BRAIN COMPUTED TOMOGRAPHIC FINDINGS OF STROKE PATIENTS IN MAIDUGURI, NORTH-EASTERN NIGERIA.

Background: Stroke is a major neurological condition with high disability and mortality rates in developing countries including Nigeria. Computed tomography (CT) scan is an important imaging modality in confirming the diagnosis of stroke, classifying stroke subtypes and ruling out stroke mimics. Objectives: To determine the CT findings of patients with stroke in Maiduguri, North-eastern Nigeria. Methodology: A retrospective hospital-based study conducted at the Department of Radiology, Federal Neuro-psychiatric Hospital, Maiduguri, North-eastern Nigeria over four-year period from January 2015 to December 2018. All patients were clinically diagnosed with stroke and referred to the department for a brain CT scan. The request forms and CT reports were retrieved from the Archive and analysed. All patients were examined with a 16-slice General Electric CT scanner. Data were analysed using SPSS statistical software version 23. Results: There were 138 patients and out of which, 83 (60%) were males and 55 (40%) females with a male to female ratio of 1.5:1. The mean age was 51.6 ± 16.6 years with an age range of 5-85 years and the majority of the patients were middle-aged group. The CT findings showed 88 (64%) were confirmed stroke cases and the remaining 50 (36%) were misdiagnoses of stroke, with normal finding in 23% and stroke mimics in the remaining 13%. Brain infarction was the most common stroke subtype accounting for 64% of the patients, followed by intracerebral haemorrhage of 33% and 3% had subarachnoid haemorrhage. The left cerebral hemisphere was the most commonly involved. Cerebral atrophy and brain tumours were the two most common stroke mimics in this study and they were mostly seen in females than males. Conclusion: In this study, the accuracy rate of clinical diagnosis of stroke was low. Therefore, CT scan is the 'gold standard’ in the diagnosis of stroke and it is strongly recommended in the management of all stroke patients.

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BRAIN COMPUTED TOMOGRAPHIC FINDINGS OF STROKE PATIENTS IN MAIDUGURI, NORTH-EASTERN NIGERIA.

Kanem Journal of Medical Sciences ◽

10.36020/kjms.2021.1501.006 ◽

2021 ◽

Vol 15 (1) ◽

pp. 45-53

Author(s):

Umar UH ◽

◽

Yunusa DM ◽

Farate A ◽

Ahmadu MS ◽

...

Keyword(s):

Ct Scan ◽

Imaging Modality ◽

Brain Infarction ◽

Ct Scanner ◽

Stroke Patients ◽

Stroke Subtype ◽

Female Ratio ◽

Stroke Mimics ◽

Ct Findings ◽

North Eastern

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Abstract TP61: Elevated CRP Between Day 1 And 7 and not Admission CRP Is An Independent Predictor For Outcome at 3 Months In Thrombolized Acute Stroke Patients

Stroke ◽

10.1161/str.44.suppl_1.atp61 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Andrea Rocco ◽

Fam Geraldine ◽

Peter Ringleb ◽

Simon Nagel

Keyword(s):

