Pub Date : 2020-11-11DOI: 10.1177/2516608520953721
P. Ojha, S. Nagendra, S. Pujari, Rakeshsingh K. Singh, R. Lalla, V. Pathak, Aniruddha Joshi
Background: Perfusion or clinical mismatch imaging is useful in selecting patients with acute ischemic stroke (AIS) for reperfusion therapies beyond 4.5 hours. These techniques are expensive, technically difficult, and therefore unavailable in most settings. The diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch pattern has been studied only in wake-up stroke/stroke with unclear time of onset but not in AIS patients with clear time of onset of more than 4.5 hours. This study assesses routinely available magnetic resonance imaging (MRI) DWI-FLAIR sequences for selecting AIS patients for intravenous thrombolytic therapy (IVT) beyond 4.5 hours of the witnessed onset of symptoms. Aim: To study the clinical spectrum and outcome of patients with AIS who received IVT based on the DWI-FLAIR mismatch seen beyond 4.5 hours of symptom onset. Methods, Observation, and Results: Retrospective analysis was performed on 10 patients who received IVT for AIS beyond 4.5 hours and had an MRI DWI-FLAIR mismatch. In cohort study, 60% patients were males, with the median age of 59 years, the median baseline National Institutes of Health Stroke Scale (NIHSS) score of 10 (range 7 to 15), and the median time from the onset to imaging of 412.5 minutes. Within 24 hours of thrombolysis, improvement of >4 points in NIHSS was seen in 7 out of 10 (70%) patients, and at the modified Rankin scale, the score of 0 to 1 was noted at 3 months in 8 out of 10 (80%) patients. Neuroimaging at 24 hours showed no intracerebral bleed. Discussion and Conclusion: DWI-FLAIR mismatch-guided IVT is safe and effective in patients with AIS beyond 4.5 hours of the onset of symptoms. More studies are recommended to confirm these findings.
{"title":"DWI-FLAIR Mismatch-guided IVT is Safe and Effective in Treatment of AIS Beyond 4.5 Hours","authors":"P. Ojha, S. Nagendra, S. Pujari, Rakeshsingh K. Singh, R. Lalla, V. Pathak, Aniruddha Joshi","doi":"10.1177/2516608520953721","DOIUrl":"https://doi.org/10.1177/2516608520953721","url":null,"abstract":"Background: Perfusion or clinical mismatch imaging is useful in selecting patients with acute ischemic stroke (AIS) for reperfusion therapies beyond 4.5 hours. These techniques are expensive, technically difficult, and therefore unavailable in most settings. The diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch pattern has been studied only in wake-up stroke/stroke with unclear time of onset but not in AIS patients with clear time of onset of more than 4.5 hours. This study assesses routinely available magnetic resonance imaging (MRI) DWI-FLAIR sequences for selecting AIS patients for intravenous thrombolytic therapy (IVT) beyond 4.5 hours of the witnessed onset of symptoms. Aim: To study the clinical spectrum and outcome of patients with AIS who received IVT based on the DWI-FLAIR mismatch seen beyond 4.5 hours of symptom onset. Methods, Observation, and Results: Retrospective analysis was performed on 10 patients who received IVT for AIS beyond 4.5 hours and had an MRI DWI-FLAIR mismatch. In cohort study, 60% patients were males, with the median age of 59 years, the median baseline National Institutes of Health Stroke Scale (NIHSS) score of 10 (range 7 to 15), and the median time from the onset to imaging of 412.5 minutes. Within 24 hours of thrombolysis, improvement of >4 points in NIHSS was seen in 7 out of 10 (70%) patients, and at the modified Rankin scale, the score of 0 to 1 was noted at 3 months in 8 out of 10 (80%) patients. Neuroimaging at 24 hours showed no intracerebral bleed. Discussion and Conclusion: DWI-FLAIR mismatch-guided IVT is safe and effective in patients with AIS beyond 4.5 hours of the onset of symptoms. More studies are recommended to confirm these findings.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83135837","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}
Pub Date : 2020-10-28DOI: 10.1177/2516608520959541
Nganji Christian, H. Ghanaati, V. Changizi, B. Siroos, Farnoosh Mousavi
