scholarly journals Primary intraventricular hemorrhage outcomes in the CLEAR III trial

2020 ◽  
Vol 15 (8) ◽  
pp. 872-880
Author(s):  
Sarah E Nelson ◽  
W Andrew Mould ◽  
Dheeraj Gandhi ◽  
Richard E Thompson ◽  
Sarah Salter ◽  
...  
Keyword(s):  
Barthel Index ◽  
Intraventricular Hemorrhage ◽  
National Institutes Of Health ◽  
Clot Lysis ◽  
Modified Rankin Scale ◽  
Long Term Outcomes ◽  
Treatment Groups ◽  
Inverse Probability Weighted ◽  
Regression Adjustment

Background Intraventricular hemorrhage occurs due to intracerebral hemorrhage with intraventricular extension or without apparent parenchymal involvement, known as primary intraventricular hemorrhage. Aims We evaluated the prognosis of primary intraventricular hemorrhage patients in the CLEAR III trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage). Methods In patients with primary intraventricular hemorrhage versus those with secondary intraventricular hemorrhage, we compared intraventricular alteplase response and outcomes including modified Rankin Scale, Barthel Index, National Institutes of Health Stroke Scale (NIHSS), and extended Glasgow Outcome Scale (eGOS) at 30, 180, and 365 days. Outcomes were also compared in primary intraventricular hemorrhage patients who received intraventricular alteplase versus placebo (normal saline) and in matched primary and secondary intraventricular hemorrhage patients using inverse-probability-weighted regression adjustment. Results Of 500 patients enrolled in CLEAR III, 46 (9.2%) had primary intraventricular hemorrhage. Combining both treatment groups, primary intraventricular hemorrhage patients had larger intraventricular hemorrhage volumes (median: 34.2 mL vs. 20.8 mL, p < 0.01) but similar intraventricular hemorrhage removal (51.0% vs. 59.0%, p = 0.24) compared to secondary intraventricular hemorrhage patients, respectively. Confirming previous studies, primary intraventricular hemorrhage patients achieved better NIHSS, modified Rankin Scale, Barthel Index, and eGOS scores at days 30, 180, and 365, respectively (all p < 0.01), although mortality was similar to secondary intraventricular hemorrhage patients; matching analysis yielded similar results. Primary intraventricular hemorrhage patients who received intraventricular alteplase ( n = 19) and saline ( n = 27) achieved similar outcomes. Conclusions In CLEAR III, primary intraventricular hemorrhage patients who survived achieved better long-term outcomes than surviving secondary intraventricular hemorrhage patients with similar mortality. Outcomes and safety were similar between primary intraventricular hemorrhage patients receiving alteplase and those receiving saline.

Abstract T P231: Does Intraventricular Hemorrhage Lead to a Normal Pressure Hydrocephalus-Like Syndrome?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Andrew J Kruger ◽  
Matthew Flaherty ◽  
Padmini Sekar ◽  
Mary Haverbusch ◽  
Charles J Moomaw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Normal Pressure Hydrocephalus ◽  
Barthel Index ◽  
Intraventricular Hemorrhage ◽  
Normal Pressure ◽  
Stroke Study ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Poor Outcomes

