Pub Date : 2024-02-06DOI: 10.1177/25166085231214875
Monali S. Malvankar-Mehta, Mushfiqur Rahman, Ashvinder Suri, Cindy M. L. Hutnik
Background: As the communal cause of irreversible vision loss in seniors, glaucoma affects more than 67 million people worldwide. Those who suffer from glaucoma have traditionally demonstrated a higher rate of developing stroke. Numerous studies have investigated the relationship between glaucoma and increased stroke risks, but they differ wildly in conclusive findings. To better elucidate the overall findings of the collective studies, a systematic review with the objective of determining the relationship between glaucoma and an increased risk of stroke. Methods: A systematic database search including MEDLINE, EMBASE, and Cochrane Library as well as unpublished literature was done. Distiller SR, a systematic review software was utilized. After two levels of screening, “Title and Abstract” and “Full text” screening, risk of bias assessment and extraction of the data from the included articles were conducted. STATA 14.0 was used to conduct the meta-analysis. The hazard ratio (HR) was the primary outcome measure. Results: Nine studies (376,650 subjects) were included in the analysis. Results indicated a significant hazard of stroke in patients with open-angle glaucoma (HR = 1.36, 95% confidence interval [CI]: [1.08, 1.71]), normal-tension glaucoma (HR = 6.34, 95% CI: [4.8, 8.38]), and neovascular glaucoma (HR = 2.07; CI: [1.41, 3.03]). Studies examining risks of stroke development showed a significant increase in the relative risks (RR) of developing stroke for those with glaucoma (RR = 2.10, CI: [1.64, 2.68]). Conclusions: The hazard of developing stroke could be greater for patients with glaucoma. However, randomized controlled trials with longer-term follow-ups need to be conducted in the future in order to make strong conclusions.
{"title":"Evidence of Stroke in Glaucoma Patients","authors":"Monali S. Malvankar-Mehta, Mushfiqur Rahman, Ashvinder Suri, Cindy M. L. Hutnik","doi":"10.1177/25166085231214875","DOIUrl":"https://doi.org/10.1177/25166085231214875","url":null,"abstract":"Background: As the communal cause of irreversible vision loss in seniors, glaucoma affects more than 67 million people worldwide. Those who suffer from glaucoma have traditionally demonstrated a higher rate of developing stroke. Numerous studies have investigated the relationship between glaucoma and increased stroke risks, but they differ wildly in conclusive findings. To better elucidate the overall findings of the collective studies, a systematic review with the objective of determining the relationship between glaucoma and an increased risk of stroke. Methods: A systematic database search including MEDLINE, EMBASE, and Cochrane Library as well as unpublished literature was done. Distiller SR, a systematic review software was utilized. After two levels of screening, “Title and Abstract” and “Full text” screening, risk of bias assessment and extraction of the data from the included articles were conducted. STATA 14.0 was used to conduct the meta-analysis. The hazard ratio (HR) was the primary outcome measure. Results: Nine studies (376,650 subjects) were included in the analysis. Results indicated a significant hazard of stroke in patients with open-angle glaucoma (HR = 1.36, 95% confidence interval [CI]: [1.08, 1.71]), normal-tension glaucoma (HR = 6.34, 95% CI: [4.8, 8.38]), and neovascular glaucoma (HR = 2.07; CI: [1.41, 3.03]). Studies examining risks of stroke development showed a significant increase in the relative risks (RR) of developing stroke for those with glaucoma (RR = 2.10, CI: [1.64, 2.68]). Conclusions: The hazard of developing stroke could be greater for patients with glaucoma. However, randomized controlled trials with longer-term follow-ups need to be conducted in the future in order to make strong conclusions.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139860137","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 : 2024-01-10DOI: 10.1177/25166085231220087
S. Nagendra, A. Gutte, Abhijit Gaikwad
59-year-old male had four episodes of transient, painless vision loss in right eye in the last 20 days which had resolved spontaneously. Three years ago, patient had been diagnosed with oropharyngeal squamous cell carcinoma, which had been treated with six cycles of chemotherapy and radiotherapy. MRI brain angiogram showed diffuse long segment wall thickening of Right Internal Carotid Artery with luminal narrowing with no acute infarct or haemorrhage; which was later confirmed by four vessel DSA. He was treated with Right Carotid Artery angioplasty with a cutting balloon while using a distal protection device, followed up by stenting. The patient recovered well on follow-up and there were no further episodes. Thus, amaurosis fugax may be a presentation of carotid artery stenosis, especially after radiotherapy and such patients can be treated by carotid angioplasty and stenting.