Purpose: The purpose of this study is to highlight the reliability of clinical DWI mismatch (CDM) in the identification of patients with large infarct growth. Methods: We prospectively reviewed 21 ischemic stroke patients who underwent DWI imaging within 72 hours from stroke symptoms onset. Description of images was made by experienced radiologists. Lesion volumes were assessed by manually outlining the DWI infarct lesions area. The percentage of infarct growth was calculated by dividing the difference between second and first infarct volume by the first infarct volume times 100. The NIHSS scores were assessed by an experienced neurologist. CDM was defined as NIHSS score ≥8 and initial infarct volume on DWI ≤ 25 mL. Statistical Tests: We assessed the relationships of variables within different groups of CDM using nonparametric tests—Kruskal-Wallis and chi-square test. Sensitivity and specificity of CDM to predict large infarct growth were tested by using crosstabs table. Results: CDM was present in 36.8% of our patients and was associated with the percentage of infarct growth (P < .01). The mean percentage growth was high in patients with CDM (211.8%) while it was low in the group of patients without CDM (5.7%; group B and 10.7%; group C). The sensitivity and specificity of CDM to predict infarct growth was 77.8% vs 100% with a likelihood ratio of 15.4 (P = .0004). Conclusion: The approach of comparing CDM and percentage of infarct growth proved that the concept of CDM can accurately indicate the existence of a large volume of tissue at risk of infarction—penumbra.
{"title":"Reliability of Clinical DWI Mismatch Approach to Predict Patient With the Probability of Large Infarct Growth: A Comparison of the Percentage of Infarct Growth and Clinical DWI Mismatch Status of the Patients With Acute Ischemic Stroke","authors":"Nganji Christian, H. Ghanaati, V. Changizi, B. Siroos, Farnoosh Mousavi","doi":"10.1177/2516608520959541","DOIUrl":"https://doi.org/10.1177/2516608520959541","url":null,"abstract":"Purpose: The purpose of this study is to highlight the reliability of clinical DWI mismatch (CDM) in the identification of patients with large infarct growth. Methods: We prospectively reviewed 21 ischemic stroke patients who underwent DWI imaging within 72 hours from stroke symptoms onset. Description of images was made by experienced radiologists. Lesion volumes were assessed by manually outlining the DWI infarct lesions area. The percentage of infarct growth was calculated by dividing the difference between second and first infarct volume by the first infarct volume times 100. The NIHSS scores were assessed by an experienced neurologist. CDM was defined as NIHSS score ≥8 and initial infarct volume on DWI ≤ 25 mL. Statistical Tests: We assessed the relationships of variables within different groups of CDM using nonparametric tests—Kruskal-Wallis and chi-square test. Sensitivity and specificity of CDM to predict large infarct growth were tested by using crosstabs table. Results: CDM was present in 36.8% of our patients and was associated with the percentage of infarct growth (P < .01). The mean percentage growth was high in patients with CDM (211.8%) while it was low in the group of patients without CDM (5.7%; group B and 10.7%; group C). The sensitivity and specificity of CDM to predict infarct growth was 77.8% vs 100% with a likelihood ratio of 15.4 (P = .0004). Conclusion: The approach of comparing CDM and percentage of infarct growth proved that the concept of CDM can accurately indicate the existence of a large volume of tissue at risk of infarction—penumbra.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72852501","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}
Pub Date : 2020-10-19DOI: 10.1177/2516608520938552
S. Tekin, Çağatay Öncel, M. B. Özdemir, Y. Yaylali, Işık Tekin, Özcan Güneş, S. Rota, Nuriye Kurbetli
Background: N-terminal probrain natriuretic peptide, which is a neurohormone produced mainly by the heart, is increased in acute ischemic cerebrovascular disease. Here we aimed to investigate the relationship of N-terminal probrain natriuretic peptide levels with cerebrovascular disease subtypes, infarct volume, and prognosis in cerebrovascular disease, and to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic cerebrovascular disease. Methods: Consecutive 105 patients with a diagnosis of acute ischemic cerebrovascular disease and 50 healthy controls were examined for serum N-terminal probrain natriuretic peptide concentration, cerebrovascular disease subtypes, infarct volumes, and clinical outcomes with the National Institute of Health Stroke Scale assessment. Results: Mean N-terminal probrain natriuretic peptide values of cardioembolic group were significantly higher than lacunar infarct group (P < .005) and transient ischemic attack group (P = .005). There was a relation between worsening in the National Institute of Health Stroke Scale and elevation at N-terminal probrain natriuretic peptide (P = .001). However, between N-terminal probrain natriuretic peptide levels and infarct volume, significant correlation was not detected (P = .44). Conclusion: N-terminal probrain natriuretic peptide can be used as a valuable marker to distinguish between cardioembolic infarct and lacunar infarct. In addition, N-terminal probrain natriuretic peptide levels might be used as a biomarker for differential diagnosis of transient ischemic attack group and to provide insight into the prognosis.
