Diagnosis of cerebral hemorrhage before the era of computed tomography

2013 ◽  
Vol 154 (44) ◽  
pp. 1743-1746
Author(s):  
Gergely Hofgárt ◽  
Rita Szepesi ◽  
Bertalan Vámosi ◽  
László Csiba
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Cranial Computed Tomography ◽  
Cerebral Stroke ◽  
Daily Routine ◽  
Stroke Patients ◽  
The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

scholarly journals Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

2011 ◽  
Vol 93 (8) ◽  
pp. 639-641 ◽  
Author(s):  
VCY Tang ◽  
A Attwell-Heap
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Ureteral Stent ◽  
The Difference ◽  
Contrast Ct ◽  
Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

scholarly journals Comparison of Clinical Diagnosis of Stroke with Computed Tomographic Scan of the Brain

2013 ◽  
Vol 28 (2) ◽  
pp. 96-101
Author(s):  
Sirajee Shafiqul Islam ◽  
Aminur Rahman ◽  
Md Manzur Alahi ◽  
Md Ahmed Ali ◽  
Md Kafiluddin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Sensitivity Specificity ◽  
The Brain

Background and purpose: Stroke is a leading cause of mortality and morbidity in both developed as well as developing countries. The clinical presentation of stroke depending on the site and extent of lesions. For the management purpose it is important to know whether we are dealing with a bleed or an infarct. Methodology: Computed Tomography (CT scan) is available most of the tertiary level hospitals in Bangladesh. This study was carried out to compare clinical diagnosis of stroke with Computed tomography (CT) scan findings in ascertaining the type of stroke (hemorrhagic or ischemic). Materials and methods: This cross-sectional comparative study was conducted in the Department of Neurology, Rajshahi Medical College Hospital during the period of January 2010 to December 2010. Total 200 stroke patients were selected by purposive sampling technique on the basis of inclusion and exclusion criteria as the study sample. . CT brain scan was done for all the patients. The clinical diagnosis was compared with the results of CT scan and performance test was done. Results: Clinically 67 patients were diagnosed as hemorrhagic stroke and 133 patients were diagnosed as ischemic stroke. Out of these 67 hemorrhagic patients CT scan revealed that 56 patients had intracerebral hemorrhage, 5 had infarct, 4 had subarachnoid hemorrhage and 2 had space occupying lesions in the brain. Out of these 133 ischemic patients CT scan revealed that 119 patients had infarction, 6 had intracerebral hemorrhage and 8 had space occupying lesions in the brain. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of hemorrhagic stroke were 90.32%, 92.03%, 83.58%, 92.02% and 91.5% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of ischemic stroke were 95.96%, 81.58%, 89.47%, 92.53% and 90.5% respectively. Conclusion: The diagnosis of stroke in clinically with high accuracy, but perform a CT scan will help to confirm and differentiate to type stroke. Thus CT scan should be done in all cases stroke to specify the diagnosis. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17179 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 96-101

scholarly journals Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Rakuhei Nakama ◽  
Ryo Yamamoto ◽  
Yoshimitsu Izawa ◽  
Keiichi Tanimura ◽  
Takashi Mato
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
High Specificity ◽  
Whole Body ◽  
Cutoff Value ◽  
Whole Body Ct ◽  
Isolated Injury ◽  
D Dimer ◽  
Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

Abstract TP221: Using Berlin Questionnaire and Epworth Sleepiness Scale to Identify Stroke Patients at Risk for the Sleep Apnea Syndrome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Millene Camilo ◽  
Alan Eckeli ◽  
Heidi Sander ◽  
Regina Fernandes ◽  
Joao Leite ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Epworth Sleepiness Scale ◽  
Berlin Questionnaire ◽  
Stroke Patients ◽  
Obstructive Sleep

Background: Sleep-disordered breathing (SDB) is frequent in the acute phase of stroke. Obstructive sleep apnea (OSA) has been found in 62% of stroke patients. The impact of OSA is significant after ischemic stroke, including early neurological deterioration, poor functional outcome and increased long-term mortality. However, performing polysomnography (PSG) for all patients with acute stroke for diagnose OSA is still impracticable. Therefore clinical tools to select patients at higher risk for OSA would be essential. The aim of this study was to determine the validity of the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS) to identify stroke patients in whom the PSG would be indicated. Methods: Subjects with ischemic stroke were stratified into high and low risk groups for SDB using a BQ. The ESS ≥ 10 was used to define excessive daytime sleepiness. The BQ and ESS were administered to the relatives of stroke patients at hospital admission. All patients were submitted to a full overnight PSG at the first night after symptoms onset. OSA severity was measured by the apnea-hypopnea index (AHI). Results: We prospectively studied 40 ischemic stroke patients. The mean age was 62 ± 12.1 years and the obstructive sleep apnea (AHI ≥ 15) was present in 67.5%. On stratifying risk of OSA in these patients based on the QB, 77.5% belonged to the high-risk and 50% to the ESS ≥ 10. The sensitivity of QB was 85%, the specificity 35%, the positive predictive value 74% and the negative predictive value 55%. For ESS was respectively 63%, 85%, 89% and 52%. The diagnostic value of the BQ and ESS in combination to predict OSA had a sensitivity of 58%, a specificity of 89%, a positive predictive value of 95% and a negative predictive value of 38%. Conclusions: The QB even applied to the bed-partners of stroke patients is a useful screening tool for OSA.