{"title":"Amaurosis Fugax Due to Radiationinduced Carotid Stenosis Treated by Carotid Artery Stenting","authors":"S. Nagendra, A. Gutte, Abhijit Gaikwad","doi":"10.1177/25166085231220087","DOIUrl":"https://doi.org/10.1177/25166085231220087","url":null,"abstract":"59-year-old male had four episodes of transient, painless vision loss in right eye in the last 20 days which had resolved spontaneously. Three years ago, patient had been diagnosed with oropharyngeal squamous cell carcinoma, which had been treated with six cycles of chemotherapy and radiotherapy. MRI brain angiogram showed diffuse long segment wall thickening of Right Internal Carotid Artery with luminal narrowing with no acute infarct or haemorrhage; which was later confirmed by four vessel DSA. He was treated with Right Carotid Artery angioplasty with a cutting balloon while using a distal protection device, followed up by stenting. The patient recovered well on follow-up and there were no further episodes. Thus, amaurosis fugax may be a presentation of carotid artery stenosis, especially after radiotherapy and such patients can be treated by carotid angioplasty and stenting.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440237","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 : 2024-01-10DOI: 10.1177/25166085231217563
Rajeswari Aghoram, Done Indira Priya, Sunil K. Narayan
Caring for young stroke survivors presents challenges for carers. Little is known about the burden experienced by them. In this study, we estimated the caregiving burden among carers of young stroke survivors and explored its patterns and determinants. One hundred and fifty young stroke survivors (aged <45 years at index stroke) and their caregivers were recruited in this hospital-based cross-sectional study, three or more months from the stroke. We estimated the burden of caregiving using Burden Assessment Schedule-20 (BAS). Cognitive status, physical disability, and neuropsychiatric symptoms were evaluated using standard instruments. We used descriptive statistics and performed multivariate analysis for factors associated with high burden. We used STATA ver. 14.2, Stata Corp, TX, USA. The median age of caregivers was 37.5 years (IQR 12) and 98 (65.3%) were women. The carers were most often spouses (101; 67.3%). The median total BAS score was 28 (IQR 12). Most carers (127; 84.7%) experienced some burden while 15 (10%; 95%CI: 5.2%–14.8%) reported high burden. The most common domain of burden was relationships with others (105; 70%) and marital relationships (66; 65%). Dementia (OR: 2.55; 95%CI: 1.07–6.07) and the presence of neuropsychiatric symptoms (OR: 7.62 95%CI: 2.94–19.81) were associated with an increased burden of caregiving. Most caregivers of young stroke survivors experience some burden, with interpersonal relationships being the most common domain. Dementia and neuropsychiatric symptoms are associated with increased burden.
