Long-term outcome in neuroZika

ObjectiveTo characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection.MethodsWe conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak.ResultsEighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13–17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12–75.22; p = 0.039).ConclusionsNeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients.

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Abstract T P98: Effect of Atrial Fibrillation and/or Large Artery Atherosclerosis on Stroke Recurrence and Long-term Outcome in Japanese Minor Stroke ~Fukuoka Strok Registry~

Stroke ◽

10.1161/str.45.suppl_1.tp98 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Shigeru Fujimoto ◽

Masato Ohsaki ◽

Masaya Kumamoto ◽

Takao Ishitsuka ◽

Takanari Kitazono

Keyword(s):

Scale Score ◽

Minor Stroke ◽

Stroke Recurrence ◽

Large Artery ◽

Term Outcome ◽

Long Term Outcome ◽

Good Outcome ◽

Group A ◽

Group D

Background & Purpose: Atrial fibrillation (AF) and large artery atherosclerosis (LAA) can be associated with a bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or LAA. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 3725 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. In accordance with AF and intracranial or extracranial LAA (stenosis of 50% or more in diameter), they were classified into 4 subgroups: patients without both AF and LAA (Group A, n=2154), patients with only AF (Group B, n=475), patients with only LAA (Group C, n=937), and patients with both AF and LAA (Group D, n=159). We observed stroke recurrence and outcome during one year. Results: On the multivariate analysis, age (OR, 0.94; 95%CI 0.93~0.95), initial NIH stroke scale score (OR, 0.70; 95%CI, 0.67~0.74), chronic kidney disease (OR, 0.72; 95%CI, 0.55~0.95), initial HbA1c value (OR 0.87, 95%CI 0.79~0.95), and LAA (OR 0.70, 95%CI 0.55~0.88) had a negative association with a good outcome. Acute stroke recurrences within 3 weeks after the onset were observed in 2.0%, 2.5%, 6.1%, and 9.4% in Group A-D patients respectively (p<0.0001). Stroke recurrences during 1 year were observed 7.0%, 10.7%, 11.6%, and 13.8% in Group A-D patients respectively (p<0.0001). A good outcome (mRS of 0-1) 1 year after the onset was observed in 77.0%, 6.4%, 67.9%, and 65.8% in Group A-D patients respectively (p<0.0001). With regard to the Kaplan-Meier method, there was a significant difference in stroke recurrence among the 4 subgroups, and stroke recurrences were most frequent in Group D (p<0.0001, Log-rank test). Conclusions: In Japanese minor stroke, age, NIH stroke scale score, chronic kidney disease, HbA1c, and LAA were significant predictors for the long-term outcome. In patients with both AF and LAA, stroke recurrences were most frequent, especially in the acute phase, and a long-term good outcome was least frequent consequently.

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Long-term outcome of full tendon vertical rectus transposition with Foster suture in unilateral complete sixth cranial nerve palsy

Clinical Ophthalmology ◽

10.2147/opth.s193751 ◽

2019 ◽

Vol Volume 13 ◽

pp. 515-519

Author(s):

Worawalun Honglertnapakul ◽

Sirinuch Sawanwattanakul ◽

Parnchat Pukrushpan ◽

Pokpong Praneeprachachon ◽

Supharat Jariyakosol

Keyword(s):

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Sixth Cranial Nerve ◽

Term Outcome ◽

Long Term Outcome ◽

Sixth Cranial Nerve Palsy

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Idiopathic hypertrophic cranial pachymeningitis

Journal of Neurosurgery ◽

10.3171/jns.1993.79.2.0270 ◽

1993 ◽

Vol 79 (2) ◽

pp. 270-276 ◽

Cited By ~ 87

Author(s):

Adam N. Mamelak ◽

William M. Kelly ◽

Richard L. Davis ◽

Mark L. Rosenblum

Keyword(s):

Age Groups ◽

Surgical Excision ◽

Mass Effect ◽

Term Outcome ◽

Long Term Outcome ◽

Content Type ◽

Cranial Nerve Palsies ◽

Cranial Neuropathies ◽

Hypertrophic Cranial Pachymeningitis

✓ Hypertrophic cranial pachymeningitis is a rare, idiopathic form of granulomatous pachymeningitis. This report describes three cases of hypertrophic cranial pachymeningitis and discusses the clinical, radiographic, and pathological findings in these and other reported cases. These lesions typically cause progressive cranial nerve palsies, headaches, and cerebellar dysfunction. They occur in patients of all age groups; the peak incidence is in the sixth decade. Hypertrophic cranial pachymeningitis is best identified by magnetic resonance imaging. The diagnosis is established by excluding all other granulomatous and infectious diseases. A dural biopsy is essential to confirm the diagnosis. Hypertrophic cranial pachymeningitis is initially responsive to steroid therapy, but in most cases it recurs or progresses despite treatment. Surgical excision of granulomas is occasionally necessary to alleviate a mass effect. The long-term outcome remains uncertain for most patients, but progressive disease is usually fatal owing to cranial neuropathies.

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Outcomes of interfacility helicopter transportation in acute stroke care

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000737 ◽

2019 ◽

Vol 10 (5) ◽

pp. 422-427 ◽

Cited By ~ 1

Author(s):

Eyad Almallouhi ◽

Sami Al Kasab ◽

Michael Nahhas ◽

Jillian B. Harvey ◽

Juanita Caudill ◽

...

