Academic literature on the topic '44.90 neurology'
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Journal articles on the topic "44.90 neurology"
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Lewis, Ariane, Azza Bakkar, Elana Kreiger-Benson, Andrew Kumpfbeck, Jordan Liebman, Sam D. Shemie, Gene Sung, Sylvia Torrance, and David Greer. "Determination of death by neurologic criteria around the world." Neurology 95, no. 3 (June 23, 2020): e299-e309. http://dx.doi.org/10.1212/wnl.0000000000009888.
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ObjectiveTo identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.MethodsWe collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.ResultsWe communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.ConclusionsThere is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.
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Persad, A., Z. Tymchak, S. Ahmed, A. Gardner, R. Whelan, ME Kelly, and L. Peeling. "P.115 Saskatchewan experience with mechanical thrombectomy under general anaesthesia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, s1 (June 2019): S44. http://dx.doi.org/10.1017/cjn.2019.208.
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Background: While recent clinical trials have demonstrated immense efficacy of mechanical thrombectomy (MT) in the setting of acute stroke, there remains debate over the safety in performing this procedure under general anesthesia (GA). In the Saskatchewan Acute Stroke Pathway, all patients presenting with LVO have endovascular thrombectomy performed under GA. Methods: Data was retrospectively reviewed on 108 consecutive LVO in 2016-2017. All MT were done under GA. Anatomical location of LVO, pre-MT ASPECTS score, post-MT TICI scores and 90-day NIHSS and mRS were recorded. Results: Of 108 LVO, 103 went on to have MT. 44 were right anterior circulation, 50 were left anterior circulation and 9 were posterior circulation. Of 94 anterior circulation strokes, 47 (50.0%), 43 (45.7%) and 4 (4.3%) had good, moderate and poor collateral circulation respectively, and the average pre-MT ASPECTS was 8.6. The average pre-MT NIHSS was 14.7. 81/90 (90.0%) achieved thrombolysis in cerebral infarction (TICI) perfusion scale grade of 2b/3 after recanalization. Average documented 90-day NIHSS was 2.4 and mRS was 2.5. Overall mortality was 21/103 (20.4%). Conclusions: In the Saskatchewan acute stroke pathway, general anesthesia is a safe modality for MT. This adds to the body of evidence supporting GA as a viable option for sedation in MT.
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Wilson, Mitchell P., Mohammad H. Murad, Timo Krings, Vitor M. Pereira, Cian O’Kelly, Jeremy Rempel, Christopher A. Hilditch, and Waleed Brinjikji. "Management of tandem occlusions in acute ischemic stroke – intracranial versus extracranial first and extracranial stenting versus angioplasty alone: a systematic review and meta-analysis." Journal of NeuroInterventional Surgery 10, no. 8 (March 9, 2018): 721–28. http://dx.doi.org/10.1136/neurintsurg-2017-013707.
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BackgroundOptimal technical approaches of large-vessel anterior circulation acute ischemic strokes with concomitant extracranial internal carotid artery tandem occlusions is controversial.PurposeThis systematic review and meta-analysis evaluates: the overall outcomes of patients with tandem occlusions treated with second-generation mechanical thrombectomy devices; differences in outcomes of extracranial versus intracranial first approaches; and differences in outcomes of extracranial stenting at time of procedure versus angioplasty alone.MethodsMEDLINE, EMBASE, and the Web of Science was searched through September 2017 for studies evaluating patients presenting with acute tandem occlusions of the extracranial ICA and intracranial ICA, and/or proximal MCA treated with second-generation mechanical thrombectomy devices. Outcomes were pooled across studies using the random-effects model and expressed as cumulative incidence (event rate) and 95% CI.ResultsThirty-three studies were included in analysis. Overall mRS≤0–2 at 90 days was 47% (95% CI 42% to 51%). No statistical difference was seen in 90-day mRS≤0–2 for patients treated with extracranial versus intracranial first approaches, 53% (95% CI 44% to 61%) vs 49% (95% CI 44% to 57%) (P=0.58). No statistical difference was seen in 90-day mRS≤0–2 for patients treated with extracranial stenting versus angioplasty alone, 49% (95% CI 42% to 56%) vs 49% (95% CI 33% to 65%) (P=0.39). No other statistical differences in outcome or safety were identified.ConclusionsNearly half of all tandem occlusion patients treated with mechanical thrombectomy have good neurological outcomes. No statistical differences in outcome are identified between extracranial first versus intracranial first approaches, nor extracranial stenting versus angioplasty alone.