{"title":"Burden of Caregiving for Young Stroke Survivors in the Community: A Cross-sectional Study","authors":"Rajeswari Aghoram, Done Indira Priya, Sunil K. Narayan","doi":"10.1177/25166085231217563","DOIUrl":"https://doi.org/10.1177/25166085231217563","url":null,"abstract":"Caring for young stroke survivors presents challenges for carers. Little is known about the burden experienced by them. In this study, we estimated the caregiving burden among carers of young stroke survivors and explored its patterns and determinants. One hundred and fifty young stroke survivors (aged <45 years at index stroke) and their caregivers were recruited in this hospital-based cross-sectional study, three or more months from the stroke. We estimated the burden of caregiving using Burden Assessment Schedule-20 (BAS). Cognitive status, physical disability, and neuropsychiatric symptoms were evaluated using standard instruments. We used descriptive statistics and performed multivariate analysis for factors associated with high burden. We used STATA ver. 14.2, Stata Corp, TX, USA. The median age of caregivers was 37.5 years (IQR 12) and 98 (65.3%) were women. The carers were most often spouses (101; 67.3%). The median total BAS score was 28 (IQR 12). Most carers (127; 84.7%) experienced some burden while 15 (10%; 95%CI: 5.2%–14.8%) reported high burden. The most common domain of burden was relationships with others (105; 70%) and marital relationships (66; 65%). Dementia (OR: 2.55; 95%CI: 1.07–6.07) and the presence of neuropsychiatric symptoms (OR: 7.62 95%CI: 2.94–19.81) were associated with an increased burden of caregiving. Most caregivers of young stroke survivors experience some burden, with interpersonal relationships being the most common domain. Dementia and neuropsychiatric symptoms are associated with increased burden.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441022","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 Repetitive Transcranial Magnetic Stimulation (r-TMS), a non-invasive brain stimulation method, appears promising in augmenting post-stroke recovery and requires further evaluation. Aims and Objective To study the effect of r-TMS treatment on motor function in patients with strokes of different duration and types. Methods A prospective, single center study was conducted to study the effect of bilateral motor cortex rTMS treatment in 100 consecutive patients with either ischemic or hemorrhagic stroke of any duration. Measured outcomes were changes in NIHSS, MRC grading for motor power, MAS (modified Ashworth scale) for spasticity and mRS (modified Rankin Score) from baseline to follow-up visit at 90 days. Paired T test was used for comparing the outcomes. Results 77% subjects were males, 82% had ischemic stroke, median age was 58.5 years, and median NIHSS score was 11. We observed favorable changes in outcome measures after treatment. mRS < = 2 at 90 days was observed in 85.71% of patients with acute stroke, 64.51% of subacute and 55.88% of chronic strokes (p value < 0.002). Acute stroke had higher rates of limb power improvement (94.28%) than subacute (70.96%) or chronic strokes (41.17%) (p value = < 0.01). Post-stroke spasticity reduction was also observed after rTMS. Patients with infarcts or hemorrhages had no significant differences. No significant adverse events were seen. Conclusion rTMS appears to be safe in our study population and could be effectively delivered at different time points to augment post-stroke motor recovery.
{"title":"Our Experience with rTMS in a Stroke","authors":"Pawan T. Ojha, Abhijit Gaikwad, Sumit Kharat, Nishu Ojha, Shashank Nagendra, Jayendra Yadav, Aamna Maniyar","doi":"10.1177/25166085231207606","DOIUrl":"https://doi.org/10.1177/25166085231207606","url":null,"abstract":"Background Repetitive Transcranial Magnetic Stimulation (r-TMS), a non-invasive brain stimulation method, appears promising in augmenting post-stroke recovery and requires further evaluation. Aims and Objective To study the effect of r-TMS treatment on motor function in patients with strokes of different duration and types. Methods A prospective, single center study was conducted to study the effect of bilateral motor cortex rTMS treatment in 100 consecutive patients with either ischemic or hemorrhagic stroke of any duration. Measured outcomes were changes in NIHSS, MRC grading for motor power, MAS (modified Ashworth scale) for spasticity and mRS (modified Rankin Score) from baseline to follow-up visit at 90 days. Paired T test was used for comparing the outcomes. Results 77% subjects were males, 82% had ischemic stroke, median age was 58.5 years, and median NIHSS score was 11. We observed favorable changes in outcome measures after treatment. mRS < = 2 at 90 days was observed in 85.71% of patients with acute stroke, 64.51% of subacute and 55.88% of chronic strokes (p value < 0.002). Acute stroke had higher rates of limb power improvement (94.28%) than subacute (70.96%) or chronic strokes (41.17%) (p value = < 0.01). Post-stroke spasticity reduction was also observed after rTMS. Patients with infarcts or hemorrhages had no significant differences. No significant adverse events were seen. Conclusion rTMS appears to be safe in our study population and could be effectively delivered at different time points to augment post-stroke motor recovery.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135475218","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 : 2023-11-02DOI: 10.1177/25166085231200766
Manesh Muraleedharan, Alaka Omprakash Chandak
Bibliometric analyses shed light on domain-specific research trends such as leading contributors and geographical distribution. This article examines these aspects in the context of stroke thrombolysis research over the past decade. Our review highlights the United States as the most prolific contributor with significant input from organizations in China, Sweden, and other countries. Overlay visualization further elucidates focus areas such as thrombolysis pharmacological agents, stroke risk factors, and advancements in assessment and diagnostic techniques.
