Variations in the Intensive Use of Head CT for Elderly Patients with Hemorrhagic Stroke

Background: Chronic diseases such as stroke most frequently occur on old people while literature on prognosis risk factors on elderly is rare particularly Sub-Sahara Africa. The aim of the study is to determine prognosis risk factors of stroke on elderly patients. Method: It was a prospective cohort study carried out during 6 months that included elderly patients over 70 years old admitted in two tertiary medical emergency departments. Results: 56 patients with mean age 75.2 ± 5.17 showed moderate NIHSS score (59%) without gender predominance. 75% of patients with a severe score were in the 70-79 years old group. Functional dependency (93%) increased with the NIHSS score severity and 50% of patients with a moderate NIHSS score showed normal nutritional status unlike patients with a severe NIHSS score and depression for most of the cases. Mortality was frequent for patients with hemorrhagic stroke with swallowing disorder and a severe NIHSS score. Conclusion: Stroke on very elderly patients appears moderate with mortality chances increasing according to the severity of the NIHSS score, swallowing disorders that require a multidisciplinary approach in a neurovascular unit.

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C1-C2 fractures in asymptomatic elderly patients with minor head trauma: evaluation with a dedicated head CT protocol

Radiologia Brasileira ◽

10.1590/0100-3984.2017.0154 ◽

2019 ◽

Vol 52 (1) ◽

pp. 17-23 ◽

Cited By ~ 2

Author(s):

Silvia Squarza ◽

Carla Luisa Uggetti ◽

Marco Angelo Politi ◽

Lorenzo Carlo Pescatori ◽

Raffaele Bisogno ◽

...

Keyword(s):

Cervical Spine ◽

Elderly Patients ◽

Head Trauma ◽

Upper Cervical Spine ◽

Minor Head Trauma ◽

Cervical Spine Injuries ◽

Head Ct ◽

Ct Protocol ◽

Spine Injuries ◽

Upper Cervical

Abstract Objective: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. Materials and Methods: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1-C2 region. Results: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. Conclusion: Inclusion of the C1-C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

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Artificial neural networks: Predicting head CT findings in elderly patients presenting with minor head injury after a fall

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2016.10.065 ◽

2017 ◽

Vol 35 (2) ◽

pp. 260-267 ◽

Cited By ~ 5

Author(s):

Michael W. Dusenberry ◽

Charles K. Brown ◽

Kori L. Brewer

Keyword(s):

Neural Networks ◽

Artificial Neural Networks ◽

Head Injury ◽

Elderly Patients ◽

Minor Head Injury ◽

Head Ct ◽

Ct Findings ◽

Artificial Neural

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How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Journal of Neurosurgery ◽

10.3171/2020.2.jns193460 ◽

2020 ◽

pp. 1-9

Author(s):

Ralph T. Schär ◽

Shpend Tashi ◽

Mattia Branca ◽

Nicole Söll ◽

Debora Cipriani ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Elderly Patients ◽

Age Groups ◽

Head Ct ◽

Estimated Blood Loss ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

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Overview of The Head CT-Scan in Stroke Patients who was Treated at Muhammadiyah Hospital Palembang

Muhammadiyah Medical Journal ◽

10.24853/mmj.2.1.24-34 ◽

2021 ◽

Vol 2 (1) ◽

pp. 24

Author(s):

Pratrisna Yusastra ◽

Indriyani Indriyani ◽

Budi Utama

Keyword(s):