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Villanueva-Meyer, Javier, Pablo Damasceno, Marisa LaFontaine, James Hawkins, Tracy Luks, Jason Crane, and Janine Lupo. "NIMG-44. INTEGRATING AUTOMATED LESION SEGMENTATIONS FROM SINGLE-IMAGES INTO ROUTINE CLINICAL WORKFLOW FOR VOLUMETRIC RESPONSE ASSESSMENT." Neuro-Oncology 22, Supplement_2 (November 2020): ii157. http://dx.doi.org/10.1093/neuonc/noaa215.657.
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Abstract INTRODUCTION Volume calculations have not been adopted into glioma response assessment due to lengthy times for manual definition and unreliable measures provided by automated algorithms. Relatively new artificial intelligence approaches such as convolutional neural networks have significantly improved lesion segmentation with performance accuracies >90%. However, their adoption into routine practice remains limited due to poor generalizability and failure rates approaching 25% when incorporated into clinical workflow. The latter can be attributed to 1) the requirement of four different types of anatomic images (T2, T2-FLAIR, T1 pre- and post-contrast); 2) cumbersome preprocessing including alignment, reformatting, and skull removal; and 3) the lack of a well-integrated clinical deployment system. The goal of this study was to demonstrate how simple modifications to a robust network coupled with an integrated workflow can provide reliable measures of tumor volume for real-time use in the reading room. METHODS Leveraging NVIDIA’s Clara-Train software and a molecularly diverse dataset of 400 labeled images for training, we modified a top-performing ensembled 2D-U-Net to require a single image-volume input (T2-FLAIR or post-contrast T1 for the T2-hyperintense or contrast-enhancing lesions) and deployed the results in the clinic to provide quantitative volumetrics. Inference was performed on a mix of image orientations without any reformatting or skull-stripping. RESULTS Training on only 115 of our 400 datasets, we achieved Dice Coefficients of 90% and 81% overlap of our auto-segmented T2 and contrast-enhancing lesions with manual labels in our 25-patient validation cohort (11 enhancing), compared to 91% and 83% overlap with the original model that required four anatomic images to segment each lesion. Radiologists can view segmentations directly from PACS as contours or overlays and provide numerical feedback for model refinement. The workflow has been applied on 50 cases to date without any failures and can be easily shared for deployment on any clinical PACS.
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Freedman, MS, J. Laks, N. Dotan, RT Altstock, A. Dukler, and CJM Sindic. "Anti-α-glucose–based glycan IgM antibodies predict relapse activity in multiple sclerosis after the first neurological event." Multiple Sclerosis Journal 15, no. 4 (March 26, 2009): 422–30. http://dx.doi.org/10.1177/1352458508101944.
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Background There is no specific serum-based biomarker for the diagnosis or prognosis of relapsing-remitting multiple sclerosis (RRMS). Objective We investigated whether levels of IgM antibodies to Glc(α1,4)Glc(α) (GAGA4) or to a panel of four glucose-based glycans could differentiate MS from other neurological diseases (OND) or predict risk of early relapse following first presentation (FP) of RRMS. Methods Retrospective analysis of 440 sera samples of three cohorts: A) FP-RRMS ( n = 44), OND ( n = 44); B) FP-RRMS ( n = 167), OND ( n = 85); and C) FP ( n = 100). Anti-GAGA4 IgM levels were measured by enzyme immunoassay in cohort-A and cohort-B. Cohort-C IgM antibodies to glucose-based glycan panel were measured by immunofluorescence. Results FP-RRMS had higher levels of anti-GAGA4 IgM than OND patients (cohort-A, P = 0.01; cohort-B, P = 0.0001). Sensitivity and specificity were 27% and 97% for cohort-A; and 26% and 90% for cohort-B, respectively. In cohort-C, 58 patients experienced early relapse (<24 months), 31 had late relapse (≥24 months), and 11 did not experience second attack during follow-up. Kaplan–Meier curves demonstrated decrease in time to next relapse for patients positive for the antibody panel ( P = 0.02, log rank). Conclusions Serum anti-GAGA4 IgM discerns FP-RRMS patients from OND patients. Higher levels of serum anti-α-glucose IgM in FP patients predict imminent early relapse.
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Gu, Thomas, Richard I. Aviv, Allan J. Fox, and Elias Johansson. "Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke." Journal of Neurology 267, no. 2 (November 7, 2019): 522–30. http://dx.doi.org/10.1007/s00415-019-09605-5.