{"title":"Global Insights: A Bibliometric Analysis of Research Trends in Stroke Thrombolysis","authors":"Manesh Muraleedharan, Alaka Omprakash Chandak","doi":"10.1177/25166085231200766","DOIUrl":"https://doi.org/10.1177/25166085231200766","url":null,"abstract":"Bibliometric analyses shed light on domain-specific research trends such as leading contributors and geographical distribution. This article examines these aspects in the context of stroke thrombolysis research over the past decade. Our review highlights the United States as the most prolific contributor with significant input from organizations in China, Sweden, and other countries. Overlay visualization further elucidates focus areas such as thrombolysis pharmacological agents, stroke risk factors, and advancements in assessment and diagnostic techniques.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135973097","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 : 2023-10-23DOI: 10.1177/25166085231202622
Bhavana Murugesh, Mary Anne Poovathingal, Geofi George
We report a case of transient bitemporal hemianopia following a hypotensive episode in a patient of coronary artery disease (CAD). A 51-year-old male presented with anterior wall myocardial infarction (AWMI) and underwent percutaneous coronary artery intervention (PCI). On the second day post procedure, he developed an acute ischemic event following a cardioembolic infarct to the left middle cerebral artery (MCA) region. Over the next few days, the patient had persistent drop in blood pressure, during which he developed a transient bitemporal hemianopia, which improved after blood pressure correction, consistent with ischemic chiasmopathy. As such in literature, ischemic optic chiasmopathy is a very rare entity. This case report emphasizes that clinicians should consider that sustained hypotension associated with a cardiac event may lead to transient ischemic phenomenon such as the witnessed visual impairment due to hypoperfusion of the optic chiasm.
{"title":"A Rare Case of Ischemic Optic Chiasmopathy Following Left Ventricular Dysfunction in a Patient with Coronary Artery Disease","authors":"Bhavana Murugesh, Mary Anne Poovathingal, Geofi George","doi":"10.1177/25166085231202622","DOIUrl":"https://doi.org/10.1177/25166085231202622","url":null,"abstract":"We report a case of transient bitemporal hemianopia following a hypotensive episode in a patient of coronary artery disease (CAD). A 51-year-old male presented with anterior wall myocardial infarction (AWMI) and underwent percutaneous coronary artery intervention (PCI). On the second day post procedure, he developed an acute ischemic event following a cardioembolic infarct to the left middle cerebral artery (MCA) region. Over the next few days, the patient had persistent drop in blood pressure, during which he developed a transient bitemporal hemianopia, which improved after blood pressure correction, consistent with ischemic chiasmopathy. As such in literature, ischemic optic chiasmopathy is a very rare entity. This case report emphasizes that clinicians should consider that sustained hypotension associated with a cardiac event may lead to transient ischemic phenomenon such as the witnessed visual impairment due to hypoperfusion of the optic chiasm.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135406092","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 : 2023-09-12DOI: 10.1177/25166085231197567
Debajyoti Datta, Debarshi Chatterjee
Background Chronic subdural haematoma (CSDH) is a common neurosurgical disease, particularly among the elderly, especially those on antiplatelet or anticoagulation with trivial trauma. While anticoagulants/antiplatelets increase the chance of rebleeding in cases of CSDH, discontinuation may increase the risk of stroke in these patients. Case Description: We report two cases of CSDH in elderly patients with risk factors who suffered from an ischaemic stroke after undergoing surgery. The first case was an elderly gentleman who had a history of percutaneous coronary intervention, presenting with a CSDH. He developed an anterior cerebral artery infarct in the immediate postoperative period. The second was an elderly gentleman with a history of hypertension presenting with a concomitant left thalamic infarct and large left-sided CSDH. He developed a second middle cerebral artery infarct of the opposite side in the immediate postoperative period. Conclusion: The medications used for stroke prophylaxis, that is, antiplatelets and anticoagulants are predisposing factors for the development of CSDH. However, the perioperative period of these patients remains vulnerable to the development of new-onset ischaemic stroke.
