Min-Surk Kye, D. Y. Kim, Dong-Wan Kang, Baik-Kyun Kim, Jung Hyun Park, Hyung Seok Guk, Nakhoon Kim, Sang-Won Choi, J. Kim, Jihoon Kang, B. Kim, Moon-Ku Han, Hee-Joon Bae
Background: This study investigated the impact of premorbid functional dependency on post-stroke mortality in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Methods: This study enrolled 9,698 patients who experienced ischemic stroke between January 2011 and December 2022. The patients were classified into the ACS and PCS groups. Premorbid functional dependency was defined as modified Rankin Scale of ≥3. The risks of premorbid functional dependency and mortality at 3 months and 1-year post-stroke were assessed. A subgroup analysis was further performed to evaluate the risk of premorbid functional dependency in patients who underwent intravenous thrombolysis and endovascular treatment (EVT). Results: Among 6,358 patients with ACS and 3,340 with PCS, those with premorbid dependency were older, predominantly female, and had a higher proportion of vascular risk factors and stroke severity. Premorbid functional dependency was associated with increased mortality at both 3 months and 1 year in the PCS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.00–3.13; P =0.04 and OR, 2.87; 95% CI, 1.86–4.38; P <0.001, respectively), but not in the ACS (OR, 1.08; 95% CI, 0.77–1.51; P =0.639 and OR, 1.22; 95% CI, 0.93–1.59; P =0.140, respectively) group. Among patients who underwent EVT, premorbid functional dependency increased the risk of mortality at 1 year in the ACS group (OR, 1.80; 95% CI, 1.04–3.08; P =0.034), but was not associated with the risk in the PCS group (OR, 2.56; 95% CI, 0.64–10.15; P =0.176). Conclusions: Premorbid functional dependency increases the risk of mortality in patients with PCS.
{"title":"Differential effects of premorbid functional dependency on mortality in patients with anterior and posterior circulation stroke","authors":"Min-Surk Kye, D. Y. Kim, Dong-Wan Kang, Baik-Kyun Kim, Jung Hyun Park, Hyung Seok Guk, Nakhoon Kim, Sang-Won Choi, J. Kim, Jihoon Kang, B. Kim, Moon-Ku Han, Hee-Joon Bae","doi":"10.18700/jnc.240013","DOIUrl":"https://doi.org/10.18700/jnc.240013","url":null,"abstract":"Background: This study investigated the impact of premorbid functional dependency on post-stroke mortality in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Methods: This study enrolled 9,698 patients who experienced ischemic stroke between January 2011 and December 2022. The patients were classified into the ACS and PCS groups. Premorbid functional dependency was defined as modified Rankin Scale of ≥3. The risks of premorbid functional dependency and mortality at 3 months and 1-year post-stroke were assessed. A subgroup analysis was further performed to evaluate the risk of premorbid functional dependency in patients who underwent intravenous thrombolysis and endovascular treatment (EVT). Results: Among 6,358 patients with ACS and 3,340 with PCS, those with premorbid dependency were older, predominantly female, and had a higher proportion of vascular risk factors and stroke severity. Premorbid functional dependency was associated with increased mortality at both 3 months and 1 year in the PCS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.00–3.13; P =0.04 and OR, 2.87; 95% CI, 1.86–4.38; P <0.001, respectively), but not in the ACS (OR, 1.08; 95% CI, 0.77–1.51; P =0.639 and OR, 1.22; 95% CI, 0.93–1.59; P =0.140, respectively) group. Among patients who underwent EVT, premorbid functional dependency increased the risk of mortality at 1 year in the ACS group (OR, 1.80; 95% CI, 1.04–3.08; P =0.034), but was not associated with the risk in the PCS group (OR, 2.56; 95% CI, 0.64–10.15; P =0.176). Conclusions: Premorbid functional dependency increases the risk of mortality in patients with PCS.","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141356108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sung Jo Bang, Jeong Eun Yang, Seong Kyung Park, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong
{"title":"Favorable outcome after intra-arterial thrombolysis in a patient with branch retinal artery occlusion: a case report","authors":"Sung Jo Bang, Jeong Eun Yang, Seong Kyung Park, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong","doi":"10.18700/jnc.240004","DOIUrl":"https://doi.org/10.18700/jnc.240004","url":null,"abstract":"","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140964241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Merhavy, Wyatt Ferrelle, Bhavyata Vaddavalli, Samir Ruxmohan
