Abstract WMP100: Factors Influencing Outcome After Childhood Arterial Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jay Gajera ◽  
Belinda Stojanovski ◽  
Mark T Mackay
Keyword(s):  
Risk Factors ◽  
Neurological Outcome ◽  
Recurrent Events ◽  
Visual Disturbance ◽  
Neurological Deficits ◽  
Arterial Ischemic Stroke ◽  
Common Data Element ◽  
Motor Disability ◽  
Poor Outcome ◽  
Poor Neurological Outcome

Introduction: Stroke is among the top 10 causes of death in children. Survivors face many potential years of disability but few studies have explored factors which contribute to poor outcome. Our aims were to describe factors associated with mortality, neurological disability and recurrence in a population of Australian children with arterial ischaemic stroke (AIS). Methods: Prospective consecutive single centre cohort study of children 1 month-18 years with AIS, from 2003-2013, who underwent standardised diagnostic work up. The NINDS common data element framework was used to select risk factors, laboratory and radiological variables of interest. The Paediatric Stroke Outcome Measure (PSOM) was used to classify neurological outcome at 12 months and the CASCADE system was used to classify aetiology. Recurrence was defined as clinical (completed stroke/TIA) or radiological event with new infarction. Chi 2 analyses were used to identify risk factors for poor outcome. Results: A total of 126 cases of childhood AIS were identified. 6% of children died, 27% had recurrent events (21 clinical, 5 radiological strokes, 9 TIAs). 63% of children had poor neurological outcome (total PSOM≥2) with motor disability (53%) being most common. Male gender, prothrombotic disorders and cortical infarct location were significantly associated with mortality (P<0.05). Hemiparesis, facial weakness, visual disturbance or altered consciousness at presentation, non-atherosclerotic arteriopathies and infection were significantly associated with poorer neurological outcome (p<0.05). Arteriopathies, multiple infarcts and haemorrhagic transformation were associated with recurrence (p<0.05). Conclusion: The economic and social costs of childhood AIS are likely substantial because long term neurological deficits are common. The finding that arteriopathies are a risk factor for recurrence is consistent with data from overseas. These findings will inform development of longitudinal multicentre Australian studies of childhood AIS.

scholarly journals A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA2CLE2

2020 ◽  
Author(s):  
Nilesh Pareek ◽  
Peter Kordis ◽  
Nicholas Beckley-Hoelscher ◽  
Dominic Pimenta ◽  
Spela Tadel Kocjancic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Risk Score ◽  
Neurological Outcome ◽  
Heart Attack ◽  
Primary Outcome ◽  
Cerebral Performance Category ◽  
Epinephrine Administration ◽  
Poor Outcome ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

AimsThe purpose of this study was to develop a practical risk−score to predict poor neurological outcome after out−of−hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre.Methods and ResultsBetween May 2012 and December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multi-variable logistic regression to identify factors independently predictive of the primary outcome in order to derive a risk score. This was externally validated in two independent cohorts comprising 474 patients. The primary outcome was poor neurological function at 6−month follow−up (Cerebral Performance Category 3-−). Seven independent variables for prediction of outcome were identified: Missed (Unwitnessed) arrest, Initial non-shockable rhythm, non-Reactivity of pupils, Age, Changing intra-arrest rhythms, Low pH<;7.20 and Epinephrine administration. From these variables, the MIRA2CLE2 score was developed which had an AUC of 0.90 in the development and 0.85 and 0.89 in the validation cohorts. 3 risk groups of the MIRA2CLE2 were defined − Low risk (≤2−5.6% risk of poor outcome; Intermediate risk (3−4−55.4% of poor outcome) and high risk (≥5−92.3% risk of poor outcome). The risk-score performance was equivalent in a sub-group of patients referred for early angiography and revascularisation where appropriate.ConclusionsThe MIRA2CLE2 score is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission to a Heart Attack Centre.

Abstract WMP111: Socioeconomic Determinants of Outcome After Childhood Arterial Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lori C Jordan ◽  
Nancy K Hills ◽  
Warren Lo ◽  
Rebecca N Ichord ◽  
Christine K Fox ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Maternal Education ◽  
Recurrent Stroke ◽  
Pediatric Population ◽  
Neurological Deficits ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Vascular Effects ◽  
Middle Income ◽  
Poor Outcome