{"title":"Relationship Between N-Terminal Probrain Natriuretic Peptide (NT-Pro BNP) Level, Infarct Type and Infarct Volume in Ischemic Cerebrovascular Disease","authors":"S. Tekin, Çağatay Öncel, M. B. Özdemir, Y. Yaylali, Işık Tekin, Özcan Güneş, S. Rota, Nuriye Kurbetli","doi":"10.1177/2516608520938552","DOIUrl":"https://doi.org/10.1177/2516608520938552","url":null,"abstract":"Background: N-terminal probrain natriuretic peptide, which is a neurohormone produced mainly by the heart, is increased in acute ischemic cerebrovascular disease. Here we aimed to investigate the relationship of N-terminal probrain natriuretic peptide levels with cerebrovascular disease subtypes, infarct volume, and prognosis in cerebrovascular disease, and to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic cerebrovascular disease. Methods: Consecutive 105 patients with a diagnosis of acute ischemic cerebrovascular disease and 50 healthy controls were examined for serum N-terminal probrain natriuretic peptide concentration, cerebrovascular disease subtypes, infarct volumes, and clinical outcomes with the National Institute of Health Stroke Scale assessment. Results: Mean N-terminal probrain natriuretic peptide values of cardioembolic group were significantly higher than lacunar infarct group (P < .005) and transient ischemic attack group (P = .005). There was a relation between worsening in the National Institute of Health Stroke Scale and elevation at N-terminal probrain natriuretic peptide (P = .001). However, between N-terminal probrain natriuretic peptide levels and infarct volume, significant correlation was not detected (P = .44). Conclusion: N-terminal probrain natriuretic peptide can be used as a valuable marker to distinguish between cardioembolic infarct and lacunar infarct. In addition, N-terminal probrain natriuretic peptide levels might be used as a biomarker for differential diagnosis of transient ischemic attack group and to provide insight into the prognosis.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86161353","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}
Pub Date : 2020-10-12DOI: 10.1177/2516608520943793
A. Alashram, G. Annino, Mohammed Al-qtaishat, E. Padua
Background: Upper extremity deficits are one of the most common impairments in individuals with stroke. Mental practice is exercised cognitively in the absence of the physical trials. The effects of the combination of mental and physical practice remain unclear. Objectives: This study aimed to examine the effects of combined physical practice and mental practice on the upper extremity functional ability poststroke, to identify which stroke population is most likely to benefit from the intervention, and to determine the effective treatment dosage. Methods: We searched in the PubMed, SCOPUS, National Rehabilitation Information REHABDATA, PEDro, and Web of Science until February 2020. Randomized clinical trials examined the effects of combined physical practice and mental practice on the upper extremity functional ability in people with a stroke. The risk of bias was evaluated and the effect sizes were calculated. Results: Nine studies met our inclusion criteria. In total, 230 stroke survivors were included in this analysis (mean age: 60.84 years). This review found that combining physical practice and mental practice has beneficial effects in improving the upper extremity functional ability poststroke. Conclusion: Combining physical practice and mental practice improves the upper extremity functional ability poststroke, this improvement can extend for 3 months after the treatment intervention. We propose that using 30 to 60 min of physical practice followed by 30 min of mental practice, 2 to 3 times weekly for 6 to 10 weeks, may give meaningful effects in individuals with stroke.