37
37
{"title":"Rapid versus gradual external ventricular drain weaning: a general review of best practices","authors":"Z. Merhavy, Wyatt Ferrelle, Bhavyata Vaddavalli, Samir Ruxmohan","doi":"10.18700/jnc.240001","DOIUrl":"https://doi.org/10.18700/jnc.240001","url":null,"abstract":"37","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Moyamoya disease (MMD) is a rare cerebrovascular disease radiologically characterized by progressive bilateral occlusion of the distal portion of the internal carotid artery and compensating collaterals. Herein, we report a case of medullary infarction in a patient with MMD.Case Report: We present the case of a 54-year-old male with hypertension, hyperlipidemia, and unstable angina with sudden onset dysarthria and ataxia. Diffusion-weighted and T2-weighted images of magnetic resonance imaging showed a high-signal intensity lesion on the right lateral medulla, suggestive of acute infarction. Transfemoral cerebral angiography also demonstrated bilateral middle cerebral artery (MCA) occlusion. Testing of the ring finger protein 213 (RNF213) gene revealed a homozygous p.R4810K variant that was possibly associated with posterior circulation involvement.Conclusion: When the MCA is occluded in MMD, there is a possibility that medullary infarction may occur due to the mechanism of increased hemodynamic stress on the anastomotic posterior vessels.
{"title":"Lateral medullary infarction in a patient with Moyamoya disease associated with RNF213 variants: a case report","authors":"Yoo Jeong Roh, Kee Ook Lee, Hyun Sook Kim","doi":"10.18700/jnc.230043","DOIUrl":"https://doi.org/10.18700/jnc.230043","url":null,"abstract":"Background: Moyamoya disease (MMD) is a rare cerebrovascular disease radiologically characterized by progressive bilateral occlusion of the distal portion of the internal carotid artery and compensating collaterals. Herein, we report a case of medullary infarction in a patient with MMD.Case Report: We present the case of a 54-year-old male with hypertension, hyperlipidemia, and unstable angina with sudden onset dysarthria and ataxia. Diffusion-weighted and T2-weighted images of magnetic resonance imaging showed a high-signal intensity lesion on the right lateral medulla, suggestive of acute infarction. Transfemoral cerebral angiography also demonstrated bilateral middle cerebral artery (MCA) occlusion. Testing of the ring finger protein 213 (RNF213) gene revealed a homozygous p.R4810K variant that was possibly associated with posterior circulation involvement.Conclusion: When the MCA is occluded in MMD, there is a possibility that medullary infarction may occur due to the mechanism of increased hemodynamic stress on the anastomotic posterior vessels.","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139147833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Baik-Kyun Kim, Seung Park, Moon-Ku Han, Jeong-Ho Hong, Dae-In Lee, K. Yum
Background: Acute ischemic stroke is a disease with multiple etiologies. Therefore, identifying the mechanism of acute ischemic stroke is fundamental to its treatment and secondary prevention. The Trial of Org 10172 in Acute Stroke Treatment classification is currently the most widely used system, but it often has a limitations of classifying unknown causes and inadequate inter-rater reliability. Therefore, we attempted to develop a three-dimensional (3D)-convolutional neural network (CNN)-based algorithm for stroke lesion segmentation and subtype classification using only the diffusion and apparent diffusion coefficient information of patients with acute ischemic stroke. Methods: This study included 2,251 patients with acute ischemic stroke who visited our hospital between February 2013 and July 2019. Results: The segmentation model for lesion segmentation in the training set achieved a Dice score of 0.843±0.009. The subtype classification model achieved an average accuracy of 81.9%, with accuracies of 81.6% for large artery atherosclerosis, 86.8% for cardioembolism, 72.9% for small vessel occlusion, and 86.3% for control.Conclusion: We developed a model to predict the mechanism of cerebral infarction using diffusion magnetic resonance imaging, which has great potential for identifying diffusion lesion segmentation and stroke subtype classification. As deep learning systems are gradually developing, they are becoming useful in clinical practice and applications.
