Clinical Predictors of Cerebrovascular Occlusion for Patients Presenting With Acute Stroke

2006 ◽  
Vol 15 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Andrew P. Slivka ◽  
Margaret A. Notestine ◽  
Jun Li ◽  
Gregory A. Christoforidis
Keyword(s):  
Acute Stroke ◽  
Clinical Predictors ◽  
Cerebrovascular Occlusion

Role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome- A Prospective observational study

2021 ◽  
Vol 12 (6) ◽  
pp. 16-22
Author(s):  
Maqsood Ahmad Dar ◽  
Eijaz Ahmad Bhat ◽  
Muzzafer M Mir
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Acute Stroke ◽  
Developed Countries ◽  
Loss Of Consciousness ◽  
Motor Score ◽  
Clinical Predictors ◽  
Focal Neurological Deficit ◽  
Ventilator Support

Background: Stroke is the third leading cause of death in developed countries and the leading cause of long term disability. As the mortality during initial few days depends upon the compression of vital organs in brain stem due to raised intracranial tension and possible herniation, treatment for impending or early herniation requires intubation and mechanical ventilation and up to 10% of patients with acute stroke need mechanical ventilation due to different reasons. Aims and Objective: The aim of the study was to find the role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome. Materials and Methods: This prospective observational cohort study was conducted from September 2017 to march 2019 of patients with acute stroke admitted either through OPD or Emergency/ Triage of Max super specialty hospital, Saket, New Delhi. Patients with acute Stroke defined as the presence of sudden onset of focal neurological deficit and admitted within 24 h of onset of symptoms with Age ≥18 years were included in the study. Patients already on ventilator support at the time of admission were excluded. Results: A total of 165 patients met the inclusion and exclusion criteria and were enrolled for the study. Out of 165 patients included in the study 43 (26.06 %) were put on the mechanical ventilation due to various reasons. Multivariate analysis of statistically significant and most clinically important variables showed the overall predictor accuracy of requirement of mechanical ventilation of 81.2% if the patients had loss of consciousness at the time of onset ( OR = 0.076) and Glasgow Coma Scale (GCS) motor score of ≤ 5 ( OR= 0.000). About 58.62% (17/29) patients who were put on ventilator support were found to have favorable outcome Modified Rankin Scale (MRS score ≤ 2) at discharge compared to 6.90% (2/29) before ventilation. Conclusion: We concluded that loss of consciousness at onset, GCS motor score ≤ 5 (OR= 0.000) were associated with overall predictor accuracy of 81.2% in determining the need for mechanical ventilation. We found overall in-hospital mortality rate of 9.1% whereas mortality rate in patients on mechanical ventilation was 32.55%.

Abstract 19026: Libman-sacks Endocarditis: Can It Be Clinically Predicted?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Leonardo Macias ◽  
Richard Snider ◽  
Michelle Ratliff ◽  
Paola Roldan ◽  
Rodrigo Rodriguez ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Diagnostic Yield ◽  
Strong Predictor ◽  
High Sensitivity ◽  
Platelet Activity ◽  
Clinical Predictors ◽  
Early Therapy ◽  
Predictive Values

Background: Libman-Sacks endocarditis, characterized by Libman-Sacks vegetations (LSV), is common in patients with systemic lupus erythematosus (SLE) and is a strong predictor of stroke and transient ischemic attacks (TIA), cognitive dysfunction, and increased mortality. Accurate detection of LSV may lead to early therapy and prevention of development or progression of embolic cerebrovascular disease. TEE is accurate for detecting LSV, but is semi-invasive. Thus, there is a need for identifying clinical variables with a high predictive value for LSV on TEE. Methods: 76 SLE patients (69 women, 38 ± 12 years old) and 26 age-and sex-matched healthy controls underwent TEE and assessment of demographics, atherogenic risk factors, and parameters of inflammation, platelet activity, coagulation, and fibrinolysis. Patients were also assessed for SLE duration, activity, injury, therapy, and autoantibodies including antiphospholipid antibodies. Multivariate regression and optimal receiver operator curve by Neyman-Pearson lemma were used to determine the best clinical predictors of LSV on TEE. Results: 39 (51%) SLE patients vs 2 (8%) controls had LSV on TEE (p<0.001). In all 76 patients, acute stroke/TIA (OR 50.6, 95% CI = 6.8 - 374, p <0.001) and SLE duration (OR = 1.18, 95% CI = 1.05 - 1.32, p = 0.004) were the predictors of LSV. In 53 patients without acute stroke/TIA, SLE duration (OR = 1.16, CI =1.03 - 1.31, p = 0.01) and age (OR = 1.06, CI = 1.0 - 1.12, p = 0.05) were the predictors of LSV. A recruitment rule of performing TEE in SLE patients with acute stroke/TIA and in those without stroke/TIA if they have a disease duration of ≥12 years or a disease duration ≥5 years and age ≥32 provide high sensitivity (85%), specificity (81%), and positive (83%) and negative (83%) predictive values for LSV on TEE ( Figure 1 ). Conclusion: In SLE patients, acute stroke/TIA, or SLE duration ≥12 years, or SLE duration ≥5 years and age ≥32 provide a high diagnostic yield for detecting LSV on TEE.