Ischemic Stroke ◽

Infarct Size ◽

Ct Scan ◽

Brain Infarction ◽

Multivariate Logistic Regression Analysis ◽

Stroke Severity ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome

Background: The value of CRP in stroke patients undergoing thrombolysis, in the acute and subacute phase of ischemic stroke as a prognostic tool for outcome is unclear, since conflicting reports exist. Aim of our study was to explore the role of admission CRP and follow-up CRP between day 1 and 7, for outcome and mortality in stroke patients treated with rtPa. Methods: From March 1998 to 2011 all patients admitted to our hospital and undergoing thrombolysis for acute ischemic stroke were included into an open, prospective database. Stroke severity was assessed using the NIHSS. In all patients CRP levels was measured upon admission in the emergency room, after 24 hours from the acute event and in the following days. CT scan before treatment and routine brain CT scan 24-36 h after thrombolysis were performed. Symptomatic haemorrhage (sICH) was defined according to ECASS II criteria. Functional outcome was assed by mRS at three months and divided into independent (mRS0-2) and dependent (mRS 3-5). Results: In total, 1292 patients were registered in our database. About 70% of patients had an increase of CRP values in the first 7 days after admission. Infection occurred in 22% of patients and about 25% had a large brain infarction (>1/3 of vessel territory). sICH occurred in 6.7% of patients. Follow-up CRP levels between day 1 and 7 were significantly associated with cardio embolic stroke (p=0.033), infarct size (p<0.001), infection (p<0.001), symptomatic haemorrhage (p<0.001), independent (p<0.001), dependent outcome (p<0.001) and mortality (p<0.001). CRP values between day 1 and 7 (OR 2.824 CI95%; 1.534 - 5.201, p=0.001), infarct size (OR 2.254; CI95% 1.480 - 3.432, p<0.001), infection (OR1.752; CI95% 1.100 - 2.789, p=0.018) and NIHSS (OR 1.043; CI95% 1.016 - 1.069, p=0.001) were independent predictors for dependent outcome. Admission CRP values were not independently associated with outcome and mortality after multivariate logistic regression analysis. Conclusion: Together with know predictors like infarct size, NIHSS and infections, maximally elevated CRP levels within day 1 and 7 were strongly and independently associated with long-term outcome in thrombolyzed stroke patients after correction for baseline variables.

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Accuracy of Siriraj stroke scale in the diagnosis of stroke subtypes among stroke patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170666 ◽

2017 ◽

Vol 5 (3) ◽

pp. 1084

Author(s):

Abhilash Somasundaran ◽

Hashik Mohammed ◽

Jayaraj Kezhukatt ◽

Alvin Treasa George ◽

S. Narayanan Potty

Keyword(s):

Ischemic Stroke ◽

Ct Scan ◽

Rural Areas ◽

Hemorrhagic Stroke ◽

Cross Sectional Study ◽

Stroke Patients ◽

Stroke Subtype ◽

Cross Sectional ◽

Tertiary Centre ◽

Low Sensitivity

Background: Early detection of intracranial blood is essential for the rational use of anti hemostatic drugs in stroke patients. CT scan is quite expensive as well as it is not easily available especially in the rural areas. Clinical stroke scores were developed to overcome these limitations. Aim of present study is to identify the stroke subtype using Siriraj stroke scoring and thus asses its accuracy by comparing with CT scan reports.Methods: A cross sectional study was conducted in a tertiary centre that evaluated 464 patients admitted with a diagnosis of stroke. Siriraj Stroke score was calculated for each patient and a CT scan of brain was also taken. The results of diagnosis made by Siriraj stroke scoring were compiled and compared with the diagnosis obtained by CT Scan.Results: Of the total 464 patients, the incidence of hemorrhagic stroke was 27.8% and ischemic stroke was 72.2%, as per the CT scan reports, while the Siriraj stroke score diagnosed 16.8% patients to have hemorrhagic stroke and 74.6% to have ischemic stroke and no definite diagnosis was made in rest of the patients (8.6%). The sensitivity of the scoring was found to be 59.2% in diagnosing hemorrhagic stroke and 95.5% in ischemic stroke.Conclusions: Our study has shown that siriraj stroke scoring has a high degree of accuracy in detecting both types of strokes, with roughly 80% of both hemorrhagic and ischemic strokes being correctly identified. However there is a low sensitivity in diagnosing hemorrhagic strokes and higher sensitivity in diagnosing ischemic strokes.