{"title":"Deep learning for prediction of mechanism in acute ischemic stroke using brain diffusion magnetic resonance image","authors":"Baik-Kyun Kim, Seung Park, Moon-Ku Han, Jeong-Ho Hong, Dae-In Lee, K. Yum","doi":"10.18700/jnc.230039","DOIUrl":"https://doi.org/10.18700/jnc.230039","url":null,"abstract":"Background: Acute ischemic stroke is a disease with multiple etiologies. Therefore, identifying the mechanism of acute ischemic stroke is fundamental to its treatment and secondary prevention. The Trial of Org 10172 in Acute Stroke Treatment classification is currently the most widely used system, but it often has a limitations of classifying unknown causes and inadequate inter-rater reliability. Therefore, we attempted to develop a three-dimensional (3D)-convolutional neural network (CNN)-based algorithm for stroke lesion segmentation and subtype classification using only the diffusion and apparent diffusion coefficient information of patients with acute ischemic stroke. Methods: This study included 2,251 patients with acute ischemic stroke who visited our hospital between February 2013 and July 2019. Results: The segmentation model for lesion segmentation in the training set achieved a Dice score of 0.843±0.009. The subtype classification model achieved an average accuracy of 81.9%, with accuracies of 81.6% for large artery atherosclerosis, 86.8% for cardioembolism, 72.9% for small vessel occlusion, and 86.3% for control.Conclusion: We developed a model to predict the mechanism of cerebral infarction using diffusion magnetic resonance imaging, which has great potential for identifying diffusion lesion segmentation and stroke subtype classification. As deep learning systems are gradually developing, they are becoming useful in clinical practice and applications.","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139155149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Group B Streptococcus meningitis following subarachnoid hemorrhage suspicions: a case report","authors":"Daniel Ratushnyak, Vishal Yajnik","doi":"10.18700/jnc.230028","DOIUrl":"https://doi.org/10.18700/jnc.230028","url":null,"abstract":"hemorrhage","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139172399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 61-year-old man presented to the emergency room with left hemiparesis and dysarthria. Brain magnetic resonance imaging showed right middle cerebral artery territory infarction with proximal internal carotid artery stenosis. Carotid endarterectomy (CEA) was performed on the 8th day of admission. After 3 hours of CEA, the patient complained of dyspnea, and stridor was developed. Chest X-ray was performed immediately (Fig. 1), and emergent endotracheal intubation was performed under suspicion of airway obstruction due to hematoma. Neck computed tomography (CT) confirmed hematoma formation around the carotid vessels (Fig. 2). Blood pressure was strictly controlled without discontinuation of clopidogrel, and hematoma was noted to Fig. 1.
{"title":"Detection of neck hematoma after carotid endarterectomy by chest X-ray","authors":"Min Joon Seo, Jin-Heon Jeong","doi":"10.18700/jnc.230027","DOIUrl":"https://doi.org/10.18700/jnc.230027","url":null,"abstract":"A 61-year-old man presented to the emergency room with left hemiparesis and dysarthria. Brain magnetic resonance imaging showed right middle cerebral artery territory infarction with proximal internal carotid artery stenosis. Carotid endarterectomy (CEA) was performed on the 8th day of admission. After 3 hours of CEA, the patient complained of dyspnea, and stridor was developed. Chest X-ray was performed immediately (Fig. 1), and emergent endotracheal intubation was performed under suspicion of airway obstruction due to hematoma. Neck computed tomography (CT) confirmed hematoma formation around the carotid vessels (Fig. 2). Blood pressure was strictly controlled without discontinuation of clopidogrel, and hematoma was noted to Fig. 1.","PeriodicalId":502541,"journal":{"name":"Journal of Neurocritical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139307629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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