scholarly journals A Patient With Hemoglobin SC Disease and Acute Ischemic Stroke Presenting With Altered Mental Status

Cureus ◽  
2021 ◽  
Author(s):  
Aye M Thida ◽  
Kitson Deane ◽  
Mateus Fernandes ◽  
Htun M Aung ◽  
Pouyan Gohari
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mental Status ◽  
Altered Mental Status ◽  
Hemoglobin Sc Disease

scholarly journals Utilization of Hospice Care in Patients With Acute Ischemic Stroke

2018 ◽  
Vol 36 (1) ◽  
pp. 28-32
Author(s):  
Nabeel Chauhan ◽  
Syed F. Ali ◽  
Yousef Hannawi ◽  
Archana Hinduja
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mental Status ◽  
Hospice Care ◽  
Private Insurance ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Altered Mental Status ◽  
Optimal Timing ◽  
Factors Associated

Background: A significant percentage of terminally ill patients are discharged to hospice care following a devastating stroke. Objective: We sought to determine the factors associated with hospital discharge to hospice care in a large cohort of patients with stroke. Methods: Using the institutional Get With The Guidelines-Stroke database, all consecutive patients with acute ischemic stroke (AIS) who were alive at discharge, from January 2009 until July 2015, were analyzed. Univariate and multivariable statistical analyses were performed to determine the factors associated with discharge to hospice care. Results: Of 2446 patients with AIS, 3.4% died and were excluded of remaining 2363 patients, and 4.2% were discharged to hospice care. Univariate analysis identified patients who were discharged to hospice care to be older, caucasian, Medicare or private insurance, have atrial fibrillation, heart failure and less often had diabetes mellitus or smoked. Altered mentation at presentation and urinary tract infection were more common in patients discharged to hospice. On multivariable analysis, patients transferred to hospice care were older (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01-1.07; P < .001), had a high National Institute of Health Stroke Scale (NIHSS; OR: 1.15, 95% CI: 1.10-1.20; P < .001), and altered mental status at presentation (OR: 2.42, 95% CI: 1.29-4.55; P < .001). Conclusion: In our study, elderly patients with high NIHSS and altered mental status were identified as factors associated with transition to hospice care following AIS. Prospective studies on the optimal timing of initiation of these consults are needed.

scholarly journals Korelasi antara Stroke dengan Covid-19

2021 ◽  
Vol 10 (2) ◽  
pp. 133-143
Author(s):  
Dewi Yulianti Bisri ◽  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Severe Pneumonia ◽  
Altered Mental Status ◽  
Multiple Organ ◽  
Special Treatment ◽  
Specific Symptom ◽  
Cerebrovascular Complication ◽  
Increased Risk ◽  
Nerve System

The clinical spectrum of Covid-19 is very broad, ranging from minor no specific symptom, such as fever, dry cough and diarrhea, some time combined with mild pneumonia and mild dyspnoe to severe pneumonia with dyspnoe, tachypnoe and exchange disorders, leading to severe pulmonary dysfunction, necessary ventilation, shock and multiple organ failure. Preliminary unpublished evidence suggest that patient with covid-19 have an increased risk of acute ischemic stroke. Neurologic complaints that oven occurs are headache, dizziness, change in taste and smell. Five percent risk of developing acute ischemic stroke. Coronavirus has a tendency to invade the central nerve system (CNS). The olfactory change that have been seen in covid-19, are attributed to reflex access from the virus to the brain via the transcribial route, although this remain to be proven for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One report from China showed that neurological complaint, such as dizziness, headaches, hypgeusia and hyposmia, were common (about 36%) in covid-19 patients. Encephalopathy and altered mental status also occurs in patients who have been infected with the SARS-CoV-2 virus. Cerebrovascular disease is more common in severe covid-19; acute ischemic stroke has been reported to occurs in 5.7% of patients and impaired consciousness in 15% of patients, and 1% cerebral hemorrhage was found. CNS disorders that require surgery require special treatment because of the effect of techniques and anesthetics on the CNS, as wll as the protection of health professionals to preventdiseses transmission. Thirty-eight percents of covid-19 patient with cerebrovascular complication died.

Abstract WP223: Ischemic Stroke After Emergency Department Discharge for Symptoms of Transient Neurological Attack

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Neal S Parikh ◽  
Alexander E Merkler ◽  
Benjamin R Kummer ◽  
Hooman Kamel
Keyword(s):  
Ischemic Stroke ◽  
Mental Status ◽  
Renal Colic ◽  
Stroke Risk ◽  
Altered Mental Status ◽  
Sensitivity Analyses ◽  
Administrative Claims ◽  
Prior Work ◽  
Increased Risk ◽  
Sensory Changes

Introduction: Compared to transient ischemic attack (TIA), little is known about the risk of ischemic stroke after the nonspecific symptoms of a transient neurological attack (TNA). Methods: Using administrative claims data, we identified patients discharged from emergency departments (ED) in New York State between 2006 and 2012 with a primary discharge diagnosis of a TNA symptom, defined as in prior work as altered mental status, generalized weakness, and sensory changes. The primary outcome of ischemic stroke was identified using validated ICD-9-CM diagnosis codes. We used Kaplan-Meier survival statistics to calculate cumulative rates, and Cox regression to compare stroke risk after TNA versus after TIA (positive control) or renal colic (negative control) while adjusting for demographics and vascular risk factors. We performed subgroup analyses stratified by age. In sensitivity analyses, TNA was limited to cases of altered mental status or sensory changes, as these were more commonly associated with stroke in prior work, or limited to discharges without neuroimaging, to assess whether limited evaluation was associated with increased risk. Results: Of 499,369 patients diagnosed with a TNA symptom and discharged from the ED, 7,756 were hospitalized for ischemic stroke over 4.7 (±1.9) years. At 90 days, the cumulative stroke rate was 0.29% (95% confidence interval [CI], 0.28-0.31%) after TNA symptoms versus 2.08% (95% CI, 1.89-2.28%) after TIA and 0.03% (95% CI, 0.02-0.04%) after renal colic. The hazard of stroke was higher after TNA than after renal colic (hazard ratio [HR], 2.13; 95% CI, 1.90-2.40). However, the risk was lower than after TIA (HR, 0.47; 95% CI, 0.44-0.50). Compared to TIA, TNA was less strongly associated with stroke among patients under 60 years of age (HR, 0.22; 95% CI, 0.19-0.25) than in those over 60 years of age (HR, 0.50; 95% CI, 0.47-0.53) ( P <0.001 for interaction). Our results were unchanged in sensitivity analyses limiting TNA diagnoses to patients with altered mental status or sensory changes or to those who did not undergo neuroimaging. Conclusions: Patients discharged from the ED with TNA symptoms faced a higher risk of ischemic stroke than low risk controls, but the magnitude of stroke risk was low, particularly in comparison to TIA.

Abstract TP365: Clinical Predictors of Ischemic Stroke in Patients Presenting With Altered Mental Status

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Aliona Nacu ◽  
Asma Moussaoui ◽  
Mohammed Alkuwaiti ◽  
Mustapha Ezzeddine
Keyword(s):  
Ischemic Stroke ◽  
Mental Status ◽  
Altered Mental Status ◽  
Clinical Predictors

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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