Background: Intracerebral hemorrhage (ICH) has the highest short and long-term morbidity and mortality rates of stroke subtypes. While increased intracranial pressure due to the presence of intraventricular hemorrhage (IVH) may relate to early poor outcomes, the mechanism of reduced 3-month outcome with IVH is unclear. We hypothesized that IVH may cause symptoms similar to normal pressure hydrocephalus (NPH), specifically urinary incontinence and gait disturbance. Methods: We used interviewed cases from the Genetic and Environmental Risk Factors for Hemorrhagic Stroke Study (7/1/08-12/31/12) that had 3-month follow-ups available. CT images were analyzed for ICH volume and location, and IVH presence and volume. Incontinence and dysmobility were defined by Barthel Index at 3 months. We chose a Barthel Index score of bladder less than 10 and mobility less than 15 to define incontinence and dysmobility, respectively. Multivariate analysis was used to assess independent risk factors for incontinence and dysmobility. ICH and IVH volumes were log transformed because of non-normal distributions. Results: Barthel Index was recorded for 308 ICH subjects, of whom 106 (34.4%) had IVH. Presence of IVH was independently associated with both incontinence (OR 2.7; 95% CI 1.4-5.2; p=.003) and dysmobility (OR 2.5; 95% CI 1.4-4.8; p=.003). The Table shows that increasing IVH volume was also independently associated with both incontinence and dysmobility after controlling for ICH location, ICH volume, age, baseline mRS, and admission GCS. Conclusion: Our data show that patients with IVH after ICH are at an increased risk for developing the NPH-like symptoms of incontinence and dysmobility. This may explain the worse long-term outcomes of patients who survive ICH with IVH than those who had ICH alone. Future studies are needed to confirm this finding, and to determine the effect of IVH interventions such as shunt or intraventricular thrombolysis.

scholarly journals Ordinal vs dichotomous analyses of modified Rankin Scale, 5-year outcome, and cost of stroke

Neurology ◽  
2018 ◽  
Vol 91 (21) ◽  
pp. e1951-e1960 ◽  
Author(s):  
Aravind Ganesh ◽  
Ramon Luengo-Fernandez ◽  
Rose M. Wharton ◽  
Peter M. Rothwell
Keyword(s):  
Ischemic Stroke ◽  
Goodness Of Fit ◽  
Mean Absolute Error ◽  
Absolute Error ◽  
Population Based ◽  
Modified Rankin Scale ◽  
Long Term Outcomes ◽  
Change In Mean ◽  
Care Costs

ObjectiveTo compare how 3 common representations (ordinal vs dichotomized as 0–1/2–6 or 0–2/3–6) of the modified Rankin Scale (mRS)—a commonly used trial outcome measure—relate to long-term outcomes, and quantify trial ineligibility rates based on premorbid mRS.MethodsIn consecutive patients with ischemic stroke in a population-based, prospective, cohort study (Oxford Vascular Study; 2002–2014), we related 3-month mRS to 1-year and 5-year disability and death (logistic regressions), and health/social care costs (generalized linear model), adjusted for age/sex, and compared goodness-of-fit values (C statistic, mean absolute error). We also calculated the proportion of patients in whom premorbid mRS score >1 or >2 would result in exclusion from trials using dichotomous analysis.ResultsAmong 1,607 patients, the ordinal mRS was more strongly related to 5-year mortality than both the 0–1/2–6 and 0–2/3–6 dichotomies (all p < 0.0001). Results were similar for 5-year disability, and 5-year care costs were also best captured by the ordinal model (change in mean absolute error vs age/sex: −$3,059 for ordinal, −$2,805 for 0–2/3–6, −$1,647 for 0–1/2–6). Two hundred forty-four (17.1%) 3-month survivors had premorbid mRS score >2 and 434 (30.5%) had mRS score >1; both proportions increased with female sex, socioeconomic deprivation, and age (all p < 0.0001).ConclusionThe ordinal form of the 3-month mRS relates better to long-term outcomes and costs in survivors of ischemic stroke than either dichotomy. This finding favors using ordinal approaches in trials analyzing the mRS. Exclusion of patients with higher premorbid disability by use of dichotomous primary outcomes will also result in unrepresentative samples.