Introduction: Lower socioeconomic status (SES) is associated with poorer outcome after adult stroke. In a large cohort of children with arterial ischemic stroke (AIS), we determined 12-month neurological outcome and tested the hypothesis that SES is a determinant of outcome in children. Methods: From 2009-2014, the Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS (29 days-18 years) at 37 international centers, including 3 in lower and middle income (LAMI) countries. Outcome was assessed at 12 months via the recurrence and recovery questionnaire (RRQ) parental report of the pediatric stroke outcome measure (PSOM). Poor outcome was defined as a PSOM of ≥1. Results: Of 355 children, outcome was available for 310 (87%) at a median of 12 months (IQR 11-13). Ten children died prior to hospital discharge and 4 by 12 months. Outcomes improved from discharge to 12 months (Figure). Of 23 cases in LAMI countries, 88% had an income <USD$10,000, compared to 11% of 287 cases in non-LAMI countries. Overall, only 39% LAMI cases had a good outcome, versus 61% of non-LAMI cases (p=0.052). There were too few cases to analyze outcome predictors in LAMI countries. However, in non-LAMI countries, income did not independently predict poor outcome (OR 1.7, 95% CI 0.57, 4.8, for income <$10,000 vs. >$100,000). Other markers of SES (maternal education level and rural/suburban/urban residence) also did not predict outcome. Independent predictors of poor outcome included moderate (OR 4.6, 95% CI 2.0, 11) or severe (OR 21, 95% CI 7.1, 60) neurological deficits at discharge (compared to no deficits) and recurrent stroke (OR 3.5, 95% CI 1.5, 8.3). Conclusion: Outcomes after childhood stroke may be worse in LAMI countries, although we were underpowered to study this subgroup. Within non-LAMI countries, SES does not appear to impact outcome in children, unlike reports in adults, perhaps reflecting better access to rehabilitation services in the pediatric population.

scholarly journals Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii

2016 ◽  
Vol 07 (03) ◽  
pp. 450-452 ◽  
Author(s):  
Gentle Sunder Shrestha ◽  
Sushil Tamang ◽  
Hem Raj Paneru ◽  
Pramesh Sunder Shrestha ◽  
Niraj Keyal ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Neurological Outcome ◽  
Multidrug Resistant ◽  
Poor Outcome ◽  
Poor Neurological Outcome ◽  
Microbiological Cure

ABSTRACT Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable.

Predictors of Neurological Outcome of Arterial Ischemic Stroke in Children

2020 ◽  
Author(s):  
Tatia Aprasidze ◽  
Nana Tatishvili ◽  
Teona Shatirishvili ◽  
Giorgi Lomidze
Keyword(s):  
Ischemic Stroke ◽  
Predictive Factors ◽  
Neurological Outcome ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Stroke Recurrence ◽  
Arterial Ischemic Stroke ◽  
Mortality And Morbidity ◽  
Multiple Stroke

AbstractStroke is an important cause of mortality and morbidity in children. The aim of the study was to evaluate long-term neurological outcome in children with arterial ischemic stroke (AIS) and explore predictive factors that affect poor outcome. Fifty-six patients aged between 1 month and 17 years who were treated at M. Iashvili Children's Central Hospital, Tbilisi, Georgia, with an onset of stroke from 2007 to 2017 were included. To explore predictive factors of outcome, the following data were collected: demographic characteristics, risk factors, he presenting signs, radiological features, and presence of stroke recurrence. Neurological status at discharge and long-term neurological outcome at least 1 year after stroke was evaluated according to Pediatric Stroke Outcome Measure subscale. The reported outcome after childhood stroke was variable with long-term neurological deficits in one-third of patients (30.4%). The neurological outcome was worse in males, in patients with multiple stroke episodes, and in those with infarctions involving a combination of cortical and subcortical areas. Pediatric AIS carries the risk of long-term morbidity, and neuroimaging has a predictive influence on outcome.

scholarly journals Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

2020 ◽  
Vol 10 (1) ◽  
pp. 24 ◽  
Author(s):  
Beata Sarecka-Hujar ◽  
Ilona Kopyta
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Age Groups ◽  
Young Patients ◽  
Fold Increase ◽  
Arterial Ischemic Stroke ◽  
Motor Disability ◽  
Children And Young Adults

Arterial ischemic stroke (AIS) experienced at a young age is undoubtedly a serious medical problem. AIS very rarely occurs at a developmental age, whereas in young adults, it occurs with a higher frequency. The etiologic mechanisms of AIS occurring in childhood and adulthood differ. However, for both age populations, neurological consequences of AIS, including post-stroke seizures, motor disability, and recurrence of the disease, are connected to many years of care, rehabilitation, and treatment. Recurrent stroke was observed to increase the risk of patients’ mortality. One of the confirmed risk factors for recurrent stroke in children is the presence of vasculopathies, especially Moyamoya disease and syndrome, and focal cerebral arteriopathy of childhood (FCA). FCA causes a 5-fold increase in the risk of recurrent stroke in comparison with idiopathic AIS. In turn, young adults with recurrent stroke were found to more often suffer from hypertension, diabetes mellitus, or peripheral artery disease than young patients with first-ever stroke. Some reports also indicate relationships between specific genetic polymorphisms and AIS recurrence in both age groups. The aim of the present literature review was to discuss available data regarding the risk factors for recurrent AIS in children and young adults.