背景:上肢功能障碍是脑卒中患者最常见的障碍之一。心理练习是在没有物理试验的情况下进行的认知练习。精神和身体锻炼相结合的效果尚不清楚。目的:本研究旨在探讨身体训练和心理训练相结合对脑卒中后上肢功能的影响，以确定哪些脑卒中人群最有可能从干预中受益，并确定有效的治疗剂量。方法:我们在PubMed、SCOPUS、National Rehabilitation Information REHABDATA、PEDro和Web of Science中检索到2020年2月。随机临床试验检验了身体锻炼和精神锻炼相结合对中风患者上肢功能的影响。评估偏倚风险并计算效应量。结果:9项研究符合我们的纳入标准。本次分析共纳入230例中风幸存者(平均年龄:60.84岁)。本综述发现，身体训练与心理训练相结合对提高脑卒中后上肢功能有有益的作用。结论:身体训练与心理训练相结合可改善脑卒中后上肢功能，且可在治疗干预后持续3个月。我们建议，在30到60分钟的体育锻炼之后再进行30分钟的心理锻炼，每周2到3次，持续6到10周，可能会对中风患者产生有意义的影响。
{"title":"Mental Practice Combined With Physical Practice to Enhance Upper Extremity Functional Ability Poststroke: A Systematic Review","authors":"A. Alashram, G. Annino, Mohammed Al-qtaishat, E. Padua","doi":"10.1177/2516608520943793","DOIUrl":"https://doi.org/10.1177/2516608520943793","url":null,"abstract":"Background: Upper extremity deficits are one of the most common impairments in individuals with stroke. Mental practice is exercised cognitively in the absence of the physical trials. The effects of the combination of mental and physical practice remain unclear. Objectives: This study aimed to examine the effects of combined physical practice and mental practice on the upper extremity functional ability poststroke, to identify which stroke population is most likely to benefit from the intervention, and to determine the effective treatment dosage. Methods: We searched in the PubMed, SCOPUS, National Rehabilitation Information REHABDATA, PEDro, and Web of Science until February 2020. Randomized clinical trials examined the effects of combined physical practice and mental practice on the upper extremity functional ability in people with a stroke. The risk of bias was evaluated and the effect sizes were calculated. Results: Nine studies met our inclusion criteria. In total, 230 stroke survivors were included in this analysis (mean age: 60.84 years). This review found that combining physical practice and mental practice has beneficial effects in improving the upper extremity functional ability poststroke. Conclusion: Combining physical practice and mental practice improves the upper extremity functional ability poststroke, this improvement can extend for 3 months after the treatment intervention. We propose that using 30 to 60 min of physical practice followed by 30 min of mental practice, 2 to 3 times weekly for 6 to 10 weeks, may give meaningful effects in individuals with stroke.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84529332","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}
Pub Date : 2020-06-01DOI: 10.1177/2516608520918998
T. Hamaguchi, M. Abo, Tomoko Tanaka, K. Murata, Makoto Suzuki, N. Nakaya, K. Taguchi
Abstract Background: To encourage patient goal setting and active participation in their own rehabilitation, physicians should provide patients with evidence-based prognostic predictions. Objective: This study aimed to analyze whether logarithmic time series changes in the Fugl-Meyer Assessment (FMA) score of the upper extremity (from treatment to one month after treatment) owing to NovEl intervention using repetitive transcranial magnetic stimulation and intensive occupational therapy (NEURO) conformed to logarithmic model formulae (group level), and whether the FMA score could be predicted by applying pre/posttreatment FMA scores following the model equation (individual level). Methods: This retrospective, longitudinal study included 514 poststroke paralysis patients admitted to our hospital between March 2010 and December 2018. FMA scores at 3 time points (before, after, and 4 weeks after treatment) were assessed, and conventional logarithmic regression analyses were performed to determine the time course of motor recovery. Subjects were randomly divided into 2 groups in derivation (n = 257) and validation (n = 257) analysis. Results: The time series change in the FMA score correlated with logarithmic model formulae (r2 = .97). The FMA score was substituted for the logarithmic formulae, and individual FMA scores (4 weeks after NEURO treatment) were predicted. The r2 value between the predicted and measured FMA scores was .65. Conclusions: The logarithmic model based on FMA scores before and after NEURO treatment individually predicted approximately 65% of FMA scores 4 weeks after treatment. NEURO allows the physicians to explain the prognosis to individual patients so that they can participate in their rehabilitation practices and achieve their goals.
