Risk of acute brain lesions in dizzy patients presenting to the emergency room: who needs imaging and who does not?

AbstractThe usefulness of brain imaging studies in dizzy patients presenting to the emergency department (ED) is controversial. We aimed to assess the ‘real-world’ probability of ischemic stroke and other acute brain lesions (ABLs) in these patients to create an algorithm that helps decision-making on whether which and when brain imaging is needed. By reviewing medical records, we identified 610 patients presenting with dizziness, vertigo or imbalance to our university hospital’s ED and receiving neurological workup. We collected timing/triggers of symptoms, ABCD2 score, focal neurological abnormalities, HINTS (head impulse, nystagmus, test-of-skew) and other central oculomotor signs. ABLs were extracted from CT/MRI reports. Uni-/multivariate logistic regression analyses investigated associations between clinical parameters and ABLs. Finally, the likelihood of ABLs was assessed for different clinically defined subgroups (‘dizziness syndromes’). Early CT (day 1) was performed in 539 (88%) and delayed MR imaging (median: day 4) in 299 (49%) patients. ABLs (89% ischemic stroke) were revealed in 75 (24%) of 318 patients with adequate imaging (MRI or lesion-positive CT). The risk for ABLs increased with the presence of central oculomotor signs (odds ratio 2.8, 95% confidence interval 1.5–5.2) or focal abnormalities (OR 3.3, 95% CI 1.8–6.2). The likelihood of ABLs differed between dizziness syndromes, e.g., HINTS-negative acute vestibular syndrome: 0%, acute imbalance syndrome with ABCD2-score ≥ 4: 50%. We propose a clinical pathway, according to which patients with HINTS-negative acute vestibular syndrome should not receive brain imaging, whereas imaging is suggested in dizzy patients with acute imbalance, central oculomotor signs or focal abnormalities.

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Physicians’ Choice in Using Internet and Fax for Patient Recruitment and Follow-up in a Randomized Controlled Trial

Methods of Information in Medicine ◽

10.1055/s-0038-1633867 ◽

2004 ◽

Vol 43 (03) ◽

pp. 268-272 ◽

Cited By ~ 5

Author(s):

S. Morita ◽

T. Fukui ◽

J. Sakamoto ◽

M. Rahman

Keyword(s):

Randomized Controlled Trial ◽

Odds Ratio ◽

Controlled Trial ◽

Data Entry ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Web Based ◽

Randomized Controlled ◽

The Web

Summary Objective: To examine the physicians’ preference between Web and fax-based remote data entry (RDE) system for an ongoing randomized controlled trial (RCT) in Japan. Methods: We conducted a survey among all the collaborating physicians (n = 512) of the CASE-J (Candesartan Antihypertensive Survival Evaluation in Japan) trial, who have been recruiting patients and sending follow-up data using the Web or a fax-based RDE system. The survey instrument assessed physicians’ choice between Web and fax-based RDE systems, their practice pattern, and attitudes towards these two modalities. Results: A total of 448 (87.5%) responses were received. The proportions of physicians who used Web, fax, and the combination of these two were 45.9%, 33.3% and 20.8%, respectively. Multivariate logistic regression analyses revealed that physicians 55 years or younger [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.1-3.3] and regular users of computers (OR = 4.2, 95% CI = 2.1-8.2) were more likely to use the Web-based RDE system. Conclusions: This information would be useful in designing an RCT with a Web-based RDE system in Japan and abroad.

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Epidemiology of Methicillin-ResistantStaphylococcus aureusBloodstream Coinfection Among Adults With Candidemia in Atlanta, GA, 2008–2012

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.185 ◽

2015 ◽

Vol 36 (11) ◽

pp. 1298-1304 ◽

Cited By ~ 5

Author(s):

Jessica Reno ◽

Saumil Doshi ◽

Amy K. Tunali ◽

Betsy Stein ◽

Monica M. Farley ◽

...