scholarly journals A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

2020 ◽  
Vol 41 (47) ◽  
pp. 4508-4517 ◽  
Author(s):  
Nilesh Pareek ◽  
Peter Kordis ◽  
Nicholas Beckley-Hoelscher ◽  
Dominic Pimenta ◽  
Spela Tadel Kocjancic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Risk Score ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Epinephrine Administration ◽  
Poor Outcome ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract Aims The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. Methods and results From May 2012 to December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King’s Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multivariable logistic regression to identify predictors of the primary outcome to derive a risk score. This was externally validated in two independent cohorts comprising 473 patients. The primary endpoint was poor neurological outcome at 6-month follow-up (Cerebral Performance Category 3–5). Seven independent predictors of outcome were identified: missed (unwitnessed) arrest, initial non-shockable rhythm, non-reactivity of pupils, age (60–80 years—1 point; &gt;80 years—3 points), changing intra-arrest rhythms, low pH &lt;7.20, and epinephrine administration (2 points). The MIRACLE2 score had an area under the curve (AUC) of 0.90 in the development and 0.84/0.91 in the validation cohorts. Three risk groups were defined—low risk (MIRACLE2 ≤2—5.6% risk of poor outcome); intermediate risk (MIRACLE2 of 3–4—55.4% of poor outcome); and high risk (MIRACLE2 ≥5—92.3% risk of poor outcome). The MIRACLE2 score had superior discrimination than the OHCA [median AUC 0.83 (0.818–0.840); P &lt; 0.001] and Cardiac Arrest Hospital Prognosis models [median AUC 0.87 (0.860–0.870; P = 0.001] and equivalent performance with the Target Temperature Management score [median AUC 0.88 (0.876–0.887); P = 0.092]. Conclusions The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.

Natural History and Risk Factor of Recurrent Hemorrhage in Hemorrhagic Adult Moyamoya Disease

Neurosurgery ◽  
2017 ◽  
Vol 81 (2) ◽  
pp. 289-296 ◽  
Author(s):  
Kang Min Kim ◽  
Jeong Eun Kim ◽  
Won-Sang Cho ◽  
Hyun-Seung Kang ◽  
Young-Je Son ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Natural History ◽  
Confidence Interval ◽  
Neurological Outcome ◽  
Intraventricular Hemorrhage ◽  
Recurrent Hemorrhage ◽  
Poor Neurological Outcome ◽  
Adult Moyamoya Disease

Abstract BACKGROUND: Recurrent hemorrhage is a serious neurosurgical problem in adult moyamoya disease (MMD) patients. OBJECTIVE: To find the natural history and risk factors of recurrent hemorrhage in cases of adult hemorrhagic MMD. METHODS: One hundred seventy-six adult MMD patients presenting with hemorrhage were enrolled. Patients’ medical records and radiological images were retrospectively reviewed. Clinical and radiological features of recurrent hemorrhage, and related risk factors were analyzed. Poor neurological outcome was defined as a score on the modified Rankin Scale of 4 to 6. The hemisphere in which the initial hemorrhage occurred was considered as the affected one. The mean follow-up duration was 83 months. RESULTS: The overall estimated rate of recurrent hemorrhage was 16.9%/person (95% confidence interval, 11.3%-24.8%) at 5 years and 26.3%/person (95% confidence interval, 18.5%-36.4%) at 10 years after the initial episode of hemorrhage. The affected hemisphere showed a higher recurrent hemorrhagic rate (11.7% vs 8.3%/hemisphere at 5 years, P = .09) after conservative treatment. As a result of recurrent hemorrhages, the number of patients with poor neurological outcome increased (first episode: 13.8%, second: 37.5%, third: 40.0%, fourth: 100%). The presence of intraventricular hemorrhage (P = .05, hazard ratio = 3.32) and bilateral MMD (P = .05, hazard ratio = 4.15) had a marginal significance for recurrent hemorrhage. Eight ischemic strokes (4.5%) including 4 postoperative infarctions were identified, and all ischemic strokes were minor stroke. CONCLUSION: During the follow-up period, recurrent hemorrhagic events continued to increase and deteriorated the patients’ neurological conditions. The presence of intraventricular hemorrhage was a significant risk factor of recurrent hemorrhage.

