scholarly journals Progress in the Treatment of Acute Ischemic Stroke, Current Challenges and the Establishment of Clinical Decision-Making System

2019 ◽  
Vol 9 (4-5) ◽  
pp. 51-59
Author(s):  
Yi Bao ◽  
Xinyu Du ◽  
Miao Zhang ◽  
Ran An ◽  
Jing Xiao ◽  
...  
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making System

Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Bryan Eckerle ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Matthew Flaherty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Imaging Method ◽  
Chi Square ◽  
Exact Test ◽  
High Prevalence ◽  
Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

scholarly journals Mortality after large artery occlusion acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rahul R. Karamchandani ◽  
Jeremy B. Rhoten ◽  
Dale Strong ◽  
Brenda Chang ◽  
Andrew W. Asimos
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Artery Occlusion ◽  
Large Artery ◽  
Multivariable Logistic Regression Model ◽  
Stroke Registry ◽  
Social Security Death Index ◽  
Revascularization Therapy

AbstractDespite randomized trials showing a functional outcome benefit in favor of endovascular therapy (EVT), large artery occlusion acute ischemic stroke is associated with high mortality. We performed a retrospective analysis from a prospectively collected code stroke registry and included patients presenting between November 2016 and April 2019 with internal carotid artery and/or proximal middle cerebral artery occlusions. Ninety-day mortality status from registry follow-up was corroborated with the Social Security Death Index. A multivariable logistic regression model was fitted to determine demographic and clinical characteristics associated with 90-day mortality. Among 764 patients, mortality rate was 26%. Increasing age (per 10 years, OR 1.48, 95% CI 1.25–1.76; p < 0.0001), higher presenting NIHSS (per 1 point, OR 1.05, 95% CI 1.01–1.09, p = 0.01), and higher discharge modified Rankin Score (per 1 point, OR 4.27, 95% CI 3.25–5.59, p < 0.0001) were independently associated with higher odds of mortality. Good revascularization therapy, compared to no EVT, was independently associated with a survival benefit (OR 0.61, 95% CI 0.35–1.00, p = 0.048). We identified factors independently associated with mortality in a highly lethal form of stroke which can be used in clinical decision-making, prognostication, and in planning future studies.

scholarly journals Time-Based Decision Making for Reperfusion in Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Mathias Grøan ◽  
Johanna Ospel ◽  
Soffien Ajmi ◽  
Else Charlotte Sandset ◽  
Martin W. Kurz ◽  
...  
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Windows ◽  
Clinical Decision ◽  
Imaging Modalities ◽  
Visual Aids ◽  
Advanced Imaging ◽  
Aid Decision ◽  
Delayed Time

Decision making in the extended time windows for acute ischemic stroke can be a complex and time-consuming process. The process of making the clinical decision to treat has been compounded by the availability of different imaging modalities. In the setting of acute ischemic stroke, time is of the essence and chances of a good outcome diminish by each passing minute. Navigating the plethora of advanced imaging modalities means that treatment in some cases can be inefficaciously delayed. Time delays and individually based non-programmed decision making can prove challenging for clinicians. Visual aids can assist such decision making aimed at simplifying the use of advanced imaging. Flow charts are one such visual tool that can expedite treatment in this setting. A systematic review of existing literature around imaging modalities based on site of occlusion and time from onset can be used to aid decision making; a more program-based thought process. The use of an acute reperfusion flow chart helping navigate the myriad of imaging modalities can aid the effective treatment of patients.

Image fusion practice to improve the ischemic-stroke-lesion detection for efficient clinical decision making

2021 ◽  
Author(s):  
D. Jude Hemanth ◽  
V. Rajinikanth ◽  
Vaddi Seshagiri Rao ◽  
Samaresh Mishra ◽  
Naeem M. S. Hannon ◽  
...  
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Image Fusion ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lesion Detection ◽  
Stroke Lesion

scholarly journals Antiepileptic Drug Management in Acute Ischemic Stroke: Are Vascular Neurologists Utilizing Electroencephalograms? An Observational Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Rahul Rao ◽  
Dominique J. Monlezun ◽  
Tara Kimbrough ◽  
Brian J. Burkett ◽  
Alyana Samai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiepileptic Drug ◽  
Clinical Decision Making ◽  
Epileptiform Activity ◽  
Clinical Decision ◽  
Prior History ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
History Of

