scholarly journals Hydrocephalus associated with childhood nonaccidental head trauma

2016 ◽  
Vol 41 (5) ◽  
pp. E8 ◽  
Author(s):  
Sudhakar Vadivelu ◽  
Harold L. Rekate ◽  
Debra Esernio-Jenssen ◽  
Mark A. Mittler ◽  
Steven J. Schneider
Keyword(s):  
Ischemic Stroke ◽  
Head Trauma ◽  
Ct Scans ◽  
Injury Score ◽  
Ventricular Dilation ◽  
Discharge Outcomes ◽  
Evans Index ◽  
Gcs Score ◽  
The Relationship ◽  
Admission Glasgow Coma Scale

OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period. Cases in which sequential CT scans had been obtained (n = 28) were evaluated for Evans' index to determine the earliest time ventricular dilation was observed. Discharge outcomes were assessed using the King's Outcome Scale for Childhood Head Injury score. RESULTS Thirty-nine percent (11 of 28) of the patients developed PTV. A low admission Glasgow Coma Scale (GCS) score predicted early PTV presentation (within < 3 days) versus a high GCS score (> 1 week). A majority of PTV/NAHT patients presented with a subdural hematoma (both convexity and interhemispheric) and ischemic stroke, but subarachnoid hemorrhage was significantly associated with PTV/NAHT (p = 0.011). Of 6 patients undergoing a DC for intractable intracranial pressure, 4 (67%) developed PTV (p = 0.0366). These patients tended to present with lower GCS scores and develop ventriculomegaly early. Only 2 patients developed hydrocephalus requiring shunt placement. CONCLUSIONS PTV presents early after NAHT, particularly after a DC has been performed. However, the authors found that only a few PTV/NAHT patients developed shunt-dependent hydrocephalus.

scholarly journals The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Hao Chen ◽  
Li-Xia Xue ◽  
Yan Guo ◽  
Shi-Wen Chen ◽  
Gan Wang ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Severe Head Trauma ◽  
Secondary Insult ◽  
Increased Risk ◽  
Associated Risk Factors ◽  
Gcs Score ◽  
Posttraumatic Cerebral Infarction ◽  
Admission Glasgow Coma Scale ◽  
D Dimer

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (≥5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

scholarly journals Detection of Midline Shift from CT Scans to Predict Outcome in Patients with Head Injuries

2021 ◽  
Vol 11 (1) ◽  
pp. 18-23
Author(s):  
Ikhlas Abdelaziz ◽  
Rowa Aljondi ◽  
Ali Alhailiy ◽  
Mustafa Mahmoud
Keyword(s):  
Clinical Outcome ◽  
Brain Injuries ◽  
Head Injuries ◽  
Clinical Status ◽  
Ct Scans ◽  
Ct Scanner ◽  
Midline Shift ◽  
Medical Systems ◽  
Gcs Score ◽  
The Relationship

Background: The present study aimed to detect the degree of midline shift from CT scans and the clinical status of the patient, to evaluate the relationship between the degree of midline shift found by the CT scan and GCS score as a predictor of clinical outcome in head injury patients. Furthermore, we aimed to assess the relationship between midline shift and age, sex, and causes. Methods and Results: The study included 50 subjects (36 males and 14 females). The age range of the patients in this study was 18–95 years old (mean age of 48.34±17.02 years). The inclusion criteria were patients with traumatic brain injury (TBI) or patients evaluated for level of consciousness by a neurosurgeon. Toshiba 16 Slice CT scanner (Toshiba Medical Systems, Nasu, Japan 2003) was used to scan all patients in the supine, head first position. Contiguous 2 mm slices were obtained using the Toshiba 16-slice machine spiral technique (pitch 1.25–1.5, 0.75 s rotation time, 120 KvP, 2 mm reconstruction interval). The results indicated that the degree of midline shift in patients with brain injuries was statistically significant as a determinant of clinical outcome. It appeared that the probability of poor clinical outcome was higher when there was a combination of midline shift and other types of intracranial hemorrhage, clinical factors, such as sex, age, and GCS score, and associated injuries. The worst outcome was seen in patients with midline shift and subdural hematoma, when compared with other lesions in patients with brain injuries. Conclusion: This study suggests that the degree of midline shift may be predictive of clinical outcome in patients with head injuries.

