scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Clinical Decision ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability ◽  
Decompressive Hemicraniectomy ◽  
Hemispheric Infarction

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE.Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction. Results: After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the use of nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Clinical Decision ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability ◽  
Decompressive Hemicraniectomy ◽  
Hemispheric Infarction

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE.Methods: 142 consecutive patients with LHI within 24h of onset between January 1, 2016 and August 31, 2019 were retrospectively reviewed. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction.Results: After adjusting for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the nomogram use for clinicians, we used the “Dynnom” package to build a dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The MANA nomogram’s C-statistic was up to 0.887 ± 0.041 and the AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent MCE predictors included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Clinical Decision ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability ◽  
Decompressive Hemicraniectomy ◽  
Hemispheric Infarction

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE. Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction. Results : After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the use of nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page ( http://www.MANA-nom.com ) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934). Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

scholarly journals A web based dynamic MANA Nomogram for predicting the malignant cerebral edema in patients with large hemispheric infarction

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Clinical Decision ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability ◽  
Decompressive Hemicraniectomy ◽  
Hemispheric Infarction

Abstract Background For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE. Methods One hundred forty-two consecutive patients with LHI within 24 h of onset between January 1, 2016 and August 31, 2019 were retrospectively reviewed. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5 mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction. Results After adjusting for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the nomogram use for clinicians, we used the “Dynnom” package to build a dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The MANA nomogram’s C-statistic was up to 0.887 ± 0.041 and the AUC-ROC value in this cohort was 0.887 (95%CI, 0.828 ~ 0.934). Conclusions Independent MCE predictors included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema 

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Binary Logistic Regression ◽  
Mass Effect ◽  
Clinical Decision ◽  
Rapid Identification ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with mortality approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for rapid identification of high-risk patients and understanding of the potential mechanism of MCE.Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received DHC with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to evaluated the independent predictors of MCE. Independent prognostic factors were incorporated to build dynamic MANA nomogram to predict MCE.Results: After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. Furthermore, to facilitate the use of the nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

Abstract TMP15: Contralateral Hemispheric Atrophy After Major Hemispheric Infarction

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Austin A Barnett ◽  
Warren Selman ◽  
Cathy Sila
Keyword(s):  
Communicating Hydrocephalus ◽  
Cerebral Peduncle ◽  
Contralateral Hemisphere ◽  
Midline Shift ◽  
Ipsilateral Hemisphere ◽  
Decompressive Hemicraniectomy ◽  
Functional Reorganization ◽  
The Mean ◽  
Hemispheric Infarction

Objective: Atrophy of the ipsilateral hemisphere, cerebral peduncle, and contralateral cerebellum predict outcome after stroke; little is known of the effect of stroke on the contralateral hemisphere although it plays an important role in functional reorganization. Methods: All patients who underwent decompressive hemicraniectomy for malignant hemispheric infarction at UH-CMC between 1/2003-12/2009 were analyzed with IRB approval. Patients with adequate CT scans both prior to surgery and after reconstructive cranioplasty were included; those with communicating hydrocephalus, confounding lesions or ≥ 10 mm of midline shift were excluded. Brainlab iPlan® software (Germany) was used to manually trace the infarct, non-infarct ipsilateral and contralateral hemisphere on axial, sagittal and coronal slices. Results: Of 30 patients, 9 met inclusion criteria. The inter-rater reliability of volumetric analyses was excellent (r=0.99). The mean contralateral hemisphere volume at follow-up was significantly reduced compared to the baseline study (465.987 ± 78.32 cc vs 493.429 ±76.92 cc, p< 0.0001, Fisher’s two-tailed t-test ). Contralateral hemispheric atrophy was identified in all patients (mean 27.441 cc, range 4.985 - 42.807 cc) and represented a loss of 5.7% (1.2 - 11.16%) of the original volume. Contralateral hemispheric atrophy was significantly related to the volume of the infarct and the time from stroke onset to decompressive hemicraniectomy but not to the extent of midline shift on the post-operative scan nor <10 mm on the pre-operative scan. Contralateral hemispheral atrophy was identified early and not related to the length of follow-up (median 4.5, range 2-43 months). Conclusions: Contralateral hemispheric atrophy occurs within months of major hemispheral infarction and is related to infarct size and the time to decompressive hemicraniectomy.