Infantile Spasms and Injuries of Prematurity: Short-Term Treatment-Based Response and Long-Term Outcomes

2017 ◽  
Vol 32 (10) ◽  
pp. 861-866 ◽  
Author(s):  
Adam Wallace ◽  
Victoria Allen ◽  
Kristen Park ◽  
Kelly Knupp
Keyword(s):  
Developmental Delay ◽  
Intraventricular Hemorrhage ◽  
Refractory Epilepsy ◽  
Age Of Onset ◽  
Periventricular Leukomalacia ◽  
Retrospective Chart Review ◽  
Infantile Spasms ◽  
Long Term Outcomes ◽  
Short Term Treatment

The association of infantile spasms and periventricular leukomalacia and/or intraventricular hemorrhage is well documented. Data regarding early treatment-based and long-term outcomes are limited. A retrospective chart review identified children with infantile spasms born prematurely (<37 weeks) with diagnoses of periventricular leukomalacia and/or intraventricular hemorrhage. Thirteen children were included. Median gestational age was 30 weeks and age of onset of infantile spasms was 8 months. Nine children had intraventricular hemorrhage, 10 had periventricular leukomalacia, and 6 children had both. Twelve of 13 children had resolution of spasms. In responders, the successful medication was adrenocorticotropic hormone (ACTH) in 7, topiramate in 3, and vigabatrin in 2. Follow-up after a median of 7.1 years found that all patients had developmental delay but only 1 had refractory epilepsy. Standard therapies (ACTH and vigabatrin) appeared to be more effective than other treatments. Developmental delay is common in children with periventricular leukomalacia / intraventricular hemorrhage and infantile spasms, but refractory epilepsy might be less frequent.

scholarly journals A Modified in vitro Clot Lysis Assay Predicts Outcomes in Non-traumatic Intracerebral Hemorrhage Stroke Patients—The IRONHEART Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Rita Orbán-Kálmándi ◽  
Tamás Árokszállási ◽  
István Fekete ◽  
Klára Fekete ◽  
Máté Héja ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Area Under The Curve ◽  
Aneurysm Rupture ◽  
Assay Method ◽  
Clot Lysis ◽  
Hemorrhagic Diathesis ◽  
Long Term Outcomes ◽  
Maximum Absorbance

Background: Non-traumatic intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes and results in a higher rate of mortality as compared to ischemic strokes. In the IRONHEART study, we aimed to find out whether a modified in vitro clot lysis assay method, that includes the effect of neutrophil extracellular traps (NETs) might predict ICH outcomes.Patients and Methods: In this prospective, observational study, 89 consecutive non-traumatic ICH patients were enrolled. Exclusion criteria included aneurysm rupture, cancer, liver- or kidney failure or hemorrhagic diathesis. On admission, detailed clinical and laboratory investigations were performed. ICH volume was estimated based on CT performed on admission, day 14 and 90. A conventional in vitro clot lysis assay (CLA) and a modified CLA (mCLA) including cell-free-DNA and histones were performed from stored platelet-free plasma taken on admission. Clot formation and lysis in case of both assays were defined using the following variables calculated from the turbidimetric curves: maximum absorbance, time to maximum absorbance, clot lysis times (CLT) and area under the curve (CLA AUC). Long-term ICH outcomes were defined 90 days post-event by the modified Rankin Scale (mRS). All patients or relatives provided written informed consent.Results: Patients with more severe stroke (NIHSS&gt;10) presented significantly shorter clot lysis times of the mCLA in the presence of DNA and histone as compared to patients with milder stroke [10%CLT: NIHSS 0–10: median 31.5 (IQR: 21.0–40.0) min vs. NIHSS&gt;10: 24 (18–31.0) min, p = 0.032]. Shorter clot lysis times of the mCLA showed significant association with non-survival by day 14 and with unfavorable long-term outcomes [mRS 0–1: 36.0 (22.5.0–51.0) min; mRS 2–5: 23.5 (18.0–36.0) min and mRS 6: 22.5 (18.0–30.5) min, p = 0.027]. Estimated ICH volume showed significant negative correlation with mCLA parameters, including 10%CLT (r = −0.3050, p = 0.009). ROC analysis proved good diagnostic performance of mCLA for predicting poor long-term outcomes [AUC: 0.73 (0.57–0.89)]. In a Kaplan-Meier survival analysis, those patients who presented with an mCLA 10%CLT result of &gt;38.5 min on admission showed significantly better survival as compared to those with shorter clot lysis results (p=0.010).Conclusion: Parameters of mCLA correlate with ICH bleeding volume and might be useful to predict ICH outcomes.