scholarly journals Relationship between the national institutes health stroke scale score and bispectral index in patients with acute ischemic stroke

2021 ◽  
Vol 38 (4) ◽  
pp. 440-444
Author(s):  
Serdar ÖZDEMİR ◽  
Tuba CİMİLLİ ÖZTÜRK ◽  
Özge ECMEL ONUR
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bispectral Index ◽  
Sedative Drug ◽  
Nihss Score ◽  
Scale Scores ◽  
History Of ◽  
Clinically Significant ◽  
Gcs Score ◽  
The Relationship

This study aimed to investigate the relationship between the bispectral index and the National Institutes of Health Stroke Scale (NIHSS) score in patients admitted to the emergency department with a first-time acute ischemic stroke. Methods: This prospective, observational study was conducted with patients admitted to our clinic with acute ischemic stroke symptoms. Patients with known cranial pathologies, such as space- occupying lesions, those with a history of clinically significant cerebrovascular events or sedative drug administration, and those with altered consciousness due to metabolic causes were excluded from the study. The National Institutes Health Stroke Scale scores were recorded by the clinician. Cerebral arterial territories were assessed on DWI and CT. The relationship between the NIHSS score and bispectral index was evaluated. Results: Forty-three patients were included in the study. The mean bispectral index of the cases was 84.23 ± 9.50. There was no significant correlation between the bispectral index values and the NIHSS score (p<0.05). Conclusion: In our study, the bispectral index values were decreased due to ischemic stroke. The results should be reevaluated studies conducted with larger series to reveal the relationship between infarcted territories, NIHSS score, bispectral index, and the GCS score.

scholarly journals The Utility of Thromboelastography for Predicting the Risk of Post-Traumatic Cerebral Infarction in Traumatic Brain Injury

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hao Chen ◽  
Hengli Tian
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Multivariate Logistic Regression Analysis ◽  
Secondary Insult ◽  
Increased Risk ◽  
Post Traumatic ◽  
Independent Risk Factors ◽  
Gcs Score ◽  
Admission Glasgow Coma Scale ◽  
Traumatic Coagulopathy

Abstract INTRODUCTION Post-traumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if post-traumatic coagulopathy determined using thrombelastography was associated with cerebral infarction after head trauma. METHODS We prospectively reviewed 316 patients with head trauma to evaluate the effects of demographics, admission Glasgow Coma Scale (GCS) score, and TEG data on the development of PTCI. Multivariate logistic regression analysis was used to identify independent risk factors. RESULTS Patients with PTCI had a shorter R, greater a-Angle, and shorter K, indicating faster clotting. Additionally, TEG results were independently associated with an increased risk of PTCI. CONCLUSION TEG demonstrates that many PTCI patients are hypercoaguable and the risk of developing PTCI may be higher in patients with a shorter R, greater a-Angle, and shorter K.

Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening

2021 ◽  
pp. 1-8
Author(s):  
Ki-Woong Nam ◽  
Chi Kyung Kim ◽  
Sungwook Yu ◽  
Jong-Won Chung ◽  
Oh Young Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Risk Scores ◽  
Stroke Patients ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Close Relationship ◽  
The Relationship

<b><i>Background:</i></b> Stroke risk scores (CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. <b><i>Objective:</i></b> The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. <b><i>Methods:</i></b> We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. <b><i>Results:</i></b> A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA<sub>2</sub>DS<sub>2</sub>-VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS<sub>2</sub> scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. <b><i>Conclusions:</i></b> High CHA<sub>2</sub>DS<sub>2</sub>-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

scholarly journals Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuhong Yu ◽  
Yi Luo ◽  
Tan Zhang ◽  
Chenrong Huang ◽  
Yu Fu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Poor Outcome ◽  
Net Reclassification Improvement ◽  
Potential Biomarker ◽  
The Impact ◽  
The Relationship ◽  
Integrated Discrimination Improvement

Abstract Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001). Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

scholarly journals The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

2021 ◽  
pp. 1-13
Author(s):  
Elisabeth Kliem ◽  
Elise Gjestad ◽  
Truls Ryum ◽  
Alexander Olsen ◽  
Bente Thommessen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Executive Function ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Psychiatric Symptoms ◽  
Post Stroke ◽  
Cognitive Difficulties ◽  
Memory And Attention ◽  
Relationship Of ◽  
The Relationship

Abstract Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

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