{"title":"Predicting Recovery of Upper Extremity Motor Function After Stroke According to the NovEl Intervention Using Repetitive Transcranial Magnetic Stimulation and Occupational Therapy: NEURO","authors":"T. Hamaguchi, M. Abo, Tomoko Tanaka, K. Murata, Makoto Suzuki, N. Nakaya, K. Taguchi","doi":"10.1177/2516608520918998","DOIUrl":"https://doi.org/10.1177/2516608520918998","url":null,"abstract":"Abstract Background: To encourage patient goal setting and active participation in their own rehabilitation, physicians should provide patients with evidence-based prognostic predictions. Objective: This study aimed to analyze whether logarithmic time series changes in the Fugl-Meyer Assessment (FMA) score of the upper extremity (from treatment to one month after treatment) owing to NovEl intervention using repetitive transcranial magnetic stimulation and intensive occupational therapy (NEURO) conformed to logarithmic model formulae (group level), and whether the FMA score could be predicted by applying pre/posttreatment FMA scores following the model equation (individual level). Methods: This retrospective, longitudinal study included 514 poststroke paralysis patients admitted to our hospital between March 2010 and December 2018. FMA scores at 3 time points (before, after, and 4 weeks after treatment) were assessed, and conventional logarithmic regression analyses were performed to determine the time course of motor recovery. Subjects were randomly divided into 2 groups in derivation (n = 257) and validation (n = 257) analysis. Results: The time series change in the FMA score correlated with logarithmic model formulae (r2 = .97). The FMA score was substituted for the logarithmic formulae, and individual FMA scores (4 weeks after NEURO treatment) were predicted. The r2 value between the predicted and measured FMA scores was .65. Conclusions: The logarithmic model based on FMA scores before and after NEURO treatment individually predicted approximately 65% of FMA scores 4 weeks after treatment. NEURO allows the physicians to explain the prognosis to individual patients so that they can participate in their rehabilitation practices and achieve their goals.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84245425","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}
Pub Date : 2020-06-01DOI: 10.1177/2516608520929490
Mridul Makkar, N. Arumugam, D. Midha
Abstract Background: Hemineglect is the inability to sense stimuli given on the paretic side. It is most frequently seen in individuals with left hemiplegia resulting from temporoparietal lobe damage. On the basis of duration poststroke, hemineglect can be acute (<3 months) or chronic (>6 months). The patients experience many challenges in rehabilitation of motor function, cognitive function, and in gaining functional independence. Aim: To identify the challenges faced by physiotherapists in rehabilitation of individuals with poststroke hemineglect. Methodology: Data Identification: An English language literature search using Google Scholar, Scopus, PubMed, and Pedro was done. Study Selection: Articles were identified and those which fulfilled the specific requirements were selected. Data Extraction: In accordance with the inclusion criteria, 9 studies done between 1997 and 2017 were reviewed. Results: In this study, we reviewed a number of studies on the treatment of hemineglect which show a variety of treatment options. The various interventions include robotic mirror therapy, repeated parietal theta-burst stimulation, low-frequency transcranial magnetic stimulation, trunk rotation and scanning training, forced use therapy, prism glass adaptation, movement detection bracelets, each of which have different effects. Conclusion: There are a limited number of studies on the different treatment methods that are currently available. Further research is needed on these treatment methods to prove their efficacy and find a suitable method to overcome the challenges that the patients with hemineglect face at present.
