CORRELATION OF DIFFUSION WEIGHTED MR DETERMINED INFARCT VOLUME WITH ALBERTA STROKE PROGRAM EARLY COMPUTED TOMOGRAPHY SCORE IN ACUTE STROKE PROGNOSIS

AIMS AND OBJECTIVES: To correlate the Diffusion MRI assessed infarct volume with the ASPECT Score to prognosticate clinical outcome in patients of acute stroke. METHOD AND MATERIALS: This was a cross sectional study comprising 36 patients of acute stroke. Diffusion weighted MR was obtained at b values of 0,500 & 1000 on Siemens Magnetom Skyra 3 Tesla scanner. Diffusion restriction on b=1000 image was measured with VOI tool using manual contouring in each slice. Volume was calculated using the formula (Area x slice thickness) after summating the infarct area measured in each slice. ASPECT Score was assessed on CT in each patient at the time of admission of the patient. Correlation of the infarct volume with ASPECTS was done using student t-test with p < 0.05 considered statistically signicant. ROC curve was used to predict cut off of volume of infarct & ASPECTS predicting adverse patient outcome. RESULTS: There was a statistically signicant inverse correlation between the volume of infarct and ASPECTS (p=0.001; r=-0.844). The AUC for a cut-off of 115 cc of the volume of infarct in predicting adverse patient outcome was 0.931 whereas that for ASPECT Scale of 6 was 0.931. CONCLUSION: Infarct volume correlates well with ASPECT Score, both serving as prognostic tools in predicting patient outcome in acute stroke and having comparable efcacy in predicting prognosis. BACKGROUND: Infarct volume and CT ASPECT Score are resourceful parameters in predicting patient prognosis. Limited studies have been done in the Indian population correlating the Volume of infarct and the CT ASPECT Scale.

External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review

BackgroundExternal lumbar drainage remains a controversial therapy for medically refractory intracranial hypertension in patients with acute TBI. This systematic review sought to compile the available evidence for the efficacy and safety of the use of lumbar drains for ICP control. MethodsA systematic review of the literature was performed with the search and data extraction performed by two reviewers independently in duplicate.ResultsNine independent studies were identified enrolling 230 patients, 159 with TBI. Efficacy for ICP control was observed across all studies, with immediate and sustained effect, reducing medical therapy requirements. Lumbar drainage with medical therapy appears effective when used alone and as an adjunct to ventricular drainage. Safety reporting varied in quality. Cerebral herniation (with unclear relationship to lumbar drainage) was observed in 14/230 patients resulting in one incident of morbidity without adverse patient outcome. ConclusionsThe available data is generally poor in quality and volume, but supportive of efficacy of lumbar drainage for ICP control. Few reports of adverse outcome are suggestive of, but are insufficient to confirm, safety of use in the appropriate patient and clinical setting. Further large prospective observational studies are required to generate sufficient support of an acceptable safety profile.

Abstract W P266: The Discharge Modified Rankin Score Correlates with Established Hemorrhagic Transformation Scores in Ischemic Stroke Patients Treated with Thrombolysis

Introduction: Several scores have been proposed to predict hemorrhagic transformation (HT) after IV r-tPA therapy. However, their utility in predicting adverse outcome has been limited to assessment of 30- or 90-day Modified Rankin Scale (mRS) scores, which are not readily available at many stroke centers. Studies evaluating discharge mRS scores as a predictor of long-term adverse patient outcome are lacking. Hypothesis: We tested the hypothesis that HT scores predicting long-term adverse outcome after r-tPA therapy correlate with readily available discharge mRS scores. Methods: Clinical data was analyzed from consecutive patients (n = 187) receiving IV r-tPA therapy from January 2009 until May 2013 at the Yale-New Haven Hospital. 8 HT scores were calculated for each patient: DRAGON, ASTRAL, Stroke-TPI, HAT Score, MSS, SITS-ICH, SEDAN and SPAN-100. Univariate logistic regression was performed using each HT score as an independent variable and discharge mRS≥5 or discharge mRS≥4 as the dependent variable. Receiver Operating Characteristic (ROC) analysis was used to test goodness of fit by the DeLong method. Results: All metrics except the HAT Score and SPAN-100 showed good agreement with discharge mRS≥5 (ROC area > 0.7). The 3 HT scores showing the best agreement with discharge mRS≥5 were Stroke-TPI (ROC 0.85 ± 0.07), ASTRAL (ROC 0.85 ± 0.06) and DRAGON (0.83 ± 0.07), with odds ratios: Stroke-TPI (1.09 ± 0.03), ASTRAL (1.17 ± 0.06) and DRAGON (2.23 ± 0.58). These 3 HT scores still performed best when the discharge mRS cutoff was relaxed to mRS ≥ 4, with similar odds ratios but modestly reduced ROC areas: ASTRAL (ROC 0.82 ± 0.06), DRAGON (ROC 0.79 ± 0.07) and Stroke-TPI (ROC 0.76 ± 0.07). Conclusions: Most established HT scores in our study showed good agreement with the discharge mRS score using two separate cutoff values. Therefore, readily available discharge mRS scores may be a useful predictor of adverse outcome following IV r-tPA therapy. These results warrant larger prospective studies to establish associations between discharge mRS scores and 90-day patient outcomes.