A Woman With Headaches and a Tumefactive Brain Lesion

2021 ◽  
pp. 202-203
Author(s):  
Andrew McKeon
Keyword(s):  
Corpus Callosum ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Brain Lesion ◽  
Brain Magnetic Resonance Imaging ◽  
Corticosteroid Treatment ◽  
Mass Effect ◽  
Clinical Decision ◽  
Contrast Imaging ◽  
Language Deficit

A 65-year-old woman sought care for a 6-month history of confusion and emotional disturbance that was initially ascribed to stress. She then had development of headaches over several weeks, which prompted brain magnetic resonance imaging with contrast. Imaging showed a mass emanating bilaterally from the splenium of the corpus callosum with heterogeneous T1 postgadolinium enhancement. Neurologic examination indicated left homonymous hemianopia, but she was otherwise normal. She had neither alexia nor other language deficit that may appear with a splenial corpus callosum lesion. A biopsy of the brain mass was performed. Histologic analysis of the biopsy specimen revealed glioblastoma multiforme. Corticosteroid treatment was prescribed, which relieved her headache. Radiation therapy and chemotherapy (temozolomide) were recommended. No further follow-up information was available. In neurologic clinical practice, a large corpus callosum–based lesion is sometimes encountered. The localization of such lesions is not specific for any one diagnosis, but radiologic characteristics can aid clinical decision making. Although the radiologic appearance of a lesion spreading out into both hemispheres from the corpus callosum can indicate butterfly glioma, the differential diagnosis also includes tumefactive demyelinating disease and lymphoma, which can also have a callosal localization and produce mass effect.

Hemispheric CSF volume ratio quantifies progression and severity of cerebral edema after acute hemispheric stroke

2021 ◽  
pp. 0271678X2110182
Author(s):  
Rajat Dhar ◽  
Ali Hamzehloo ◽  
Atul Kumar ◽  
Yasheng Chen ◽  
June He ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cerebral Edema ◽  
Volume Ratio ◽  
Stroke Onset ◽  
Contralateral Hemisphere ◽  
Midline Shift ◽  
Hemispheric Stroke ◽  
Early Biomarker ◽  
Hemispheric Infarction

As swelling occurs, CSF is preferentially displaced from the ischemic hemisphere. The ratio of CSF volume in the stroke-affected hemisphere to that in the contralateral hemisphere may quantify the progression of cerebral edema. We automatically segmented CSF from 1,875 routine CTs performed within 96 hours of stroke onset in 924 participants of a stroke cohort study. In 737 subjects with follow-up imaging beyond 24-hours, edema severity was classified as affecting less than one-third of the hemisphere (CED-1), large hemispheric infarction (LHI, over one-third the hemisphere), without midline shift (CED-2) or with midline shift (CED-3). Malignant edema was LHI resulting in deterioration, requiring osmotic therapy, surgery, or resulting in death. Hemispheric CSF ratio was lower on baseline CT in those with LHI (0.91 vs. 0.97, p < 0.0001) and decreased more rapidly in those with LHI who developed midline shift (0.01 per hour for CED-3 vs. 0.004/hour CED-2). The ratio at 24-hours was lower in those with midline shift (0.41, IQR 0.30–0.57 vs. 0.66, 0.56–0.81 for CED-2). A ratio below 0.50 provided 90% sensitivity, 82% specificity for predicting malignant edema among those with LHI (AUC 0.91, 0.85–0.96). This suggests that the hemispheric CSF ratio may provide an accessible early biomarker of edema severity.