{"title":"Challenges Experienced by Physiotherapists in Rehabilitation of Individuals With Poststroke Hemineglect: A Review Study","authors":"Mridul Makkar, N. Arumugam, D. Midha","doi":"10.1177/2516608520929490","DOIUrl":"https://doi.org/10.1177/2516608520929490","url":null,"abstract":"Abstract Background: Hemineglect is the inability to sense stimuli given on the paretic side. It is most frequently seen in individuals with left hemiplegia resulting from temporoparietal lobe damage. On the basis of duration poststroke, hemineglect can be acute (<3 months) or chronic (>6 months). The patients experience many challenges in rehabilitation of motor function, cognitive function, and in gaining functional independence. Aim: To identify the challenges faced by physiotherapists in rehabilitation of individuals with poststroke hemineglect. Methodology: Data Identification: An English language literature search using Google Scholar, Scopus, PubMed, and Pedro was done. Study Selection: Articles were identified and those which fulfilled the specific requirements were selected. Data Extraction: In accordance with the inclusion criteria, 9 studies done between 1997 and 2017 were reviewed. Results: In this study, we reviewed a number of studies on the treatment of hemineglect which show a variety of treatment options. The various interventions include robotic mirror therapy, repeated parietal theta-burst stimulation, low-frequency transcranial magnetic stimulation, trunk rotation and scanning training, forced use therapy, prism glass adaptation, movement detection bracelets, each of which have different effects. Conclusion: There are a limited number of studies on the different treatment methods that are currently available. Further research is needed on these treatment methods to prove their efficacy and find a suitable method to overcome the challenges that the patients with hemineglect face at present.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74579179","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}
Pub Date : 2020-06-01DOI: 10.1177/2516608520934639
J. Pandian, I. Sebastian
Abstract The COVID-19 pandemic is a serious public health emergency, which has caught the world unawares. The rapidly escalating intensity of this outbreak has overwhelmed the existent health care resources leading to major implications on the optimal management of other important medical emergencies like stroke. Timely treatment of acute stroke is imperative to prevent disability, thereby necessitating the need for guidelines so as to maintain the continuum of stroke care, while also protecting health care personnel. We have summarized the global consensus with focus on India.
{"title":"Management of Acute Stroke During COVID-19 Global Pandemic","authors":"J. Pandian, I. Sebastian","doi":"10.1177/2516608520934639","DOIUrl":"https://doi.org/10.1177/2516608520934639","url":null,"abstract":"Abstract The COVID-19 pandemic is a serious public health emergency, which has caught the world unawares. The rapidly escalating intensity of this outbreak has overwhelmed the existent health care resources leading to major implications on the optimal management of other important medical emergencies like stroke. Timely treatment of acute stroke is imperative to prevent disability, thereby necessitating the need for guidelines so as to maintain the continuum of stroke care, while also protecting health care personnel. We have summarized the global consensus with focus on India.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83265928","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}
Pub Date : 2020-06-01DOI: 10.1177/2516608520927198
Dhananjay Gupta, P. R, A. Mehta, M. Javali, P. T. Acharya, R. Srinivasa
Abstract Objective: To report an atypical case of acute onset sensorimotor paraparesis secondary to bilateral cerebral stroke. Background: Acute onset paraparesis or paraplegia is usually secondary to a spinal cord disease. Central or cerebral causes of paraparesis are rare and include parasagittal and bilateral precentral lesions. Design/Methods: Case report and literature review. Results: A 65-year-old man presented with acute onset weakness of both lower limbs, associated with pins and needle sensation. On examination, he was found to have paraparesis (grade 2/5, both legs) and an asymmetric sensory loss in both legs and thighs. Spinal magnetic resonance imaging ruled out any compressive or noncompressive etiology. Magnetic resonance imaging of the brain showed an acute infarction in the bilateral cerebral hemisphere in both the pre- and postcentral gyrus. An angiogram of the brain revealed an aplastic right ACA-A1 with left ACA-A1 feeding bilateral A2. There was distal left ACA-A1 stenosis seen, the probable cause of bilateral stroke in this patient. The patient was treated conservatively and showed symptomatic improvement during the course of stay at the hospital. Conclusion: This case of acute paraparesis secondary to bilateral cerebral infarction demonstrates the need to always look for a cerebral cause. In patients with cerebral infarction, who present early to a hospital, it may provide a window for thrombolytic or endovascular therapy.