Ischemic Stroke ◽

Ct Scan ◽

Hemorrhagic Stroke ◽

Right Hemisphere ◽

Clinical Symptoms ◽

Neurological Deficits ◽

Thalamic Lesion ◽

Stroke Patients ◽

Head Ct ◽

The Right

Background: Stroke is a collection of symptoms of neurological deficits due to sudden acute disturbance of brain function, both focal and global, caused by blockage or rupture of arteries and veins and proven by imaging and/or reflex pathology. Using CT-Scan, the description of acute phase stroke can be easier and can determine the appropriate treatment criteria for stroke. Purposes: To determine characteristic Head CT-Scan image of stroke patients hospitalized in Muhammadiyah Palembang Hospital. Methods: This study was conducted in a retrospective descriptive manner and obtained a sample of 41 stroke patients according to the inclusion and exclusion criteria using total sampling. Result: In this study, there were 28 patients (68.2%) with ischemic stroke and 13 patients (31.7%) with hemorrhagic stroke. Head CT-Scan image of ischemic stroke shows basal ganglia lesion (28.5%) and the right hemisphere lesions (57.1%) as the most predominant area. Head CT-Scan image of hemorrhagic stroke (58.3%) had intracerebral hemorrhage with the dominant thalamic lesion area (66.6%) and the right hemisphere (58.3%) had the most lesions with 8 patients (66, 6%) had a midline shift. Stroke patients were treated as experienced by the elderly (90.2%) and were dominated by the female sex (63.4%) and are dominated by clinical symptoms of hemiparesis (29.2%). Conclusion: Stroke patients at Muhammadiyah Palembang hospital dominated by ischemic stroke and on head CT Scan image predominantly shows lesions on the right cerebral hemisphere.

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Abstract T MP107: Measurement of Acute Brain Hemorrhage in the Pre-hospital Setting

Stroke ◽

10.1161/str.46.suppl_1.tmp107 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Deborah Murphy ◽

Phil deKerillis ◽

Jennifer Frabizzio ◽

Bradford Nash ◽

Qaisar Shah

Keyword(s):

Pilot Study ◽

Acute Stroke ◽

Ct Scan ◽

False Positive ◽

Hemorrhagic Stroke ◽

Hospital Setting ◽

Ischemic Lesion ◽

Head Ct ◽

Infra Red ◽

Screening Device

Purpose: Delay in identification and treatment of hemorrhagic stroke can result in severe disability and death. Differentiation of acute stroke is essential to successful emergency treatment and patient outcome. A head CT scan is the gold standard for identifying hemorrhagic stroke. This pilot study evaluates utilization of a handheld infra-red screening device for possible detection of hemorrhagic stroke in the pre-hospital setting. Methods: The study involved collaboration with regional emergency medical services. Device education and competencies were completed by all paramedics. A stroke assessment form was utilized in conjunction with the device on all patients experiencing signs and symptoms of acute stroke. Data obtained by the device was compared to the initial head CT scan obtained in the hospital Emergency Trauma Center. Results: A total of 46 patients were enrolled in this pilot study. The device and head CT data were evaluated on ability to detect the presence of hemorrhagic stroke. Of the 46 patients, 7 patients were admitted with hemorrhagic stroke after positive head CT results. Out of these 7 patients, 5 had positive device results. There were 14 patients admitted with a diagnosis of acute ischemic stroke, 8 of these patients had false positive device results. Stroke mimic enrollment included 25 patients, 15 with false positive device results. Conclusion: The handheld infra-red screening device detected all hemorrhagic stroke cases that were within the detection abilities of the system. Large vessel ischemic strokes scanned by EMS demonstrated increased blood flow and on the opposite side of the ischemic lesion. Stroke mimics included cardiac abnormality, seizure and dehydration. Several challenges in the use of the device are noted. The 2-3 minutes it took EMS to scan correctly, was too long for scanning stroke patients, decreasing this measurement time appeared to contribute to false positive results. Measurements performed during fast ambulance transport appeared to also cause false positive readings. Difficulty to achieve reliable measurement was also noted with combative and epileptic patients. EMS feedback was provided to the device manufacturer. The researchers recommend continued research to support this effort.

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Energy correction of hemorrhagic stroke in elderly patients

Advances in Gerontology ◽

10.1134/s207905701401010x ◽

2014 ◽

Vol 4 (1) ◽

pp. 62-66

Author(s):

E. V. Silina ◽

S. A. Rumyantseva ◽

S. B. Bolevich

Keyword(s):

Elderly Patients ◽

Hemorrhagic Stroke ◽

Energy Correction

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Use of Cranial Computed Tomography (CT) in Elderly Patients Presenting After a Fall: Can We Predict Those Having Abnormal Head CT Scans

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2015/10435 ◽

2015 ◽

Vol 6 (3) ◽

pp. 342-350 ◽

Cited By ~ 3

Author(s):

Jennifer Bennett ◽

Nathan Nehus ◽

Matthew Astin ◽

Charles Brown ◽

Reuben Johnson ◽

...

