Renato Spaziante
- Department of Neurosurgery, University of Salerno, Salerno, Italy
| | - Massimo Giusti
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Diego Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Gianluigi Zona
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy.
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Liu CH, Wei YC, Lin JR, Chang CH, Chang TY, Huang KL, Chang YJ, Ryu SJ, Lin LC, Lee TH. Initial blood pressure is associated with stroke severity and is predictive of admission cost and one-year outcome in different stroke subtypes: a SRICHS registry study. BMC Neurol 2016; 16:27. [PMID: 26923538 PMCID: PMC4770548 DOI: 10.1186/s12883-016-0546-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background To investigate if initial blood pressure (BP) on admission is associated with stroke severity and predictive of admission costs and one-year-outcome in acute ischemic (IS) and hemorrhagic stroke (HS). Methods This is a single-center retrospective cohort study. Stroke patients admitted within 3 days after onset between January 1st and December 31st in 2009 were recruited. The initial BP on admission was subdivided into high (systolic BP ≥ 211 mmHg or diastolic BP ≥ 111 mmHg), medium (systolic BP 111–210 mmHg or diastolic BP 71–110 mmHg), and low (systolic BP ≤ 110 mmHg or diastolic BP ≤ 70 mmHg) groups and further subgrouped with 25 mmHg difference in systole and 10 mmHg difference in diastole for the correlation analysis with demographics, admission cost and one-year modified Rankin scale (mRS). Results In 1173 IS patients (mean age: 67.8 ± 12.8 years old, 61.4 % male), low diastolic BP group had higher frequency of heart disease (p =0.001), dehydration (p =0.03) and lower hemoglobin level (p <0.001). The extremely high and low systolic BP subgroups had worse National Institutes of Health Stroke Scale (NIHSS) score (p =0.03), higher admission cost (p <0.001), and worse one-year mRS (p =0.03), while extremely high and low diastolic BP subgroups had higher admission cost (p <0.01). In 282 HS patients (mean age: 62.4 ± 15.4 years old, 60.6 % male), both low systolic and diastolic BP groups had lower hemoglobin level (systole: p =0.05; diastole: p <0.001). The extremely high and low BP subgroups had worse NIHSS score (p =0.01 and p <0.001, respectively), worse one-year mRS (p =0.002 and p =0.001, respectively), and higher admission cost (diastole: p <0.002). Conclusions Stroke patients with extremely high and low BP on admission have not only worse stroke severity but also higher admission cost and/or worse one-year outcome. In those patients with low BP, low admission hemoglobin might be a contributing factor.
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Affiliation(s)
- Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.,Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.,Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan
| | - Kuo-Lun Huang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan
| | - Yeu-Jhy Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan
| | - Shan-Jin Ryu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.
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Chen W, Yi T, Chen Y, Zhang M, Wu Z, Wu Y, Chen B, Guo T, Wu C, Yang M, Chen X, Shi Y. Assessment of bilateral cerebral peduncular infarction: Magnetic resonance imaging, clinical features, and prognosis. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Inoa V, Aron AW, Staff I, Fortunato G, Sansing LH. Lower NIH stroke scale scores are required to accurately predict a good prognosis in posterior circulation stroke. Cerebrovasc Dis 2014; 37:251-5. [PMID: 24686370 DOI: 10.1159/000358869] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/20/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The NIH stroke scale (NIHSS) is an indispensable tool that aids in the determination of acute stroke prognosis and decision making. Patients with posterior circulation (PC) strokes often present with lower NIHSS scores, which may result in the withholding of thrombolytic treatment from these patients. However, whether these lower initial NIHSS scores predict better long-term prognoses is uncertain. We aimed to assess the utility of the NIHSS at presentation for predicting the functional outcome at 3 months in anterior circulation (AC) versus PC strokes. METHODS This was a retrospective analysis of a large prospectively collected database of adults with acute ischemic stroke. Univariate and multivariate analyses were conducted to identify factors associated with outcome. Additional analyses were performed to determine the receiver operating characteristic (ROC) curves for NIHSS scores and outcomes in AC and PC infarctions. Both the optimal cutoffs for maximal diagnostic accuracy and the cutoffs to obtain >80% sensitivity for poor outcomes were determined in AC and PC strokes. RESULTS The analysis included 1,197 patients with AC stroke and 372 with PC stroke. The median initial NIHSS score for patients with AC strokes was 7 and for PC strokes it was 2. The majority (71%) of PC stroke patients had baseline NIHSS scores ≤4, and 15% of these 'minor' stroke patients had a poor outcome at 3 months. ROC analysis identified that the optimal NIHSS cutoff for outcome prediction after infarction in the AC was 8 and for infarction in the PC it was 4. To achieve >80% sensitivity for detecting patients with a subsequent poor outcome, the NIHSS cutoff for infarctions in the AC was 4 and for infarctions in the PC it was 2. CONCLUSION The NIHSS cutoff that most accurately predicts outcomes is 4 points higher in AC compared to PC infarctions. There is potential for poor outcomes in patients with PC strokes and low NIHSS scores, suggesting that thrombolytic treatment should not be withheld from these patients based solely on the NIHSS. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Violiza Inoa
- University of Connecticut School of Medicine, Farmington, Conn., USA
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