{"title":"Acute Onset Asymmetric Sensorimotor Paraparesis: Not Always Spinal!","authors":"Dhananjay Gupta, P. R, A. Mehta, M. Javali, P. T. Acharya, R. Srinivasa","doi":"10.1177/2516608520927198","DOIUrl":"https://doi.org/10.1177/2516608520927198","url":null,"abstract":"Abstract Objective: To report an atypical case of acute onset sensorimotor paraparesis secondary to bilateral cerebral stroke. Background: Acute onset paraparesis or paraplegia is usually secondary to a spinal cord disease. Central or cerebral causes of paraparesis are rare and include parasagittal and bilateral precentral lesions. Design/Methods: Case report and literature review. Results: A 65-year-old man presented with acute onset weakness of both lower limbs, associated with pins and needle sensation. On examination, he was found to have paraparesis (grade 2/5, both legs) and an asymmetric sensory loss in both legs and thighs. Spinal magnetic resonance imaging ruled out any compressive or noncompressive etiology. Magnetic resonance imaging of the brain showed an acute infarction in the bilateral cerebral hemisphere in both the pre- and postcentral gyrus. An angiogram of the brain revealed an aplastic right ACA-A1 with left ACA-A1 feeding bilateral A2. There was distal left ACA-A1 stenosis seen, the probable cause of bilateral stroke in this patient. The patient was treated conservatively and showed symptomatic improvement during the course of stay at the hospital. Conclusion: This case of acute paraparesis secondary to bilateral cerebral infarction demonstrates the need to always look for a cerebral cause. In patients with cerebral infarction, who present early to a hospital, it may provide a window for thrombolytic or endovascular therapy.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79263189","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}
Pub Date : 2020-06-01DOI: 10.1177/2516608520921104
Jun Hayakawa, Mitsuhiro Ochi, Y. Yano, R. Matsugaki, Yuto Ogata, T. Murakami, Satoshi Kuhara, H. Itoh, K. Hachisuka, S. Saeki
Abstract Purpose: This study aimed to determine the inter- and intra-rater reliability of and minimal detectable changes (MDCs) at the 95% confidence interval in gait performance tests in patients with chronic hemiplegic stroke who can walk independently. Materials and Methods: Thirty patients with chronic hemiplegic stroke (24 men, 6 women, mean age 62.5 ± 11.6 years) were enrolled. Physical therapists (mean clinical experience: 9.1 ± 9.3 years) performed the timed up and go test (TUG), 10-m walk test (10MWT), and 6-min walk test (6MWT) 1 day apart. Reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Results: The ICC was ≥0.9 for all tests, and no systematic bias was found. MDC at the 95% confidence interval was 1.9 s for the TUG, 0.16 m/s for the 10MWT, and 28.4 m for the 6MWT. Discussion: We demonstrated excellent intra- and inter-rater reliability of all tests. These results suggest that gait performance tests are reliable. Conclusion: These commonly used gait performance tests demonstrated high reliability and can be recommended to evaluate clinically meaningful improvements in patients with chronic hemiplegic stroke who can walk independently.
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Pub Date : 2020-05-20DOI: 10.1177/2516608520901388
P. Vinny, M. Padma, P. Sylaja, P. Kesav, V. Lal, L. Narasimhan, S. Dwivedi, P. Nair, T. Iype, Anuragini Gupta, A. Patil, V. Vishnu
Abstract Background: Diagnostic errors in neurological diagnosis are a source of preventable harm. Software tools like Differential Diagnosis (DDx) apps in neurology that hold the potential to mitigate this harm are conspicuously lacking. Materials and Methods: A multicenter cross-sectional observational study was designed to compare the diagnostic accuracy of a Neurology DDx App (Neurology Dx) with neurology residents by using vascular neurology clinical vignettes. The study was conducted at 7 leading neurology institutes in India. Study participants comprised of 100 neurology residents from the participating institutes. Measurements: Detecting diagnostic accuracy of residents and App measured as a proportion of correctly identified high likely gold standard DDx was prespecified as the main outcome. Proportions of correctly identified first high likely, first 3 high likely, first 5 high likely, and combined moderate plus high likely gold standard differentials by residents and App were secondary outcomes. Results: 1,000 vignettes were attempted by residents. Frequency of gold standard, high likely differentials correctly identified by residents was 27% compared to 72% by App (absolute difference 45%, 95% CI 35.7-52.8). When high and moderate likely differentials were combined, residents scored 17% compared to 57% by App (absolute difference 40%, 95% CI 33.8-50.0). Residents correctly identified first high likely gold standard differential as their first high likely differential in 34% compared to 18% by App (absolute difference 16%, 95% CI 1.2-25.4). Conclusion: App with predefined knowledge base can complement clinical reasoning of neurology residents. Portability and functionality of such Apps may further strengthen this symbiosis between humans and algorithms (CTRI/2017/06/008838).