Keyword(s):

Computed Tomography ◽

Elderly Patients ◽

Ct Scans ◽

Cranial Computed Tomography ◽

Head Ct ◽

Abnormal Head

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Kinesiotherapy After Ischemic Stroke

GYMNASIUM ◽

10.29081/gsjesh.2019.20.1s.09 ◽

2019 ◽

Vol XX (1 (Supplement)) ◽

pp. 105

Author(s):

Olivia Carmen Timnea ◽

Vladimir Potop ◽

Andreea Consuela Timnea ◽

Larisa Potop

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Clinical Examination ◽

Hemorrhagic Stroke ◽

The Other ◽

Physical Medicine ◽

Age And Gender ◽

X Ray ◽

And Gender ◽

Recovery Program

The purpose of the paper is to demonstrate the efficiency of the physio - kinesiotherapy recovery in young and elderly patients who had a transient stroke, as well as an ischemic/hemorrhagic stroke. The studies of case were conducted at the National Institute of Recovery, Physical Medicine and Balneoclimatology of Bucharest, in the Recovery Department no 1. The admission note, anamnesis, X-ray and MRI data and observations following the clinical examination were considered for each patient separately. A recovery program was developed taking into account the patients’ characteristics depending on age and gender. The research results highlight that both patients were fortunate enough not to have any other strokes. The lady had an excellent evolution; on the other hand, the evolution of the man was spectacular, as he had a rather sever stroke followed by a recovery of 70%, with the recommendation to continue the program.

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Computerized Tomography of the Brain for Elderly Patients Presenting to the Emergency Room with Acute Confusion State in Eastern Nepal

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i2.22086 ◽

2018 ◽

Vol 1 (2) ◽

pp. 95-100

Author(s):

Shakuntala Kumari ◽

B.K. Rai ◽

R. Bhandari ◽

S.N. Gupta ◽

K. Ahmed

Keyword(s):

Elderly Patients ◽

Emergency Room ◽

Ct Scan ◽

Computerized Tomography ◽

Hemorrhagic Stroke ◽

Cerebral Atrophy ◽

Neurological Deficits ◽

Limb Weakness ◽

Cross Sectional ◽

Acute Confusion

Background: Acute confusion is a common reason for presentation of elderly patients to the emergency which may be of neurological or non-neurological origin. Computerized tomography (CT) scans are often routinely ordered to investigate the cause. Objective: To determine the usefulness of CT scan brain in confused elderly patients. Methods: A cross-sectional observational study was conducted in emergency room (ER) of B. P. Koirala Institute of Health Sciences over a period of 6 months in 84 patients above the age of 65 years who had CT scan brain done in view of acute confusion. They were reviewed for symptoms, indications of CT scan and presence of focal neurological deficits (FND). Results: Among patients presenting in confusion and with loss of consciousness or limb weakness, CT scan was abnormal in 90% and 92% cases respectively (p <0.05) whereas those presenting with fever, cough, headache, dizziness, seizure in confusion also had abnormal CT but was statistically not significant (p> 0.05). Out of 84 elderly cases of acute confusion, 52 had FND and the remaining 32 cases were without FND. Among those with FND, 40% and 46% cases had features of ischemic and hemorrhagic stroke respectively. Among the 32 without FND, 66% patients had normal scan and 38% had cerebral atrophy. In patients with Glasgow Coma Scale (GCS) < 9 with FND, 75% had CT scan suggestive of hemorrhagic stroke whereas those with GCS> 13 with FND, 57% and 29% cases had ischemic and hemorrhagic stroke respectively. Conclusion: CT scan brain for confused elderly should be advised for those with focal neurological symptoms and may be suggested in cases of head trauma or alleged history of fall irrespective of GCS and symptomatology.

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