Rapid Detection of Neonatal Intracranial Hemorrhage by Transillumination

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 843-847
Author(s):  
Steven M. Donn ◽  
Marcia J. Sharp ◽  
Lawrence R. Kuhns ◽  
Joaquin O. Uy ◽  
James E. Knake ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Light Beam ◽  
Intracranial Hemorrhage ◽  
Rapid Detection ◽  
Light Transmission ◽  
Postmortem Examination ◽  
Cranial Computed Tomography ◽  
Anterior Fontanel ◽  
Light Passing

Using transillumination and a sensitive cadmium sulfide light meter, 145 newborns were screened for the presence of intracranial hemorrhage. Intracranial hemorrhage (ICH) was suspected when the light meter could not detect any light passing through the anterior fontanel when the light beam was directed through the frontal eminence. ICH was confirmed by cranial computed tomography or postmortem examination in all 17 infants not transmitting light. Spectrophotometry was performed on samples of cerebrospinal fluid (CSF) to demonstrate the mechanism through which blood in the CSF blocks light transmission.

Association of Bacteria Species with Positive Predictive Value of Bacteria Isolated from Cerebrospinal Fluid Cultures: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yi Ye ◽  
Guanghui Zheng ◽  
Yueyue Kong ◽  
Jiawei Ma ◽  
Guojun Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cohort Study ◽  
Positive Predictive Value ◽  
Retrospective Cohort Study ◽  
Predictive Value ◽  
Retrospective Cohort ◽  
Klebsiella Oxytoca ◽  
P Value ◽  
Coagulase Negative Staphylococci ◽  
Predictive Values

Abstract Background: Previous studies discuss the positive predictive value through whether the bacteria are coagulase-negative staphylococci. The view may need to be updated. The aim was to evaluate the positive predictive value of different bacteria species isolated from cerebrospinal fluid cultures and discuss the rationality to view coagulase-negative staphylococci as a group.Methods: This retrospective cohort study recruit all adults with positive cerebrospinal fluid cultures sampled by lumbar puncture 2012-2020 in the Department of Neurosurgery. The exposure was bacteria species, and the outcome was positive predictive value. An episode was defined as a patient with one bacteria. When episodes with a bacteria species reached five, the bacteria species was analyzed specifically. The positive predictive value was defined as the incidence of isolated-bacteria-related infected episodes. The isolated-bacteria-related infected episode was defined as the patient was with clinical features of bacterial meningitis, and the improvement was related to sensitive antibacterial agents. Then the differences of the positive predictive value of different bacteria in all specific bacteria species, coagulase-negative staphylococci, and non-coagulase-negative staphylococci bacteria were calculated, respectively. The results were statistically significant when P-value <.05.Results: 1180 episodes from 1133 patients with 79 bacteria were studied; the positive predictive value was 54.3%. The bacteria included 67 bacteria species, ten bacteria genus, viridans streptococci, and unclassified coagulase-negative staphylococci. Twenty-four specific bacteria species were analyzed. The range of positive predictive values of them was 29.4%-100.0% (P<.0001). The positive predictive value for Enterobacter aerogenes, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca was the highest, while the positive predictive value for Staphylococcus cohnii was the lowest. Moreover, 767 (65.0%) were with coagulase-negative staphylococci, the positive predictive value was 46.4%, and the range was 29.4%-85.7% (P=.0020); 413 (35.0%) were with non-coagulase-negative staphylococci bacteria, the positive predictive value was 69.0%, and the range was 40.0%-100.0% (P<.0001).Conclusions: This study suggests that the positive predictive value of different bacteria species is different. It is more reasonable to discuss the positive predictive value of bacteria isolated from cerebrospinal fluid cultures through the bacteria species rather than whether they are coagulase-negative staphylococci.Trial registration: This is a retrospective study without interventions on participants.

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