Keyword(s):

Nursing Home ◽

Medical Records ◽

Odds Ratio ◽

Nursing Home Residents ◽

Population Based ◽

Emerging Infections ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Active Population ◽

Invasive Infections

BACKGROUNDPatients with candidemia are at risk for other invasive infections, such as methicillin-resistantStaphylococcus aureus(MRSA) bloodstream infection (BSI).OBJECTIVETo identify the risk factors for, and outcomes of, BSI in adults withCandidaspp. and MRSA at the same time or nearly the same time.DESIGNPopulation-based cohort study.SETTINGMetropolitan Atlanta, March 1, 2008, through November 30, 2012.PATIENTSAll residents withCandidaspp. or MRSA isolated from blood.METHODSThe Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.RESULTSAmong 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%,P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.CONCLUSIONSA small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.Infect. Control Hosp. Epidemiol.2015;36(11):1298–1304

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Association between the number of prosthetic crowns and periodontitis: a cross-sectional study

10.21203/rs.3.rs-183824/v1 ◽

2021 ◽

Author(s):

Yun-Jeong Kim ◽

Jae-Young Lee ◽

Young Ku ◽

Hyun-Jae Cho

Keyword(s):

Odds Ratio ◽

Cross Sectional Study ◽

Demographic Variables ◽

Nutrition Examination Survey ◽

Regression Analyses ◽

Sectional Study ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Health And Nutrition ◽

Health Related

Abstract BackgroundAlthough the presence of prosthetic restorations has been associated with plaque accumulation, gingivitis, and periodontitis, there is a lack of large epidemiological investigations providing credible evidence on the association of prosthetic crowns with periodontitis. The purpose of the study was to analyze the association between the number of prosthetic crowns and the presence of periodontitis.MethodsThis study was based on the Seventh Korea National Health and Nutrition Examination Survey (2016-2018). A total of 12,689 participants over the age of 19 years were surveyed. Multivariate logistic regression analyses were used to identify the association between the number of prosthetic crowns and periodontitis after adjusting for potential confounders, including demographic variables, socio-economic characteristics, oral health-related variables, and oral and systemic clinical variables. ResultsThe odds ratio of periodontitis showed statistically significant differences in the anterior and posterior regions, and the prevalence of periodontal disease increased as the number of crown prostheses increased. Participants with 6–10 and 11 prosthetic crowns had 1.24 and 1.28 times higher prevalence of periodontitis, respectively, than patients with no prosthetic crown.ConclusionsThe results of this study show that the number of prosthetic crowns present in adults is related to the prevalence of periodontitis.

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CNS imaging studies in cystic fibrosis patients presenting with sudden neurological events

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000456 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000456

Author(s):

Samantha Ellis ◽

Catherine Rang ◽

Tom Kotsimbos ◽

Dominic Keating ◽

Felicity Finlayson ◽

...

Keyword(s):

Cystic Fibrosis ◽

Brain Imaging ◽

Medical Records ◽

Seizure Activity ◽

Neurological Complications ◽

Neurological Symptoms ◽

Imaging Studies ◽

Vascular Events ◽

Mri Brain ◽

Large Teaching Hospital

BackgroundAcute neurological events may present as an extrapulmonary complication in patients with cystic fibrosis (CF). These events can be secondary to a range of different aetiologies.MethodsA retrospective analysis of 476 medical records of CF patients attending a large teaching hospital between 2000 and 2018 was performed. Patients presenting with acute neurological events who had MRI brain imaging were evaluated. Patients who had headaches without associated neurological symptoms were excluded from this analysis.ResultsAcute neurological presentations, excluding headaches without associated neurological symptoms, were reported in 27 index patients out of the 476 patients. Of these, 16 patients had MRI brain imaging for review. Three patients suffered pathology secondary to vascular events, both ischaemic and haemorrhagic; four patients had evidence of ischaemia or infarction not consistent with a vascular territory stroke and the remaining patients experienced a range of different neurological events. The most common presentation among these patients was seizure activity, followed by a transient motor or sensory deficit.ConclusionsNeurological complications are recognised among individuals with CF. Although rare, they can be secondary to a range of different aetiologies, including dysfunctional cell energetics. Additional studies are required to further evaluate this association.