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Abstract W P5: “No Turn Back Approach” to Reduce Treatment Time for Endovascular Treatment of Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp5 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Hossam Egila ◽

Malik M Adil ◽

Harris Siddiqi ◽

Nidaullah Mian ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

National Institutes Of Health ◽

Time Interval ◽

Ct Scanner ◽

Stroke Patients ◽

Computed Tomographic

Background: A delay in endovascular treatment is less likely if acute ischemic stroke patients proceed from emergency department(ED) to computed tomographic (CT) scanner and directly to angiographic suite (no turn back approach). We determined the feasibility of the “no turn back approach” and its effect on treatment times and patient outcomes. Methods: The primary outcomes were procedures performed with a time interval: 1) between ED arrival and microcatheter placement of <120 minutes; and 2) between CT scan acquisition and microcatheter placement of <90 minutes. We determined the affect of the “no turn back approach” on favorable outcome at discharge. Results: There was a significantly higher rate of CT scan acquisition and microcatheter placement time of <90 minutes in patients in whom “no turn back approach” was used (57.6% versus 31.6%, p=0.0007). There was a significantly higher rate of ED arrival to microcatheter placement time of <120 minutes in patients in whom “no turn back approach” was used (31.8% versus 13.7%, p=0.004). In the exploratory analysis, there was a trend towards higher rate of favorable outcomes (OR 1.6, 95% CI 0.9-2.8, p=0.07) among those treated with “no turn back approach” after adjusting for age, admission National Institutes of Health Stroke Scale (NIHSS) score strata, congestive heart failure and diabetes mellitus. Conclusions: The “no turn back approach” appeared to be feasible and reduced the time interval between ED arrival and microcatheter placement in acute ischemic stroke patients undergoing endovascular treatment.

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Use of CT-Scan for Predicting Mortality of Acute Intracerebral Haemorrhagic Stroke within 7 and 28 Days

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i1.42168 ◽

2019 ◽

Vol 5 (1) ◽

pp. 42-46

Author(s):

Md Durrul Huda ◽

Niranjan Kumar Sana ◽

Quamruddin Ahmad ◽

Md Kafil Uddin ◽

Md Munzur Alahi ◽

...

Keyword(s):

Pineal Gland ◽

Ct Scan ◽

Haemorrhagic Stroke ◽

Morbidity And Mortality ◽

Stroke Patients ◽

Factors Affecting ◽

Medical College ◽

Proper Management ◽

Ct Findings ◽

Different Characteristics

Background: Recognition of factors affecting morbidity and mortality of a disease helps in the proper management of a disease. CT scan of Brain is an essential investigation for all stroke patients. Identifying different characteristics of the CT findings of stroke patients which affect morbidity and mortality will help in the specific management of stroke patients. Thus this study was done to identify such factors from CT scan of Brain which will help in the proper management of stroke patients. Objectives: The aim of this present study was to determine the 7th and 28th days’ mortality rate of acute intracerebral hemorrhagic stroke and to determine the predictors of mortality. Methodology: Consecutive CT scan proven stroke patients following ICH were studied in the department of Radiology & Imaging at Rajshahi Medical College, Rajshahi, Bangladesh in collaboration with the Department of Neurology of Rajshahi Medical College, Rajshahi from January 2012 to December 2013. Site, size and volume of haematoma, midline shift, pineal gland displacement, hydrocephalus and intraventricular extension of haemorrhage were correlated with the mortality within 7th and 28th days of acute stroke. Risk factors like hypertension, smoking, diabetes and alcoholism were also recorded. Result: Ninety-nine consecutive CT scan proven stroke patients following ICH were studied. The 28-day mortality of intracerebral hemorrhage was 44.44% and it was 29.30% within the first 7 days of onset. Maximum number of death occurred in brainstem haemorrhage (75%), initial haematoma volume 61 to 80 ml (89.47%), >80 ml (91.7%), pineal gland displacement >3mm (79.5%), septum pellucidum displacement >5 mm (72.4%), ventricular extension (88.57%), and hydrocephalus (76.74%). Conclusion: The present study shows that deaths within 7th and 28th day of acute haemorrhagic stroke are correlated with the initial CT findings which could be regarded as a good predictor of mortality. Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 42-46

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CAN ULTRASOUND ALONE SUFFICE IN THE EVALUATION OF ACUTE ABDOMEN IN ADULTS – A COMPARATIVE COMPUTED TOMOGRAPHY VERSUS ULTRASOUND (HOSPITAL BASED) STUDY