scholarly journals Validation of the National Institutes of Health Stroke Scale, Modified Rankin Scale and Barthel Index in Brazil: The Role of Cultural Adaptation and Structured Interviewing

2008 ◽  
Vol 27 (2) ◽  
pp. 119-122 ◽  
Author(s):  
Carolina Cincura ◽  
Octavio M. Pontes-Neto ◽  
Iuri S. Neville ◽  
Henrique F. Mendes ◽  
Daniela F. Menezes ◽  
...  
Keyword(s):  
Cultural Adaptation ◽  
Barthel Index ◽  
National Institutes Of Health ◽  
Modified Rankin Scale

Comparison of endovascular and microsurgical management of 208 basilar apex aneurysms

2017 ◽  
Vol 127 (6) ◽  
pp. 1342-1352 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
Mary Ziemba-Davis ◽  
Rishabh Sethia ◽  
Troy D. Payner ◽  
Andrew DeNardo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Endovascular Management ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Treatment Groups ◽  
Microsurgical Treatment ◽  
Select Group ◽  
Discharge Status ◽  
Perforating Arteries

OBJECTIVEThe deep and difficult-to-reach location of basilar apex aneurysms, along with their location near critical adjacent perforating arteries, has rendered the perception that microsurgical treatment of these aneurysms is risky. As a result, these aneurysms are considered more suitable for treatment by endovascular intervention. The authors attempt to compare the immediate and long-term outcomes of microsurgery versus endovascular therapy for this aneurysm subtype.METHODSA prospectively maintained database of 208 consecutive patients treated for basilar apex aneurysms between 2000 and 2012 was reviewed. In this group, 161 patients underwent endovascular treatment and 47 were managed microsurgically. The corresponding records were analyzed for presenting characteristics, postoperative complications, discharge status, and Glasgow Outcome Scale (GOS) scores up to 1 year after treatment and compared using chi-square and Student t-tests.RESULTSAmong these 208 aneurysms, 116 (56%) were ruptured, including 92 (57%) and 24 (51%) of the endovascularly and microsurgically managed aneurysms, respectively. The average Hunt and Hess grade was 2.4 (2.4 in the endovascular group and 2.2 in the microsurgical group; p = 0.472). Postoperative complications of cranial nerve deficits and hemiparesis were more common in patients treated microsurgically than endovascularly (55.3% vs 16.2%, p < 0.05; and 27.7% vs 10.6%, p < 0.05, respectively). However, aneurysm remnants and need for retreatment were more common in the endovascular than the microsurgical group (41.3% vs 2.3%, p < 0.05; and 10.6% vs 0.0%, p < 0.05, respectively). Stent placement significantly reduced the need for retreatment. Rehemorrhage rates and average GOS score at discharge and 1 year after treatment were not statistically different between the two treatment groups.CONCLUSIONSPatients with basilar apex aneurysms were significantly more likely to be treated via endovascular management, but compared with those treated microsurgically, they had higher rates of recurrence and need for retreatment. The current study did not detect an overall difference in outcomes at discharge and 1 year after either treatment modality. Therefore, in a select group of patients, microsurgical treatment continues to play an important role.

National Institutes of Health Stroke Scale, modified Rankin Scale, and modified Thrombolysis in Cerebral Infarction as autonomy predictive tools for stroke patients

2019 ◽  
Vol 30 (7) ◽  
pp. 701-708 ◽  
Author(s):  
Emilio Rubén Pego-Pérez ◽  
Isaac Fernández-Rodríguez ◽  
José Manuel Pumar-Cebreiro
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Age Groups ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Term Care ◽  
Predictive Tools ◽  
Primary Determinant