Introduction. This study examines the utility of electroencephalography (EEG) in clinical decision making in acute ischemic stroke (AIS) patients in regards to the prescription of antiseizure medications. Methods. Patients were grouped as having positive EEG (+) for epileptiform activity or negative EEG (-). These studies were no more than 30 minutes in length. Patients’ charts were retrospectively reviewed for antiepileptic drug (AED) use before, during, and on discharge from AIS hospitalization. Results. Of the 509 patients meeting inclusion criteria, 24 (4.7%) had a positive EEG. Patients did not significantly differ with respect to any demographic or baseline characteristics with the exception of prior history of seizure. In the EEG- group, AEDs were discontinued in only 3.5% of patients. In the EEG+ group, only 37.5% of patients had an initiation or change to their AED regimen within 36 hours of the study. 62.5% of the EEG+ group had a cortical stroke. Significance. Our results indicate that vascular neurologists are not using spot EEGs to routinely guide inpatient AED management. EEGs may have greater utility in those with a prior history of seizures and cortical strokes. Longer or continuous EEG monitoring may have better utility in the AIS population if there is clinical suspicion of seizure.

scholarly journals Monitoring Pressure Augmentation in Patients With Ischemic Penumbra Using Continuous Electroencephalogram: Three Cases and a Review of the Literature

2017 ◽  
Vol 7 (4) ◽  
pp. 179-187 ◽  
Author(s):  
Christopher R. Newey ◽  
Vikas Gupta ◽  
Agnieszka A. Ardelt
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Clinical Decision Making ◽  
Case Series ◽  
Clinical Decision ◽  
Ischemic Penumbra ◽  
Review Of The Literature ◽  
Acute Thrombosis ◽  
Continuous Electroencephalography ◽  
Noninvasive Monitor

Background: Continuous electroencephalography (CEEG) is a sensitive, noninvasive surrogate monitor of cerebral blood flow (CBF). Changes in CBF can be seen as changes in the frequencies on the CEEG. This case series suggests that increase in CEEG frequencies may be used to detect improved CBF following pressure augmentation such as with treatment of vasospasm from subarachnoid hemorrhage (SAH) or acute thrombosis from ischemic stroke. The application of this observation to clinical decision-making has not been clearly defined and requires further study. Methods: Case series and imaging. Results: We present 3 patients with ischemic penumbras either from vasospasm from SAH or thrombosis from acute ischemic stroke. All patients were monitored on CEEG and found to have lateralized slowing. During pressure augmentation, the lateralized slowing improved in frequency, which corresponded with improvement in the patients’ neurological examinations. Conclusion: Continuous electroencephalography may be used as a noninvasive monitor to allow for individualization of pressure augmentation in cases of vasospasm from SAH or in cases of acute ischemic strokes. This customized approach may allow for less morbidity associated with pressure augmentation in patients who otherwise may have dysfunction of their intracerebral autoregulation.

A Clinical Decision-Making System for COVID-19

2021 ◽  
pp. 245-249
Author(s):  
Rui Zhou ◽  
Yonghang Tai ◽  
Hongfei Yu ◽  
Xuejuan Wang ◽  
Liqiang Zhang
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making System

scholarly journals A neutrosophic clinical decision-making system for cardiovascular diseases risk analysis

2020 ◽  
Vol 39 (5) ◽  
pp. 7807-7829
Author(s):  
Shaista Habib ◽  
Wardat us Salam ◽  
M. Arif Butt ◽  
M. Akram ◽  
F. Smarandache
Keyword(s):  
Decision Making ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Electrolyte Imbalance ◽  
Medical Professionals ◽  
Pericardial Disease ◽  
Decision Making System ◽  
Artery Disease

Cardiovascular diseases are the leading cause of death worldwide. Early diagnosis of heart disease can reduce this large number of deaths so that treatment can be carried out. Many decision-making systems have been developed, but they are too complex for medical professionals. To target these objectives, we develop an explainable neutrosophic clinical decision-making system for the timely diagnose of cardiovascular disease risk. We make our system transparent and easy to understand with the help of explainable artificial intelligence techniques so that medical professionals can easily adopt this system. Our system is taking thirty-five symptoms as input parameters, which are, gender, age, genetic disposition, smoking, blood pressure, cholesterol, diabetes, body mass index, depression, unhealthy diet, metabolic disorder, physical inactivity, pre-eclampsia, rheumatoid arthritis, coffee consumption, pregnancy, rubella, drugs, tobacco, alcohol, heart defect, previous surgery/injury, thyroid, sleep apnea, atrial fibrillation, heart history, infection, homocysteine level, pericardial cysts, marfan syndrome, syphilis, inflammation, clots, cancer, and electrolyte imbalance and finds out the risk of coronary artery disease, cardiomyopathy, congenital heart disease, heart attack, heart arrhythmia, peripheral artery disease, aortic disease, pericardial disease, deep vein thrombosis, heart valve disease, and heart failure. There are five main modules of the system, which are neutrosophication, knowledge base, inference engine, de-neutrosophication, and explainability. To demonstrate the complete working of our system, we design an algorithm and calculates its time complexity. We also present a new de-neutrosophication formula, and give comparison of our the results with existing methods.

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