Clinical predictors and outcome of patients of acute stroke requiring ventilatory support: A prospective hospital based cohort study

2014 ◽  
Vol 337 (1-2) ◽  
pp. 14-17
Author(s):  
Priya Gupta ◽  
Kameshwar Prasad ◽  
Amit Kumar ◽  
Pradeep Kumar ◽  
Rohit Bhatia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Acute Stroke ◽  
Ventilatory Support ◽  
Clinical Predictors

Abstract W P239: Multiscale Entropy Analysis of Heart Rate Variability Predicts Functional Outcome in ICU-Admitted Acute Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sung-Chun Tang ◽  
Hsiao-I Jen ◽  
Yen-Hung Lin ◽  
ChiI-Sheng Hung ◽  
Dar-Ming Lai ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Linear Method ◽  
Functional Independence ◽  
Multiscale Entropy ◽  
Clinical Predictors ◽  
Stroke Patients ◽  
Glucose Levels

Objectives: Heart rate variability (HRV) has been proposed as a predictor of acute stroke outcome. The present study aimed to apply a novel non-linear method, multiscale entropy (MSE) analysis to investigate the association between the complexity of HRV and outcome in intensive care unit (ICU) admitted acute stroke patients. Methods: Continuous EKG signals were recorded for one hour in non-atrial fibrillation (AF) stroke patients within 48 hours after admission and controls. The complexity index (CI) was defined as the area under the MSE curve from scale 1 to scale 20. The values of CI related to outcome of functional independence (modified Rankin Scale 0-2) and death at 3 months were analyzed. Results: From February, 2012 to February, 2013, a total of 109 non-AF acute stroke patients (mean age 61.7±15.0 years, female 45.9%) and 60 age-sex matched controls were recruited. The CI of the MSE was significantly lower in stroke patients than the controls (32.3 ±4.25 versus 25.2 ±6.84 p<0.001). After adjustment for age, gender, and known clinical predictors including NIH stroke scales and glucose levels at admission, the values of CI had significant associations with outcomes of both functional independence and death at 3 months (adjusted odds ratio=1.186, p=0.004 and 0.784, p=0.039, respectively). Conclusions: In ICU admitted non-AF acute stroke patients, early assessing the complexity of HRV via MSE can help in predicting long-term functional outcome.

Clinical predictors of dysphagia and aspiration risk: Outcome measures in acute stroke patients

2000 ◽  
Vol 81 (8) ◽  
pp. 1030-1033 ◽  
Author(s):  
Stephanie K. Daniels ◽  
Lindsay A. Ballo ◽  
Mary-Claudia Mahoney ◽  
Anne L. Foundas
Keyword(s):  
Acute Stroke ◽  
Outcome Measures ◽  
Clinical Predictors ◽  
Stroke Patients ◽  
Aspiration Risk

scholarly journals Identification of Stroke Mimics in the Emergency Department Setting

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2280 ◽  
Author(s):  
W. Oliver Tobin ◽  
Joseph G. Hentz ◽  
Bentley J. Bobrow ◽  
Bart M. Demaerschalk
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Clinical Predictors ◽  
Acute Stroke Care ◽  
Stroke Mimics ◽  
Emergency Department Setting ◽  
Multivariable Regression ◽  
Stroke Mimic ◽  
Stroke Centre

Background and Purpose Previous studies have shown a stroke mimic rate of 9%–31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics. Methods This was a retrospective cohort observational study. Consecutive “stroke alert” patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as “stroke” or “stroke mimic”. Multivariable regression analysis was used to define clinical predictors of stroke mimic. Results 206 patients were reviewed. 22% were classified as stroke mimics. Multivariable scoring did not help in identification of stroke mimics. 99.5% of patients had a neurological diagnosis at final diagnosis. Discussion 22% of patients with suspected acute stroke had a stroke mimic. The aetiology of stroke mimics was varied, with seizure, encephalopathy, syncope and migraine being commonest. Multivariable scoring for identification of stroke mimics is not feasible. 99.5% of patients had a neurological diagnosis. This strengthens the case for the involvement of stroke neurologists/stroke physicians in acute stroke care.

scholarly journals Clinical Predictors of Prolonged Hospital Stay after Acute Stroke: Relevance of Medical Complications

2012 ◽  
Vol 03 (06) ◽  
pp. 502-507 ◽  
Author(s):  
Adrià Arboix ◽  
Joan Massons ◽  
Luís García-Eroles ◽  
Cecilia Targa ◽  
Montserrat Oliveres ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Medical Complications ◽  
Prolonged Hospital Stay ◽  
Clinical Predictors ◽  
Prolonged Hospital

The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽  
1999 ◽  
Vol 12 (1) ◽  
pp. 21-27
Author(s):  
Marit Kirkevold
Keyword(s):  
Acute Stroke ◽  
Theoretical Perspective ◽  
Stroke Patients ◽  
Role Of Nursing ◽  
Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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