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Abstract 100: Right Insular Infarction is an Independent Predictor of Mortality in Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.100 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Laura Hanne ◽

Peter Brunecker ◽

Matthias Endres ◽

Jochen B Fiebach ◽

Martin Ebinger

Keyword(s):

Ischemic Stroke ◽

Multivariate Regression ◽

Independent Predictor ◽

Lesion Volume ◽

Regression Analyses ◽

Imaging Studies ◽

Ischemic Lesion ◽

Patients At Risk ◽

The Right

Introduction: The association between insular infarction and mortality has often been described. However, whether this is simply due to higher lesion volumes is still controversial. Hypothesis: We hypothesized that there is an association between insular infarction and mortality independent of lesion volume. Methods: We included consecutive stroke patients between 01.09.2008 and 11.11.2012 from the 1000Plus data base with an acute ischemic lesion on diffusion-weighted imaging on day one and a completed 90 days follow-up. Insular location of the infarction was determined using the Stroke Lesion Atlas (SLA). The SLA is an in-house developed spatial database for analyses of imaging studies (Figure). In multivariate regression analyses of mortality and insular infarcts we adjusted for age, lesion volume, atrial fibrillation, NIHSS, capsular infarcts, and left hemispheric infarcts. Results: We included 718 patients. Out of 165 patients with insular infarcts 20 patients died; among the 553 patients with lesions outside the Insula 16 patients died (mortality 12% vs. 3%; p<.001). In analyses adjusting for all mentioned confounders insular infarction was not an independent predictor of mortality. After exclusion of NIHSS insular infarcts were independently associated with mortality (OR=3.003, CI 1.41 - 6.38, p=.004). Right insular infarction was an independent mortality predictor adjusted for all confounders including the NIHSS (OR=2.793, CI 1.27 - 6.15, p=.011). Conclusion: Right insular involvement is an independent predictor of mortality in ischemic stroke and may be used to improve identification of patients at risk. Figure. Lesion overlap of patients who survived (A) or died (B). Red indicates voxels involved in at least 15% of patients. Deceased patients show a maximum lesion overlap in the right Insula.

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Subclinical Vascular Brain Lesions in Young Adults With Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.121.036038 ◽

2021 ◽

Author(s):

Valeria De Giuli ◽

Mario Grassi ◽

Michele Besana ◽

Marialuisa Zedde ◽

Andrea Zini ◽

...

Keyword(s):

Young Adults ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Odds Ratio ◽

White Matter Hyperintensities ◽

Hazard Ratio ◽

Brain Lesions ◽

End Point ◽

Stroke In Young Adults ◽

Stroke In Young

Background and Purpose: Subclinical vascular brain lesions are highly prevalent in elderly patients with stroke. Little is known about predisposing factors and their impact on long-term outcome of patients with stroke at a young age. Methods: We quantified magnetic resonance-defined subclinical vascular brain lesions, including lacunes and white matter hyperintensities, perivascular spaces and cerebral microbleeds, and assessed total small-vessel disease (SVD) score in patients with first-ever acute ischemic stroke aged 18 to 45 years, and followed them up, as part of the multicentre Italian Project on Stroke in Young Adults. The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. We assessed the predictive accuracy of magnetic resonance features and whether the addition of these markers improves outcome prediction over a validated clinical tool, such as the Italian Project on Stroke in Young Adults score. Results: Among 591 patients (males, 53.8%; mean age, 37.5±6.4 years), 117 (19.8%) had subclinical vascular brain lesions. Family history of stroke was associated with lacunes (odds ratio, 2.24 [95% CI, 1.30–3.84]) and total SVD score (odds ratio, 2.06 [95% CI, 1.20–3.53] for score≥1), hypertension with white matter hyperintensities (odds ratio, 2.29 [95% CI, 1.22–4.32]). After a median follow-up of 36.0 months (25th–75th percentile, 38.0), lacunes and total SVD score were associated with primary end point (hazard ratio, 2.13 [95% CI, 1.17–3.90] for lacunes; hazard ratio, 2.17 [95% CI, 1.20–3.90] for total SVD score ≥1), and the secondary end point brain ischemia (hazard ratio, 2.55 [95% CI, 1.36–4.75] for lacunes; hazard ratio, 2.61 [95% CI, 1.42–4.80] for total SVD score ≥1). The predictive performances of the models, including magnetic resonance features were comparable to those of the random model. Adding individual magnetic resonance features to the Italian Project on Stroke in Young Adults score did not improve model prediction. Conclusions: Subclinical vascular brain lesions affect ≈2 in 10 young adults with ischemic stroke. Although lacunes and total SVD score are associated with thrombotic recurrence, they do not improve accuracy of outcome prediction over validated clinical predictors.

