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 Superiority of Siriraj Stroke Score Over Guy’s Hospital Score in Diagnosing Acute Hemorrhagic Stroke at Bedside

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 142-146
Author(s):  
Raseul Kabir ◽  
Md Amjad Hossain Pramanik ◽  
SM Emdadul Haque ◽  
Muhatarima Tabassum ◽  
Fateha Sultana
Keyword(s):  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Ct Scan ◽  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Kappa Statistic ◽  
Risk Scores ◽  
Simple Method ◽  
Sensitivity Specificity

Background: The clinical diagnosis of stroke in a patient admitted in the intensive care unit (ICU) is undeniably challenging. Several point-based risk scores have been developed to predict clinical outcomes after ischemic stroke. Objective: To assess the Siriraj stroke score and Guy’s Hospital stroke score in the clinical diagnosis of acute stroke. Materials and Methods: All patients were subjected to Computed tomography (CT) scan head within 72 hours of admission. The sensitivity, specificity, positive predictive value was calculated for both the scores. Comparability between the scores and CT scan head finding was determined with the help of Kappa statistic program. Results: Sensitivity of Guy’s Hospital stroke score for ischemic stroke is 100%, specificity is 96.4%, accuracy 97.1%, positive predictive value of 87.5% and negative predictive value 100%. The sensitivity of Guy’s Hospital stroke score for hemorrhage stroke is 96.4%, specificity is 100%, accuracy 97.1%, positive predictive value of 100% and negative predictive value 87.5% Conclusion: Siriraj stroke score as a simple method of screening patients for intracerebral hemorrhage, as it is easier to use at bedside and has a greater accuracy in diagnosing hemorrhage than Guy’s Hospital score. KYAMC Journal. 2021;12(3): 142-146

scholarly journals Significance of Computed Tomography in the Diagnosis of Cerebrovascular Accidents

2014 ◽  
Vol 2 (1) ◽  
pp. 18
Author(s):  
Sumnima Acharya ◽  
Shyam Kishore Chaturvedi
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Cerebrovascular Accident ◽  
Hemorrhagic Stroke ◽  
Diagnostic Significance ◽  
Diagnostic Modality ◽  
Female Ratio ◽  
One Year

Introduction: Cerebrovascular Accident (CVA) is defined as abrupt onset of a neurological deficit that is attributable to a focal vascular cause. CT scan is a widely available, affordable, non-invasive and relatively accurate investigation in patients with stroke and is important to identify stroke pathology and exclude mimics. Aim of this study is to establish the diagnostic significance of computed tomography in cerebrovascular accident and to differentiate between cerebral infarction and cerebral haemorrhage with CT for better management of CVA. Methods: A one year observational cross sectional study was conducted in 100 patients that presented at the department of radiodiagnosis from emergency or ward within the one year of study period with the clinical diagnosis of stroke, and had a brain CT scan done within one to fourteen days of onset. Results: A total of 100 patients were studied. 66 were male and 34 were female with a male/female ratio of 1.9:1. Maximum number of cases (39%) was in the age group of 61-80 yrs. Among 100 patients, 55 cases were clinically diagnosed as hemorrhagic stroke and 45 cases were clinically diagnosed with an infarct. Out of the 55 hemorrhagic cases, two cases were diagnosed as both hemorrhage and infarct by CT scan, one case had normal CT scan findings and one had subdural haemorrhage. These four cases were excluded while comparing the clinical diagnosis with CT scan finding. Among 51 clinically diagnosed cases of hemorrhagic stroke, 32(62.7%) cases were proved by CT scan as hemorrhagic stroke and among clinically diagnosed cases of infarct, 39(86.7%) cases were proved by CT scan as infarct which is statistically significant (p <0.001). A significant agreement between clinical and CT diagnosis was observed as indicated by kappa value of 0.49. Sensitivity, specificity, positive predictive value and negative predictive value of clinical findings as compared to CT in diagnosing hemorrhage were 84.2%, 67.2%, 62.8% and 86.7% respectively. The accuracy of clinical diagnosis is 74%. Conclusion: This study showed that CT scan is a useful diagnostic modality to identify stroke pathology and to exclude mimics.

scholarly journals KADAR D-DIMER PLASMA DI STROK ISKEMIK AKUT

2018 ◽  
Vol 21 (2) ◽  
pp. 183
Author(s):  
Yessi Mayke ◽  
Adi Koesoema Aman ◽  
Y. Anwar
Keyword(s):  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Ct Scan ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Plasma Levels ◽  
Latex Agglutination ◽  
Cross Sectional ◽  
The Brain ◽  
D Dimer