Keyword(s):

Functional Outcome ◽

Scale Score ◽

Multivariate Logistic Regression Analysis ◽

Acute Stroke Care ◽

Vessel Occlusion ◽

Term Outcome ◽

Long Term Outcome ◽

Transportation Time ◽

Interhospital Transfer

ObjectiveTo evaluate the long-term functional outcome of interhospital transfer of patients with stroke with suspected large vessel occlusion (LVO) using Helicopter Emergency Medical Services (HEMS).MethodsRecords of consecutive patients evaluated through 2 telestroke networks and transferred to thrombectomy-capable stroke centers between March 2017 and March 2018 were reviewed. Inverse probability of treatment weighting (IPTW) using the propensity score was performed to address confounding factors. Multivariate logistic regression analysis with IPTW was used to determine whether HEMS were associated with good long-term functional outcome (modified Rankin scale score ≤ 2).ResultsA total of 199 patients were included; median age was 67 years (interquartile range [IQR] 55–79 years), 90 (45.2%) were female, 120 (60.3%) were white, and 100 (50.3%) were transferred by HEMS. No significant differences between the 2 groups were found in mean age, sex, race, IV tissue plasminogen activator (tPA) receipt, and thrombectomy receipt. The median baseline NIH Stroke Scale score was 14 (IQR 9–18) in the helicopter group vs 11 (IQR 6–18) for patients transferred by ground (p = 0.039). The median transportation time was 60 minutes (IQR 49–70 minutes) by HEMS and 84 minutes (IQR 25–102 minutes) by ground (p < 0.001). After weighting baseline characteristics, the use of HEMS was associated with higher odds of good long-term outcome (OR 4.738, 95% CI 2.15–10.444, p < 0.001) controlling for transportation time, door-in-door-out time, and thrombectomy and tPA receipt. The magnitude of the HEMS effect was larger in thrombectomy patients who had successful recanalization (OR 1.758, 95% CI 1.178–2.512, p = 0.027).ConclusionsHEMS use was associated with better long-term functional outcome in patients with suspected LVO, independently of transportation time.

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Conventionally fractionated stereotactic radiotherapy for vestibular schwannoma: long-term outcome and cranial nerve function

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(01)01929-0 ◽

2001 ◽

Vol 51 (3) ◽

pp. 58

Author(s):

A.W. Chan ◽

N. Ramakrishna ◽

P.M. Black ◽

J.S. Loeffler

Keyword(s):

Vestibular Schwannoma ◽

Stereotactic Radiotherapy ◽

Cranial Nerve ◽

Fractionated Stereotactic Radiotherapy ◽

Nerve Function ◽

Term Outcome ◽

Long Term Outcome ◽

Cranial Nerve Function ◽

Conventionally Fractionated

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Bypass and Flow Reduction for Complex Basilar and Vertebrobasilar Junction Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e3182870703 ◽

2013 ◽

Vol 72 (5) ◽

pp. 763-776 ◽

Cited By ~ 57

Author(s):

M. Yashar S. Kalani ◽

Joseph M. Zabramski ◽

Peter Nakaji ◽

Robert F. Spetzler

Keyword(s):

Scale Score ◽

Modified Rankin Scale ◽

Long Term Outcome ◽

Flow Reduction ◽

Basilar Arteries ◽

Vertebrobasilar Junction ◽

The Mean ◽

Vertebrobasilar Aneurysms

Abstract BACKGROUND: Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat. OBJECTIVE: To evaluate the long-term outcomes of patients with vertebrobasilar aneurysms treated with extracranial-intracranial bypass and flow reduction. METHODS: We retrospectively reviewed a prospective database of aneurysms cases treated between December 1993 and August 2011. RESULTS: Eleven patients (8 male, 3 female) with 12 aneurysms were treated. There were 3 basilar apex aneurysms, 2 aneurysms of the basilar trunk, and 7 vertebrobasilar junction aneurysms. There were 5 saccular and 7 fusiform aneurysms. All patients underwent extracranial-intracranial bypass and vessel occlusion. Flow was reversed or reduced by complete (n = 6) or partial occlusion of the basilar artery (n = 3) or by occlusion of the vertebral arteries distal to the posterior inferior cerebellar artery (n = 3). Postoperatively (mean follow-up, 71.6 months; range, 4-228; median, 49 months), the bypass patency rate was 92.3% (12/13). The perioperative mortality rate for the initial treatment was 18.2% (2/11). In 4 cases, the aneurysms continued to grow and required further treatment; after re-treatment, 3 of these patients died. Of the initial 11 patients, 6 were treated successfully and 5 died. The mean preoperative modified Rankin Scale score was 2.1 (range, 1-3; median, 2). At last follow-up for all patients, the mean modified Rankin Scale score was 3.45 (range, 1-6; median, 3) and 2.5 (range, 1-4; median, 2.5) for the 6 long-term survivors. CONCLUSION: Vertebrobasilar aneurysms are challenging lesions with limited microsurgical or endovascular options. Despite aggressive surgical treatment, the long-term outcome remains poor for most patients.

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