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Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases

Journal of Neurosurgery ◽

10.3171/2009.3.jns081695 ◽

2009 ◽

Vol 111 (4) ◽

pp. 820-824 ◽

Cited By ~ 34

Author(s):

Ellen L. Air ◽

James L. Leach ◽

Ronald E. Warnick ◽

Christopher M. McPherson

Keyword(s):

Medical Records ◽

Stereotactic Biopsy ◽

Brain Regions ◽

Postoperative Hemorrhage ◽

Brain Lesions ◽

Imaging Studies ◽

Lesion Location ◽

Biopsy Site ◽

Increased Risk ◽

The Brain

Object Frameless stereotactic biopsy has been shown in multiple studies to be a safe and effective tool for the diagnosis of brain lesions. However, no study has directly evaluated its safety in lesions located in eloquent regions in comparison with noneloquent locations. In this study, the authors determine whether an increased risk of neurological decline is associated with biopsy of lesions in eloquent regions of the brain. Methods Medical records, including imaging studies, were reviewed for 284 cases in which frameless stereotactic biopsy procedures were performed by 19 neurosurgeons at 7 institutions between January 2000 and December 2006. Lesion location was classified as eloquent or noneloquent in each patient. The incidence of neurological decline was calculated for each group. Results During the study period, 160 of the 284 biopsies predominately involved eloquent regions of the brain. In evaluation of the complication rate with respect to biopsy site, neurological decline occurred in 9 (5.6%) of 160 biopsies in eloquent brain areas and 10 (8.1%) of 124 biopsies in noneloquent regions; this difference was not statistically significant (p = 0.416). A higher number of needle passes was associated with the presence of a postoperative hemorrhage at the biopsy site, although not with a change in the result of neurological examination. Conclusions Frameless stereotactic biopsy of lesions located in eloquent brain regions is as safe and effective as biopsy of lesions in noneloquent regions. Therefore, with careful planning, frameless stereotactic biopsy remains a valuable and safe tool for diagnosis of brain lesions, independent of lesion location.

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Factors for Treatment Success in Anisometropic Amblyopia: Effect of Refractive Errors of the Amblyopic Eyes

10.21203/rs.3.rs-635271/v1 ◽

2021 ◽

Author(s):

Daye Diana Choi ◽

Dae Hee Kim ◽

Ungsoo Samuel Kim ◽

Seung-Hee Baek

Keyword(s):

Medical Records ◽

Odds Ratio ◽

Treatment Success ◽

Refractive Errors ◽

Spherical Equivalent ◽

Multivariate Logistic Regression ◽

Anisometropic Amblyopia ◽

Younger Age ◽

Significant Factors

Abstract Purpose: To investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Methods: Medical records of 397 children with anisometropic amblyopia aged 3 to 12 years during 2010~2016 were retrospectively reviewed. Anisometropia was defined as ≥1 diopter (D) difference in SE, or ≥1.5 D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥1D), emmetropia (-1< SE <+1) and myopia (SE ≤-1D) groups. Treatment success was defined as achieving interocular LogMAR visual acuity difference < 0.2. Multivariate logistic regression was used to analyze the factors for treatment success.Results: Significant factors for the amblyopia treatment success in hyperopia group (n=270) were younger age [adjusted odds ratio (aOR) (95% confidence interval, CI) = 0.60 (0.41-0.88)], larger astigmatism of sound eye [aOR (95% CI) = 0.04 (0-0.78)], better BCVA in amblyopic eyes at presentation [aOR (95% CI) = 0.01 (0-0.16)], longer follow-up period [aOR (95%CI)=1.1 (1.04-1.17)], and no comorbid strabismus [aOR (95%CI)= 0.25 (0.06-0.99)]. In myopia group (n=68), older age [aOR (95% CI) =0.45 (0.20-0.97)] and worse BCVA in amblyopic eyes [aOR (95% CI) = 0.04 (0-0.61)] were inversely associated with higher odds of treatment success. There was no significant factor for treatment success in emmetropia group (n=59).Conclusions: The type of refractive error of amblyopic eyes at presentation affects the factors for treatment success of anisometropic amblyopia.