Ischemic stroke is a clinical sign of brain dysfunction or tissue damage caused by lack of blood flow to the brain that disrupts theblood and oxygen requirements in the brain tissue. In Indonesia, stroke is the third ranks after heart disease and malignancy. The promptdiagnosis can reduce morbidity and mortality. CT-scan is the gold standard, but it has some limitations that are difficult to recognize theearly signs of ischemia on the first day and the cost of the related treatment is expensive. Because of these limitations, such case requireanother sign that is noninvasive, sensitive, specific, easier and cheaper to detect the presence of thrombus while the cause of ischemicstroke is D-dimer. This study was design to know the diagnostic value of plasma levels of D-dimer of the CT-scan in acute ischemic strokeby determination. A cross-sectional study was conducted, where forty patients with inclusion criteria were taken from The NeurologyDepartment. The research was done at the Department of Clinical Pathology RSUP.H.Adam Malik/FK USU Medan. CT-scan as the goldstandard for the D-dimer examination Plasma levels of D-dimer using latex agglutination method with a cut-off 500/mL. Statisticalanalysis using a 2×2 table to determine the sensitivity, specificity, positive predictive value, negative predictive value, prevalence and thelikelihood ratio. The result found were as follows: sensitivity 77.7%, specificity 53.8%, positive predictive value 77.7%, negative predictivevalue 53.8%, prevalence 67.5%, likelihood ratio positive 1.74 and the likelihood ratio negative 0.43. Based on this study, the level plasmaD-dimer could possibly can be used as an exclusion diagnostic in acute ischemic stroke case.

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 Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3765-3769
Author(s):  
Charles Esenwa ◽  
Ji-Ae Lee ◽  
Taha Nisar ◽  
Anna Shmukler ◽  
Inessa Goldman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Computed Tomography Angiography ◽  
Predictive Value ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Shortness Of Breath ◽  
Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

scholarly journals The Diagnostic Ability of rs-DWI to Detect Subtle Acute Infarction Lesion in the Different Regions of the Brain and the Comparison between Different b-Values

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Tanoj Bahadur Singh ◽  
Liwu Zhang ◽  
Xiaoting Huo ◽  
Guoping Liu ◽  
Hongyan Ni ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Brain Infarction ◽  
True Positive ◽  
Diagnostic Ability ◽  
B Values ◽  
Acute Infarction ◽  
Sensitivity Specificity ◽  
The Brain

Objective. To evaluate the diagnostic ability of rs-DWI to detect subtle acute infarction lesion in the different regions of the brain in comparison to routine DWI and the comparison between different b-values. Method. 35 acute brain infarction patients were included. The subtle acute infarction lesions in ss-DWI and rs-DWI sequence were evaluated in 9 anatomical regions of the brain, and the ss-EPI DWI was also acquired with different b-values of 0, 1000, 2000, and 3000s/mm2. The McNemar test was performed for comparing the diagnostic ability of ss-DWI and rs-DWI and different b-values. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the whole brain and in each anatomical region were calculated. Result. A total of 406 subtle acute infarction lesions were confirmed. The ss-DWI detected 338 subtle lesions, out of which 318 were true positive and 20 were false positive lesions. The rs-DWI detected 386 subtle lesions, out of which 385 were true positive lesions and 1 was true negative lesion. Sensitivity, specificity, positive predictive value, and negative predictive value in rs-DWI were better than ss-DWI in all anatomical regions of the brain. In the comparison of different b-values, b2000 was found better among b1000, b2000, and b3000. Conclusion. The rs-DWI offers a useful alternative to routine DWI for detecting the subtle acute infarctions, especially in the regions that are susceptible to distortion as in frontal cortex. In addition, high b-value can also provide benefit by increasing diffusion weighting but further raising can deteriorate image quality as SNR is decreased.

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

2008 ◽  
Vol 122 (11) ◽  
pp. 1230-1234 ◽  
Author(s):  
S M Ragab ◽  
F A Erfan ◽  
M A Khalifa ◽  
E M Korayem ◽  
H A Tawfik
Keyword(s):  
Computed Tomography ◽  
Nasopharyngeal Carcinoma ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
External Beam Radiotherapy ◽  
Reliability Coefficient ◽  
Histological Findings ◽  
Significant Agreement ◽  
Sensitivity Specificity

AbstractObjectives:To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.Methods:Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.Results:Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).Conclusions:Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

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 positive predictive value of computed tomography versus diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Abdul Ghaffar ◽  
Saeed Mahmood ◽  
Muhammad Kareemullah ◽  
Saqib Uddin Khan ◽  
Ambreen Akram ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Peritoneal Lavage ◽  
Organ Damage ◽  
Solid Organ ◽  
Diagnostic Peritoneal Lavage

Background: Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. Objectives: To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: Data Collection: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CT-scan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT.

scholarly journals Rehabilitation following hemorrhagic stroke: building the case for stroke-subtype specific recovery therapies

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2044 ◽  
Author(s):  
Tomoko Kitago ◽  
Rajiv R. Ratan
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Functional Recovery ◽  
Hemorrhagic Stroke ◽  
Current Understanding ◽  
Stroke Recovery ◽  
Stroke Subtype ◽  
The Brain ◽  
Significant Mortality

Intracerebral hemorrhage (ICH), a form of brain bleeding and minor subtype of stroke, leads to significant mortality and long-term disability. There are currently no validated approaches to promote functional recovery after ICH. Research in stroke recovery and rehabilitation has largely focused on ischemic stroke, but given the stark differences in the pathophysiology between ischemic and hemorrhagic stroke, it is possible that strategies to rehabilitate the brain in distinct stroke subtypes will be different. Here, we review our current understanding of recovery after primary intracerebral hemorrhage with the intent to provide a framework to promote novel, stroke-subtype specific approaches.

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