A comparison study of automated approaches for brain lesions segmentation in ischemic stroke

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, <0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, <0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p<0.001) compared to controls (71.6%). CVR < 10% was registered in 33.8% patients with seizures versus 13.4% controls (p<0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p<0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (> 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, <0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

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Machine learning volumetry of ischemic brain lesions on CT after thrombectomy—prospective diagnostic accuracy study in ischemic stroke patients

Neuroradiology ◽

10.1007/s00234-020-02419-7 ◽

2020 ◽

Vol 62 (10) ◽

pp. 1239-1245

Author(s):

Jiri Kral ◽

Martin Cabal ◽

Linda Kasickova ◽

Jaroslav Havelka ◽

Tomas Jonszta ◽

...

Keyword(s):

Machine Learning ◽

Ischemic Stroke ◽

Diagnostic Accuracy ◽

Brain Lesions ◽

Diagnostic Accuracy Study ◽

Stroke Patients ◽

Ischemic Brain ◽

Accuracy Study

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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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Cervene in acute ischemic stroke: Results of a double-blind, placebo-controlled, dose-comparison study

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/s1052-3057(99)80071-8 ◽

1999 ◽

Vol 8 (4) ◽

pp. 224-230 ◽

Cited By ~ 15

Author(s):

Wayne Clark ◽

William Ertag ◽

Edward Orecchio ◽

Eric Raps

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Comparison Study ◽

Double Blind ◽

Double Blind Placebo ◽

Dose Comparison

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Neuroplasticity pathophysiological mechanisms underlying neuro-optometric rehabilitation in ischemic stroke – a brief review

Balneo and PRM Research Journal ◽

10.12680/balneo.2021.412 ◽

2021 ◽

Vol 12 (Vol.12, no.1) ◽

pp. 16-20

Author(s):

Adriana Elena BULBOACA ◽

Ioana STANESCU ◽

Cristina NICULA ◽

Angelo BULBOACA

Keyword(s):

Patient Outcome ◽

Ischemic Stroke ◽

Visual Function ◽

Current Knowledge ◽

Life Quality ◽

Brain Lesions ◽

Stroke Patients ◽

Ischemic Brain ◽

Pathophysiological Mechanisms ◽

The Brain

Neuroplasticity is an essential phenomenon underlying on neurorehabilitation process, by which the brain can remodel the dysfunction consequent to a lesion. Ischemic brain lesions are the most frequent brain lesions often associated with visual function disability. Experimental and clinical studies established that visual function disability can impede the neurorehabilitation therapy efficiency. Neuro-optometric therapy has been proved to significantly improve the patient outcome after brain lesions. The pathophysiological mechanisms underlying this process are yet to be deciphered. Current knowledge regarding the pathophysiological mechanisms involved in ischemic lesions and neuroplasticity as a reparation process offers real support to a more efficient neurorehabilitation therapy that can contribute to the improvement of life quality in stroke patients. Keywords: neuroplasticity, neuro-optometric rehabilitation, ischemic stroke,

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Abstract WP344: Vascular Unloading Technique for Continuous Non-invasive Blood Pressure Monitoring After Intravenous Thrombolysis in Acute Ischemic Stroke: Interim Analysis of a Prospective Method Comparison Study

Stroke ◽

10.1161/str.47.suppl_1.wp344 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Timo Siepmann ◽

Anne Koehler ◽

Kristian Barlinn ◽

Jessica Kepplinger ◽

Alexandra Prakapenia ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Interim Analysis ◽

Method Comparison ◽

Comparison Study ◽

Non Invasive ◽

Method Comparison Study ◽

Iv Tpa ◽

Vascular Unloading Technique

Introduction: Elevated arterial blood pressure (BP) increases the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis with tPA in acute ischemic stroke (AIS). While arterial BP is usually monitored using intermittent oscillometric measurements with an upper arm cuff, the vascular unloading technique (VUT) provides non-invasive continuous BP monitoring with a finger cuff. Hypothesis: We hypothesized that VUT monitoring is feasible in AIS patients receiving IV tPA, is comparable to the standard technique, and allows detection of BP peaks that might be missed in oscillometric BP monitoring. Methods: We performed an interim analysis of an ongoing prospective method comparison study. AIS patients were simultaneously monitored over 24 h following IV tPA bolus using VUT and contralateral oscillometric BP assessment every 30 min. Results: We present interim data from 15 out of 24 AIS (4 m, 11 f; aged 72.5±14.9 y, mean±SD) receiving IV tPA. Nominal significance level was set to 0.029 in accordance with Pocock’s rule. Missing data were less than 5% for both techniques. There was a positive correlation between VUT and oscillometric BP assessment (Pearson’s correlation coefficient r=0.91, p<0.001 for systolic BP; and r=0.88, p<0.001 for diastolic BP). Bland-Altman analysis confirmed this agreement (figure 1). The mean difference between VUT and oscillometric BP measurements was 9.4±6.1 mmHg for systolic, and 4.5±3.0 mmHg for diastolic BP (p=n.s.). Peaks (systolic BP>180 or diastolic BP>110 mmHg) were detected by VUT monitoring (at least one episode≥5 min) in 12 patients, and by oscillometric BP assessment (≥one time point of measurement) in 7 patients (p<0.01). Conclusions: Our interim data suggest that VUT-based BP monitoring is feasible in AIS patients receiving IV tPA, and might be more sensitive than intermittent oscillometric BP assessment in detecting potentially harmful blood pressure peaks. Figure 1: Bland Altman plot

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Assessment of Aortic Arch Stiffness Using Pulse-Wave Tissue Doppler Imaging: A Transesophageal Echocardiographic Comparison Study of Acute Ischemic Stroke Patients and Stroke-Free Patients

Echocardiography ◽

10.1111/echo.12521 ◽

2014 ◽

Vol 31 (9) ◽

pp. 1113-1121 ◽

Cited By ~ 2

Author(s):

Kazuyoshi Kaneko ◽

Tetsuya Takahashi ◽

Hiroki Saito ◽

Nobuyuki Kiribayashi ◽

Koki Omi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Aortic Arch ◽

Tissue Doppler Imaging ◽

Pulse Wave ◽

Tissue Doppler ◽

Doppler Imaging ◽

Comparison Study ◽

Stroke Patients

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

Journal of Neurology ◽

10.1007/s00415-020-09909-x ◽

2020 ◽

Vol 267 (S1) ◽

pp. 126-135 ◽

Cited By ~ 1

Author(s):

Björn Machner ◽

Jin Hee Choi ◽

Peter Trillenberg ◽

Wolfgang Heide ◽

Christoph Helmchen

Keyword(s):

Ischemic Stroke ◽

Brain Imaging ◽

Medical Records ◽

Odds Ratio ◽

Brain Lesions ◽

Clinical Parameters ◽

Regression Analyses ◽

Imaging Studies ◽

Multivariate Logistic Regression ◽

Acute Vestibular Syndrome

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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