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Association between the Number of Prosthetic Crowns and Periodontitis: The Korea National Health and Nutrition Examination Survey (KNANES VII) from 2016–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115957 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5957

Author(s):

Yun-Jeong Kim ◽

Jae-Young Lee ◽

Young Ku ◽

Hyun-Jae Cho

Keyword(s):

Logistic Regression ◽

Oral Health ◽

National Health ◽

Odds Ratio ◽

Demographic Variables ◽

Nutrition Examination Survey ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Health And Nutrition ◽

Health Related

Although the presence of prosthetic restorations has been associated with plaque accumulation, gingivitis, and periodontitis, there is a lack of large epidemiological investigations providing evidence on the association of prosthetic crowns with periodontitis. This study aimed to analyze the association between the number of prosthetic crowns and the presence of periodontitis. This study was based on the Seventh Korea National Health and Nutrition Examination Survey (2016–2018). A total of 12,689 participants over the age of 19 years were surveyed. Multivariate logistic regression analyses were used to identify the association between the number of prosthetic crowns and periodontitis after adjusting for potential confounders, including demographic variables, socio-economic characteristics, oral health-related variables, and oral and systemic clinical variables. The odds ratio of periodontitis showed statistically significant differences in the anterior and posterior regions, and the prevalence of periodontal disease increased as the number of crown prostheses increased. Participants with 6–10 and 11 prosthetic crowns had 1.24 and 1.28 times higher prevalence of periodontitis, respectively, than patients with no prosthetic crown. The results of this study show that the number of prosthetic crowns present in adults is related to the prevalence of periodontitis.

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Perioperative Acute Ischemic Stroke in Noncardiac and Nonvascular Surgery

Anesthesiology ◽

10.1097/aln.0b013e318194b5ff ◽

2009 ◽

Vol 110 (2) ◽

pp. 231-238 ◽

Cited By ~ 56

Author(s):

Brian T. Bateman ◽

H Christian Schumacher ◽

Shuang Wang ◽

Shahzad Shaefi ◽

Mitchell F. Berman

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Ischemic Stroke ◽

Renal Disease ◽

Acute Ischemic Stroke ◽

Hip Replacement ◽

Odds Ratio ◽

Lung Resection ◽

Multivariate Logistic Regression

Background Perioperative acute ischemic stroke (AIS) is a recognized complication of noncardiac, nonvascular surgery, but few data are available regarding incidence and effect on outcome. This study examines the epidemiology of perioperative AIS in three common surgeries: hemicolectomy, total hip replacement, and lobectomy/segmental lung resection. Methods Discharges for patients aged 18 yr or older who underwent any of the surgical procedures listed above were extracted from the Nationwide Inpatient Sample, an administrative database that contains 20% of all discharges from non-Federal hospitals each year, for years 2000 to 2004. Using appropriate International Classification of Diseases, 9th revision, Clinical Modification codes, patients with perioperative AIS were identified, as were comorbid conditions that may be risk factors for perioperative AIS. Multivariate logistic regression was performed to identify independent predictors of perioperative AIS and to ascertain the effect of AIS on outcome. Results A total of 0.7% of 131,067 hemicolectomy patients, 0.2% of 201,235 total hip replacement patients, and 0.6% of 39,339 lobectomy/segmental lung resection patients developed perioperative AIS. For patients older than 65 yr, AIS rose to 1.0% for hemicolectomy, 0.3% for hip replacement, and 0.8% for pulmonary resection. Multivariate logistic regression analysis revealed renal disease (odds ratio, 3.0), atrial fibrillation (odds ratio, 2.0), history of stroke (odds ratio, 1.6), and cardiac valvular disease (odds ratio, 1.5) to be the most significant risk factors for perioperative AIS. Conclusions Perioperative AIS is an important source of morbidity and mortality associated with noncardiac, nonvascular surgery, particularly in elderly patients and patients with atrial fibrillation, valvular disease, renal disease, or previous stroke.

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