scholarly journals Severe cerebral edema following nivolumab treatment for pediatric glioblastoma: case report

2017 ◽  
Vol 19 (2) ◽  
pp. 249-253 ◽  
Author(s):  
Xiao Zhu ◽  
Michael M. McDowell ◽  
William C. Newman ◽  
Gary E. Mason ◽  
Stephanie Greene ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Tumor Necrosis ◽  
Phase Iii ◽  
Do Not Resuscitate ◽  
Midline Shift ◽  
Decompressive Hemicraniectomy ◽  
Phase Iii Clinical Trials ◽  
First Case ◽  
Immune Mediated ◽  
Left Pupil

Nivolumab is an immune checkpoint inhibitor (ICI) currently undergoing Phase III clinical trials for the treatment of glioblastoma. The authors present the case of a 10-year-old girl with glioblastoma treated with nivolumab under compassionate-use guidelines. After the first dose of nivolumab the patient developed hemiparesis, cerebral edema, and significant midline shift due to severe tumor necrosis. She was managed using intravenous dexamethasone and discharged on a dexamethasone taper. The patient's condition rapidly deteriorated after the second dose of nivolumab, demonstrating hemiplegia, seizures, and eventually unresponsiveness with a fixed and dilated left pupil. Computed tomography of her brain revealed malignant cerebral edema requiring emergency decompressive hemicraniectomy. Repeat imaging demonstrated increased size of the lesion, reflecting immune-mediated inflammation and tumor necrosis. The patient remained densely hemiplegic, but became progressively more interactive and was ultimately extubated. She resumed nivolumab several weeks later, but again her condition deteriorated with headache, vomiting, swelling at the craniectomy site, and limited right-sided facial movement following the sixth dose. MRI demonstrated severe midline shift and uncal herniation despite her craniectomy. Her condition gradually declined, and she died several days later under “do not resuscitate/do not intubate” orders. To the authors' knowledge, this represents the first case of malignant cerebral edema requiring operative intervention following nivolumab treatment for glioblastoma in a pediatric patient.

Can artificial intelligence support the clinical decision making for Barcelona clinic liver cancer stage 0/a hepatocellular carcinoma in China?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15634-e15634
Author(s):  
Ze-bin Chen ◽  
Shu-Ling Chen ◽  
Rui-Ming Liang ◽  
Zhen-Wei Peng ◽  
Jing-Xian Shen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Clinical Decision Support System ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Concordance Rate ◽  
Chinese Patients ◽  
Cancer Types ◽  
Ibm Watson

e15634 Background: Artificial intelligence (AI) is emerging as a revolutionary technology with the power to transform healthcare. IBM Watson for Oncology (WFO), as an AI clinical decision support system (CDSS), has been investigated about its impact on clinical decision making in some cancer types and shown potential to be an effective CDSS in cancer care. However, the feasibility of WFO in Chinese patients with hepatocellular carcinoma (HCC) has not been reported. Methods: Artificial intelligence (AI) is emerging as a revolutionary technology with the power to transform healthcare. IBM Watson for Oncology (WFO), as an AI clinical decision support system (CDSS), has been investigated about its impact on clinical decision making in some cancer types and shown potential to be an effective CDSS in cancer care. However, the feasibility of WFO in Chinese patients with hepatocellular carcinoma (HCC) has not been reported. Results: The overall concordance rate was 60.5%, with 53.7% and 61.4% in BCLC stage 0 and A respectively. After the MDT re-review, the overall, BCLC stage 0 and A concordance rate increased to 67.3%, 65.9% and 67.3%. The main discordance was that MDT recommended more aggressive treatment options (eg. hepatectomy) than WFO did. The increase in concordance rate may be due to the progress of treatment of HCC in the past 5 years. Conclusions: With the concordance and reasonability verified by MDT in this study, WFO may provide practical reference in BCLC stage 0/A HCC. Localization is required to cover the disparity in guideline and patient characteristics between China and the US.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

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