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Abstract Objective To assess the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusion with and without full collapse. Methods Included were consecutive patients eligible for revascularization, grouped into symptomatic conventional ≥ 50% carotid stenosis (n = 266), near-occlusion without full collapse (n = 57) and near-occlusion with full collapse (n = 42). The risk of preoperative recurrent ipsilateral ischemic stroke was analyzed, or, for cases not revascularized within 90 days, 90-day risk was analyzed. Results The risk of a preoperative recurrent ipsilateral ischemic stroke or ipsilateral retinal artery occlusion was 15% (95% CI 9–20%) for conventional ≥ 50% stenosis, 22% (95% CI 6–38%) among near-occlusion without full collapse and 30% (95% CI 16–44%) among near-occlusion with full collapse (p = 0.01, log rank test). In multivariate analysis, near-occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke (adjusted HR 2.6, 95% CI 1.3–5.3) and near-occlusion without full collapse tended to have a higher risk (adjusted HR 2.0, 95% CI 0.9–4.5) than conventional ≥ 50% stenosis. Only 24% of near-occlusion with full collapse underwent revascularization, common causes for abstaining were misdiagnosis as occlusion (31%), deemed surgically unfeasible (21%) and low perceived benefit (10%). Conclusions Symptomatic carotid near-occlusion has a high short-term risk of recurrent ipsilateral ischemic stroke, especially near-occlusion with full collapse.
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Maus, Volker, Jan Borggrefe, Daniel Behme, Christoph Kabbasch, Nuran Abdullayev, Utako Birgit Barnikol, Leonard Leong Litt Yeo, et al. "Order of Treatment Matters in Ischemic Stroke: Mechanical Thrombectomy First, Then Carotid Artery Stenting for Tandem Lesions of the Anterior Circulation." Cerebrovascular Diseases 46, no. 1-2 (2018): 59–65. http://dx.doi.org/10.1159/000492158.
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Background: One endovascular treatment option of acute ischemic stroke due to tandem occlusion (TO) comprises intracranial thrombectomy and acute extracranial carotid artery stenting (CAS). In this setting, the order of treatment may impact the clinical outcome in this stroke subtype. Methods: Retrospective analysis was performed on data prospectively collected in 4 international stroke centers between 2013 and 2017. One hundred sixty-five patients with anterior TO were treated by endovascular therapy. Clinical and procedural data were evaluated. Favorable clinical outcome was defined as modified Rankin Scale (mRS) ≤2 at 90 days. Propensity score matching was performed for different treatment strategies. Results: Patients’ mean age was 65 ± 11 years and 118 were male (69%). The median admission National Institutes of Health Stroke Scale was 15 (interquartile range 8). In 59% of the patients (n = 101), the antegrade strategy (first stenting, then thrombectomy) was performed, in 41% (n = 70) retrograde treatment (first thrombectomy, then stenting). Successful reperfusion (mTICI ≥2b) was achieved in 128 patients (75%). Fifty-nine patients (39%) showed a favorable clinical outcome after 90 days. After propensity score matching, data of 100 patients could be analyzed. Analysis revealed that the retrograde strategy yielded a significantly higher rate of successful reperfusion compared to the antegrade strategy (92 vs. 56%; p < 0.001). The rate of favorable clinical outcome after 90 days (mRS ≤2) was consistently higher (44 vs. 30%; p < 0.05) in the retrograde strategy group. Conclusion: Mechanical thrombectomy prior to acute CAS in TO is a predictive factor for favorable clinical outcome at 90 days.
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Stetzler, Trisha, Sharjeel Ahmad, Mohammad Almoujahed, John J. Farrell, David K. Hong, Douglas Kasper, Joseph Kim, Rone Lin, and Marlynn Patel. "762. Integrating Diagnostics of Tomorrow into Clinical Practice Today: One Infectious Disease Group’s First 90 Days Experience with the Karius® Test." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S339. http://dx.doi.org/10.1093/ofid/ofz360.830.