背景:神经学诊断中的诊断错误是可预防伤害的一个来源。像神经病学的鉴别诊断(DDx)应用程序这样的软件工具显然缺乏减轻这种伤害的潜力。材料和方法:设计了一项多中心横断面观察性研究，通过血管神经学临床影像，比较神经内科DDx应用程序(Neurology Dx)与神经内科住院医师的诊断准确性。这项研究是在印度7家领先的神经病学研究所进行的。研究参与者包括来自参与机构的100名神经内科住院医师。测量:检测居民和App的诊断准确性，以正确识别的高可能金标准DDx的比例进行测量，预先指定为主要结果。居民和App正确识别第一个高可能性、前3个高可能性、前5个高可能性以及中等加高可能性金标准差异的比例是次要结果。结果:居民尝试了1000个小短片。居民正确识别金标准，高可能差异的频率为27%，而App为72%(绝对差为45%，95% CI 35.7-52.8)。当高度和中度可能差异合并时，居民得分为17%，而App得分为57%(绝对差为40%，95% CI 33.8-50.0)。居民正确识别第一个高可能金标准差异为其第一个高可能差异的比例为34%，而App为18%(绝对差值为16%，95% CI 1.2-25.4)。结论:具有预定义知识库的App可以补充神经内科住院医师的临床推理。这些应用程序的可移植性和功能性可能会进一步加强人类与算法之间的这种共生关系(CTRI/2017/06/008838)。
{"title":"Comparison of Diagnostic Accuracy in Vascular Neurology Between Neurology Residents and a Neurology Differential Diagnosis App: A Multi-Center Cross-Sectional Observational Study","authors":"P. Vinny, M. Padma, P. Sylaja, P. Kesav, V. Lal, L. Narasimhan, S. Dwivedi, P. Nair, T. Iype, Anuragini Gupta, A. Patil, V. Vishnu","doi":"10.1177/2516608520901388","DOIUrl":"https://doi.org/10.1177/2516608520901388","url":null,"abstract":"Abstract Background: Diagnostic errors in neurological diagnosis are a source of preventable harm. Software tools like Differential Diagnosis (DDx) apps in neurology that hold the potential to mitigate this harm are conspicuously lacking. Materials and Methods: A multicenter cross-sectional observational study was designed to compare the diagnostic accuracy of a Neurology DDx App (Neurology Dx) with neurology residents by using vascular neurology clinical vignettes. The study was conducted at 7 leading neurology institutes in India. Study participants comprised of 100 neurology residents from the participating institutes. Measurements: Detecting diagnostic accuracy of residents and App measured as a proportion of correctly identified high likely gold standard DDx was prespecified as the main outcome. Proportions of correctly identified first high likely, first 3 high likely, first 5 high likely, and combined moderate plus high likely gold standard differentials by residents and App were secondary outcomes. Results: 1,000 vignettes were attempted by residents. Frequency of gold standard, high likely differentials correctly identified by residents was 27% compared to 72% by App (absolute difference 45%, 95% CI 35.7-52.8). When high and moderate likely differentials were combined, residents scored 17% compared to 57% by App (absolute difference 40%, 95% CI 33.8-50.0). Residents correctly identified first high likely gold standard differential as their first high likely differential in 34% compared to 18% by App (absolute difference 16%, 95% CI 1.2-25.4). Conclusion: App with predefined knowledge base can complement clinical reasoning of neurology residents. Portability and functionality of such Apps may further strengthen this symbiosis between humans and algorithms (CTRI/2017/06/008838).","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89464837","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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