Evaluation of Serum Sodium Correction Rates for Management of Hyponatremia in Hospitalized Patients

2021 ◽  
pp. 106002802110197
Author(s):  
Christine T. Pham ◽  
Hagar S. Kassab ◽  
Jackie P. Johnston
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Serum Sodium ◽  
Neurological Outcome ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Lengths Of Stay ◽  
Institutional Review ◽  
Poor Neurological Outcome ◽  
Sodium Correction

Background: Appropriate correction of hyponatremia can reduce complications such as osmotic demyelination syndrome (ODS). Objective: To evaluate rates of serum sodium correction in hyponatremic hospitalized patients and identify factors associated with higher rates of overcorrection. Methods: This is an institutional review board–approved single-center, retrospective chart review of patients ≥18 years of age with at least 1 serum sodium <130 mEq/L during hospitalization. The primary end point was percentage of patients appropriately corrected for hyponatremia. Appropriate correction was defined as a sodium change ≤12 mEq/L over 24 hours and 18 mEq/L over 48 hours, and overcorrection was defined as an increase in serum sodium exceeding these cutoffs. Secondary end points included incidence of ODS, poor neurological outcome, intensive care unit (ICU) and hospital lengths of stay (LOSs), and in-hospital mortality. Results: Of 234 patients evaluated, 100 were included. Mean age was 72 ± 16 years, and 47% were male. Overcorrection occurred in 14 patients. There was no incidence of ODS. Rates of poor neurological outcome ( P = 0.77), ICU ( P = 0.09) and hospital LOS ( P = 0.13), and in-hospital mortality ( P = 0.20) were similar between appropriately corrected and overcorrected patients. Using a logistic regression analysis, severe hyponatremia (serum sodium < 120 mEq/L; P = 0.0122) and history of alcohol use disorder ( P < 0.001) were risk factors found to be associated with overcorrection. Conclusion and Relevance: Overcorrection of hyponatremia occurred in 14% of patients in this study. To minimize this risk, further caution should be taken when managing patients presenting with identified risk factors.

Abstract WMP98: Thrombophilia Risk Factors in Perinatal Stroke: 213 Consecutive Cases

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Laura Lehman ◽  
Jeanette Beaute ◽  
Hayley Malkin ◽  
Michael Rivkin ◽  
Cameron Trenor
Keyword(s):  
Risk Factors ◽  
Recurrent Events ◽  
Cardiac Risk ◽  
Arterial Ischemic Stroke ◽  
Perinatal Stroke ◽  
Cardiac Anomalies ◽  
Cardiac Risk Factors ◽  
Sinovenous Thrombosis ◽  
Ischemic Attack

Introduction: Perinatal stroke, including neonatal and presumed perinatal presentation, is the most common type of pediatric stroke. No guidelines exist for evaluation after perinatal stroke and the roles of thrombophilia, arteriopathy and cardiac anomalies are unclear. We took a systematic approach to perinatal stroke evaluation to better understand these risk factors. Hypothesis: Thrombophilia, arteriopathy and cardiac anomalies are more common in perinatal stroke and may predict recurrence. Methods: After IRB-approval, we reviewed records of perinatal stroke patients from August 2008 to July 2015. Demographics, echocardiography, MRA and thrombophilia testing were collected. Statistical analysis is descriptive. Results: Among 213 children with perinatal stroke, 92 (43.2%) were female and mean age at diagnosis was 1.56 years. Caucasians comprised 69.5%, African-Americans, 7.5%, Asians, 1.9%, other, 8% and undeclared, 13.1%. Presentation was neonatal (113, 53.1%) or presumed perinatal (100, 46.9%). Strokes were classified as arterial (140, 65.7%), venous (51, 23.9%), both (4, 1.9%) or uncertain (19, 8.5%) by imaging. Mean length of follow-up was 3.2 years. Of 213 patients, 10 (4.7%) experienced recurrent events (4 transient ischemic attack, 3 sinovenous thrombosis and 3 arterial ischemic stroke). Thrombophilia data are presented in Table 1. After excluding venous events, 162 patients were evaluated for arteriopathy, cardiac risk factors and recurrence. Of eight recurrences in this group, none had arteriopathy, 3 (37.5%) had patent foramen ovale and none had other cardiac risk factors, compared to 5/108 (4.6%), 52/102 (51%) and 7/102 (6.8%) in the non-recurrent cases. Conclusions: Arteriopathy and cardiac anomalies were not associated with recurrence. Some thrombophilia tests appear enriched in perinatal stroke. With few cases of recurrence after perinatal stroke, it is unclear whether thrombophilia predicts recurrence.

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