10.36106/gjra/1511686 ◽

2021 ◽

pp. 55-62

Author(s):

Vishal Gupta ◽

Swati Awasthi ◽

Vaibhav Jaiswal ◽

Mallika Gupta

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Radiation Exposure ◽

Acute Abdomen ◽

Imaging Modality ◽

Color Doppler ◽

Radiology Department ◽

P Value ◽

Slice Thickness ◽

Ct Scanner

OBJECTIVE The objective of this study was to study the role of ultrasound and computed tomography in evaluation of acute abdomen and to assess whether ultrasound alone will sufce in majority situations, so that radiation exposure may be minimized. MATERIALS AND METHODS This institutional review board approved prospective observational study comprised of 50 adult patients attending the emergency department for non-traumatic acute abdominal pain less than 3 days of duration. The radiological evaluation with US and CT scan (Non contrast and contrast enhanced) of abdomen was done at radiology department of Sharda hospital. The exclusion criteria were trauma and pregnancy. The equipments used were Ultrasound with color Doppler PHILIPS EPIQ 7G and CT Scan - GE Optima 660 - 128 slice CT Scanner with slice thickness of 0.6 mm. RESULTS The overall sensitivity of US was 74% and that of CT was 96.15% with insignicant difference (p value – 0.018). Also, the sensitivity of US compared to CT in diagnosing common etiologies of acute abdomen namely acute cholecystitis, acute appendicitis, intestinal obstruction, pancreatitis and ureteric calculi sensitivity did not differ signicantly. CT was necessary only in patients with retro-caecal appendicitis, bowel obstruction cases for dening the transition point and in patients with pancreatitis to obtain the CT Severity index. CONCLUSION We propose that US should remain the primary imaging modality in all patients of acute abdomen in order to prevent radiation exposure, especially as it was found to have a sensitivity comparable to CT, in majority of the clinical situations. Moreover, it is a more cost-effective investigation. Therefore, CT should be reserved only for the minority of clinical situations where US is signicantly inconclusive.

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The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

Insights into Imaging ◽

10.1186/s13244-020-00957-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Vikram rao Bollineni ◽

Koenraad Hans Nieboer ◽

Seema Döring ◽

Nico Buls ◽

Johan de Mey

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Ct Imaging ◽

Chest Ct ◽

University Hospital ◽

Rt Pcr ◽

Ct Findings ◽

Epidemic Area ◽

Chest Ct Scan ◽

Pcr Test

Abstract Background To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients. Methods From March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus. Results Out of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive. Conclusion Chest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

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Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

Journal of Neurosurgery ◽

10.3171/jns.1983.59.2.0217 ◽

1983 ◽

Vol 59 (2) ◽

pp. 217-222 ◽

Cited By ~ 143

Author(s):

M. Peter Heilbrun ◽

Theodore S. Roberts ◽

Michael L. J. Apuzzo ◽

Trent H. Wells ◽

James K. Sabshin

Keyword(s):

Ct Scan ◽

Computerized Tomography ◽

Guidance System ◽

Production Model ◽

Ct Scanner ◽

Content Type ◽

Ct Scanners ◽

Guidance Systems ◽

Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

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Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽

10.1161/str.48.suppl_1.17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sabreena J Gillow ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moonmaw ◽

Daniel Woo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Univariate Analysis ◽

Onset Time ◽

Population Based ◽

Neurological Deterioration ◽

Stroke Patients ◽

Stroke Subtype ◽

Hospital Arrival ◽

Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

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EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

British Journal of Surgery ◽

10.1093/bjs/znab312.065 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Benjamin Clayphan ◽

Anna Fairclough ◽

Jeff Lim ◽

Roderick Alexander

Keyword(s):

Ct Scan ◽

Patient Outcomes ◽

Bowel Obstruction ◽

Care Pathway ◽

Imaging Modality ◽

Ct Scans ◽

Abdominal Ct ◽

Retrospective Audit ◽

Raising Awareness ◽

Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO. Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation. Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr. Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes.

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