Abstract Whereas mortality from ischemic stroke is decreasing in all age groups, the prevalence of stroke continues to increase. Its increasing incidence in the younger population adds to the large number of survivors who will live many years with their disabilities related to stroke. Thus, the objectives of this study are to determine the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the modified Thrombolysis in Cerebral Infarction (mTICI) as adequate prognostic functionality tools for stroke patients and to analyze the relation between stroke and rehabilitation. This study involved a systematic review. We obtained articles found on Google Scholar and MEDLINE and published from January 2008 to May 2018. The functionality of the patient after a stroke is associated with the likelihood of a hospital readmission, which should be taken into account during the diagnosis. Patients with poor functionality at discharge are also more likely to need long-term care and intensive rehabilitation plans. The severity of the initial stroke is a primary determinant of the clinical outcome. The NIHSS, mRS, and mTICI appear to be predictive tools of the functionality of the patient with ischemic stroke, especially in the acute phase. Rehabilitation demonstrates better results in reducing disability and greater participation of affected people.

Abstract TP338: Differences Between the Modified Rankin Scale and Barthel Index in Measuring Intracerebral Hemorrhage Recovery at 12 Months

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anirudh Sreekrishnan ◽  
Audrey Leasure ◽  
Sonya Zhou ◽  
Hardik Amin ◽  
Nils Petersen ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Barthel Index ◽  
Repeated Measures ◽  
Modified Rankin Scale ◽  
New Haven ◽  
Time Points ◽  
Parametric Testing ◽  
One Year ◽  
Non Parametric

Background: The modified Rankin Scale (mRS) and the Barthel Index (BI) are both commonly employed measures of recovery used in intracerebral hemorrhage (ICH) patients. While these measures have been utilized routinely between 3 to 6 months post-hemorrhage, few outcome studies have compared improvements in these measures in long-term outcome.out to one year. The aim of this study was to examine differences in improvement across these measures through up to 12 months post-ICH. Methods: 139 patients diagnosed with primary ICH at Yale-New Haven Hospital were prospectively enrolled in this observational study between July 1, 2014, and July 1, 2016. Patient recovery was evaluated using the mRS and BI at discharge, 3 months, 6 months, and 12 months. Repeated-measures parametric and non-parametric testing was conducted to examine improvement in measures over time. Results: Using the BI, there was a significant improvement across time points (p = 0.005), with follow-up testing showing improvement between discharge and 3 months (p < 0.001), 6 months (p < 0.001), and 12 months (p = 0.036), and between 3 months and 12 months (p = 0.021). There was no significant trend in mRS scores across all time points in non-parametric testing (p > 0.05). Between individual time points, there was a significant improvement in mRS scores between discharge and 3 months (p = 0.004) as well as 6 months (p = 0.010). Conclusions: These results suggest improved recovery of ICH patients in activities of daily living up to 1 year post-hemorrhage. While the mRS has a plateau effect in measuring recovery for this patient population between 3 and 6 months, the BI may be a more sensitive measure for assessing recovery up to 12 months.

scholarly journals Use of decompressive craniectomy in the treatment of hemispheric infarction

2008 ◽  
Vol 66 (2a) ◽  
pp. 204-208 ◽  
Author(s):  
José Antonio Fiorot Jr. ◽  
Gisele Sampaio Silva ◽  
Sergio Cavalheiro ◽  
Ayrton Roberto Massaro
Keyword(s):  
Conservative Treatment ◽  
Decompressive Craniectomy ◽  
Glasgow Coma Score ◽  
Barthel Index ◽  
Neurological Status ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Therapeutic Decision ◽  
Hemispheric Infarction ◽  
Overall Mortality

Decompressive craniectomy (DC) has demonstrated efficacy in reducing mortality in hemispheric infarction of the middle cerebral artery. The aim of our study was to compare the outcome of patients submitted to DC to patients treated in a conservative way. Eighteen patients were submitted to DC and 14 received conservative treatment. Neurological status was assessed by the Glasgow Coma Score and National Institutes of Health Stroke Scale score. Mortality, modified Rankin Scale and Barthel Index scores were assessed at 90 days to evaluate outcome. We did not observe reduction in overall mortality and functional outcome in patients submitted to DC. The differences between our group and previously published series are probably related to the neurological status of the patients at the time of therapeutic decision.

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