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Abstract Background Infection disease (ID) groups covering inpatient and office, antimicrobial stewardship, and infection prevention duties may welcome an opportunity to streamline diagnostics via metagenomic next-generation sequencing (NGS). But the appropriate patient profile for NGS has yet to be defined. In 2019, we began using the Karius Test (KT), an NGS test that identifies and quantifies microbial cell-free DNA in plasma. Methods On January 10, 2019 our ID group (7 MDs and an APN covering 14 Illinois hospitals) began using the KT (Redwood City, CA). 5 ml of whole blood is collected, spun to plasma, and shipped to Karius for analysis. Following NGS, human sequences are removed and remaining sequences are aligned to a curated pathogen database of >1,000 organisms. Organisms present above a statistical threshold are quantified in DNA molecules per microliter (MPM) and reported. Results Over 90 days 45 KTs were ordered on 42 patients (mean age = 46); including 3 repeat tests. Thirty-six were inpatients (8 in the ICU) with a mean 4.7 days to ID consult and length-of-stay of 16 days. 31% (13/42) were immunocompromised: i.e., transplant, oncology, or HIV/AIDS. Fine needle or open biopsies were performed on 13 patients and 13 patients had bronchoscopy; 30.8% (8/26) were diagnostic of infection. A valid KT result was returned in 44/45 tests (mean 3.5 days from ID consult). 56.8% (25/44) of tests were positive for one or more organisms (a single pathogen was detected on 11 KTs). Among positive tests, 56% (14/25 - 10 bacterial and 4 fungal infections) were confirmed by culture, antigen, or PCR. Mean time to diagnosis for culture, PCR, antigen, and KT was 16.4, 3, 5.5, and 3.5 days, respectively. In 3 cases, the KT was the only positive test but correlated with the clinical scenario resulting in antimicrobial changes (Pneumocystis jirovecii pneumonia in AIDS, pulmonary aspergillosis in AIDS, and Fusobacterium nucleatum septic thrombophlebitis). Conclusion We identified 4 clinical scenarios where the KT provided value: patients with suspected invasive fungal infections, culture-negative endovascular infections/endocarditis, possible discitis or paravertebral infection, and pulmonary disease in AIDS. Future efforts will include outreach for prevention of invasive diagnostic procedures when a KT is pending or positive. Disclosures All authors: No reported disclosures.
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Johnson, Candace L., Alexandra Hill-Ricciuti, and Lisa Saiman. "1245. Infection Prevention and Control (IP&C) and Antibiotic Stewardship (AS) Practices in Pediatric Long-Term Care Facilities." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S379. http://dx.doi.org/10.1093/ofid/ofy210.1078.
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Abstract Background In November 2017, the Centers for Medicare and Medicaid (CMS) implemented a requirement for long-term care facilities (LTCFs) to incorporate AS into their IP&C programs. The purpose of this study was to describe baseline IP&C and AS practices in pediatric LTCFs. Methods We modified a survey from the CDC to assess IP&C in pediatric LTCFs. The internet-based survey was distributed to the 41 pLTCFs in the Pediatric Complex Care Association from May to June 2017. The 67-question survey included questions to assess IP&C domains and infrastructure such as written policies, hand and respiratory hygiene (HH), personal protective equipment (PPE) use, environmental cleaning, and AS practices. Responses to questions were summarized using frequencies and analyzed using χ2 or Fisher’s exact tests, as appropriate. The characteristics of sites with ≥90% compliance with the CMS rule, as assessed by 14 relevant survey questions, were compared with those of sites with <90% compliance. Results Overall, 25 (61%) facilities nationwide completed the survey. All sites reported having written IP&C policies and most had a person responsible for IP&C (96%); fewer reported reviewing/updating these policies annually (72%). Few sites provided feedback to staff on HH adherence (44%), PPE use (40%), and cleaning/disinfection procedures (44%). Few had written policies on antibiotic prescribing (48%) or provided prescribers with feedback about their prescribing practices (40%). Sites with ≥90% compliance with the CMS rule were more likely to report providing prescribers with feedback (70% vs. 20%, P = 0.03), to have provided AS training to clinical (60% vs. 0%, P < 0.01) and nursing staff (70% vs. 7%, P < 0.01) in the past 12 months, and to provide feedback regarding HH (70% vs. 27%, P = 0.05). Conclusion While most facilities had implemented some IP&C and AS strategies pertaining to the CMS rule before its enforcement, this survey identified several gaps, especially pertaining to staff feedback for IP&C practices and antibiotic prescribing. Facilities should develop feedback strategies and regularly reinforce the importance of IP&C at employment and during regular trainings. Disclosures All authors: No reported disclosures.
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Sader, Helio S., Mariana Castanheira, Jennifer M. Streit, Leonard R. Duncan, and Robert K. Flamm. "Cefepime-Zidebactam (WCK 5222) Activity Tested against Gram-negative Organisms Causing Bloodstream Infections Worldwide." Open Forum Infectious Diseases 4, suppl_1 (2017): S374—S375. http://dx.doi.org/10.1093/ofid/ofx163.922.
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Abstract Background Zidebactam (ZID), a bicyclo-acyl hydrazide, is a β-lactam enhancer with a dual mechanism of action involving selective and high binding affinity to Gram-negative (GN) PBP2 and β-lactamase inhibition. We evaluated the in vitro activity of cefepime (FEP) combined with ZID against GN organisms causing bloodstream infections (BSI) in hospitals worldwide. Methods A total of 2,094 isolates from 105 medical centers were evaluated. Isolates were collected from Europe (1,050), USA (331), Latin America (LA; 200) and the Asia-Pacific region (AP; 393) in 2015, and China (120) in 2013 by the SENTRY Program. Susceptibility (S) testing was performed by reference broth microdilution method against FEP-ZID (1:1 ratio) and comparators. The collection included 1,809 Enterobacteriaceae (ENT), 170 P. aeruginosa (PSA) and 115 Acinetobacter spp. (ASP). Results FEP-ZID was very active against ENT (MIC50/90 of ≤0.03/0.12 μg/mL) with 99.9 and 100.0% of isolates inhibited at ≤4/4 and ≤8/8 μg/mL, respectively, and retained potent activity against carbapenem-resistant (CRE; n = 44; MIC50/90, 1/4 μg/mL), multidrug-resistant (MDR), and extensively drug-resistant (XDR) isolates (Table). Amikacin (AMK; MIC50/90, 2/4 μg/mL; 97.7% S) was also very active against ENT, and colistin (COL; MIC50/90, 0.12/>8 μg/mL) inhibited only 87.3% of isolates at ≤2 μg/mL. FEP-ZID was highly active against PSA, including isolates resistant to other antipseudomonal β-lactams, MDR (MIC50/90, 4/8 μg/mL) and XDR (MIC50/90, 4/8 μg/mL) isolates. Among the comparators, COL (MIC50/90 of ≤0.5/1 μg/mL; 100.0% S) and AMK (MIC50/90, 4/16 μg/mL; 91.2% S) were the most active agents against PSA. FEP-ZID (MIC50/90, 16/32 μg/mL) was 4-fold more active than FEP against ASP. Conclusion FEP-ZID (WCK 5222) exhibited potent in vitro activity against a large worldwide collection of GN isolates from BSI, including MDR and XDR isolates. These results support further clinical development of WCK 5222 for treating BSI. Disclosures H. S. Sader, Wockhardt Bio Ag: Research Contractor, Research grant; M. Castanheira, Wockhardt Bio Ag: Research Contractor, Research grant; J. M. Streit, Wockhardt Bio Ag: Research Contractor, Research grant; L. R. Duncan, Wockhardt Bio Ag: Research Contractor, Research grant; R. K. Flamm, Wock: Research Contractor, Research support
Book chapters on the topic "44.90 neurology"
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Wolters, E. Ch, and H. J. Groenewegen. "44 Cerebrale doorbloeding en doorbloedingsstoornissen." In Neurologie, 583–606. Houten: Bohn Stafleu van Loghum, 2004. http://dx.doi.org/10.1007/978-90-313-6364-3_44.
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Kuks, J. B. M., J. W. Snoek, and J. M. Fock. "44 Een kind met haar mond op slot." In Praktische neurologie, 153–55. Houten: Bohn Stafleu van Loghum, 2004. http://dx.doi.org/10.1007/978-90-313-9236-0_44.
Full textConference papers on the topic "44.90 neurology"
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Silva, vã Taiuan Fialho, Vinícius Bessa Mendez, Fernanda Ferreira de Abreu, Alice Monteiro Soares Cajaíba, and Pedro Antonio Pereira de Jesus. "Does hemorrhagic transformation in patients with ischemic stroke predict worse functional outcomes?" In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.679.
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Background: Hemorrhagic transformation (HT) is a complication of stroke described as cause of early neurologic deterioration. Previous studies are discordant about the real impact of HT on stroke prognosis. Objectives: to describe the impact of HT in patient prognosis. Design and setting: Prospective cohort with acute ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2020. Methods: All patients performed a brain computer tomography (CT) scan on their arrival and 24 hours later. Patients with or without HT were compared regarding functional 90-day outcome using the modified rankin scale (mRS). Functional disability was considered as mRS < 2. Results: 383 patients were included, mean age was 62,2 (±13,8), which 54,3% were male, 80,9% hypertensive, 33,1% diabetics and 27,2% were dyslipidemic. HT occurred in 11,5% patients (n= 44) increasing the risk of poorer functional outcome in discharge [RR= 1,47; (IC95% 1,25–1,72), in 30 days [RR = 1,54; (IC95% 1,01-1,92)], and in 90 days [RR= 1,39; (IC95% 1,01-1,92)]. Multivariate analysis HT was not associated with worse outcome in 90 days (mRS>2) [OR= 1,01; (IC95% 0,44–2,33) p= 0,987], when adjusted to age, sex, NIHSS, ASPECTS, trombolysis and other relevant variables. Conclusion: Although the occurrency of HT had been associated with worse short-term outcomes, patients seems to recover from disability over time.
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Silva, Ivã Taiuan Fialho, Vinícius Bessa Mendez, Fernanda Ferreira de Abreu, Alice Monteiro Soares Cajaíba, and Pedro Antonio Pereira de Jesus. "Does hemorrhagic transformation in patients with ischemic stroke predict worse functional outcomes?" In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.687.
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Background: Hemorrhagic transformation (HT) is a complication of stroke described as cause of early neurologic deterioration. Previous studies are discordant about the real impact of HT on stroke prognosis. Objectives: to describe the impact of HT in patient prognosis. Design and setting: Prospective cohort with acute ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2020. Methods: All patients performed a brain computer tomography (CT) scan on their arrival and 24 hours later. Patients with or without HT were compared regarding functional 90-day outcome using the modified rankin scale (mRS). Functional disability was considered as mRS < 2. Results: 383 patients were included, mean age was 62,2 (±13,8), which 54,3% were male, 80,9% hypertensive, 33,1% diabetics and 27,2% were dyslipidemic. HT occurred in 11,5% patients (n= 44) increasing the risk of poorer functional outcome in discharge [RR= 1,47; (IC95% 1,25–1,72), in 30 days [RR = 1,54; (IC95% 1,01-1,92)], and in 90 days [RR= 1,39; (IC95% 1,01-1,92)]. Multivariate analysis HT was not associated with worse outcome in 90 days (mRS>2) [OR= 1,01; (IC95% 0,44–2,33) p= 0,987], when adjusted to age, sex, NIHSS, ASPECTS, trombolysis and other relevant variables. Conclusion: Although the occurrency of HT had been associated with worse short-term outcomes, patients seems to recover from disability over time.
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Bozzi, Vitor Sossai, Débora Cavalini Gabriel, Francisco Mateus Vieira, Mateus Alan Marasca, Priscila Martins Langbecker, and Helena Fussiger. "Assumed hemorrhagic stroke in a emergency of inland hospital: a case report." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.257.
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Context: Hemorrhagic stroke (HS) is characterized by cerebral vessel´s rupture, causing potentially fatal hemorrhage. Approximately 20% of HS are due to spontaneous intracranial hemorrhage, being risk factors: age over 55, systemic arterial hypertension, smoking, obesity, physical inactivity and alcoholism. Case Report: Male, 84 years old, previously hypertensive, is brought by family members after being found unconscious. He was admitted to hypertensive emergency room, with irregular respiratory rate, anisochoric pupils (mydriasis on the right) non-photoreactive, Glasgow Coma Scale 3 and urinary loss. He was intubated without complications and later developed bradycardia (44 bpm), keeping hypertensive (160/90 mmHg), suggesting Cushing´s Triad (CT). Capillary bloody glucose of 98 mg/dl and laboratory tests showing: hemoglobin 9,3; platelets 184000; negative troponin; urea 52; creatinine 1.7; sodium 136; potassium 3.9. Due to the abrupt installation in a previously hypertensive patient, with unilateral mydriasis on physical examination and the development of CT, the diagnostic hypothesis were HS associated with intracranial hypertension. A skull´s scancomputed tomography or lumbar puncture were not requested because were unavailable at hospital. Patient was removed to a specialized servisse, 12 hours after arrival. Conclusion: Mortality after stroke is known to be substantially lower when patients are treated in high-volume regional centers and have access to qualified interventionists who specialize in neuro-intensive treatment. As it is a servisse without resources for definitive treatment, the patient was stabilized in the best way within the hospital condition, with priority being the removal of the patient as soon as possible, in order to reduce morbidity and mortality