{"title":"Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease","authors":"Debajyoti Datta, Debarshi Chatterjee","doi":"10.1177/25166085231197567","DOIUrl":"https://doi.org/10.1177/25166085231197567","url":null,"abstract":"Background Chronic subdural haematoma (CSDH) is a common neurosurgical disease, particularly among the elderly, especially those on antiplatelet or anticoagulation with trivial trauma. While anticoagulants/antiplatelets increase the chance of rebleeding in cases of CSDH, discontinuation may increase the risk of stroke in these patients. Case Description: We report two cases of CSDH in elderly patients with risk factors who suffered from an ischaemic stroke after undergoing surgery. The first case was an elderly gentleman who had a history of percutaneous coronary intervention, presenting with a CSDH. He developed an anterior cerebral artery infarct in the immediate postoperative period. The second was an elderly gentleman with a history of hypertension presenting with a concomitant left thalamic infarct and large left-sided CSDH. He developed a second middle cerebral artery infarct of the opposite side in the immediate postoperative period. Conclusion: The medications used for stroke prophylaxis, that is, antiplatelets and anticoagulants are predisposing factors for the development of CSDH. However, the perioperative period of these patients remains vulnerable to the development of new-onset ischaemic stroke.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135878202","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 : 2023-09-10DOI: 10.1177/25166085231197573
Aiswarya Raj, Ashraf V. Valappil, Paul Johny, Paul J. Alapatt, K. P. Abdurehiman, L. K. Sreevidya, Noufal Basheer
Background The susceptibility vessel sign (SVS), which can be seen on susceptibility-weighted imaging (SWI), is typically described as a dark blooming artifact. Objective SVS, which can be seen on T2*-weighted gradient echo imaging, is typically described as a dark blooming artifact. The hypointense vessel’s diameter is thus larger on imaging than the opposing vessel’s diameter. We conducted a study to investigate the reliability of this sign on SWI in the principal intracranial arteries in 156 individuals with acute stroke and to assess the 3-month outcome using the modified Rankin Scale (mRS) in these patients. Results Among the 106 patients with large vessel occlusion (LVO) on magnetic resonance angiography (MRA), 73 patients demonstrated a positive SVS on magnetic resonance imaging (MRI), while 33 patients did not. Among the 50 patients without LVO, only 4 patients showed a false-positive SVS, while 46 patients showed a negative SVS. The sensitivity, specificity, positive predictive value, and negative predictive value of SVS as a screening tool were 67.05%, 90.7%, 93.65%, and 57.35% in anterior circulation LVO, and 77.8%, 100%, 100%, and 63.6% in posterior circulation LVO, respectively. The chi-square test showed p < .05, demonstrating a significant association. With a modified thrombolysis in cerebral infarction (mTICI) score of 2B or 3, 83.3% of SVS-positive patients had a successful recanalization, while 64.4% had an mRS score of less than 3. Interpretation SVS is a good screening tool for the presence of intracranial LVO, with good sensitivity, high specificity, and positive predictive value for LVO (posterior > anterior). SVS positivity may also indicate successful recanalization and a good 90-day mRS outcome.
{"title":"Susceptibility Vessel Sign as a Predictor of Intracranial Large Vessel Occlusion","authors":"Aiswarya Raj, Ashraf V. Valappil, Paul Johny, Paul J. Alapatt, K. P. Abdurehiman, L. K. Sreevidya, Noufal Basheer","doi":"10.1177/25166085231197573","DOIUrl":"https://doi.org/10.1177/25166085231197573","url":null,"abstract":"Background The susceptibility vessel sign (SVS), which can be seen on susceptibility-weighted imaging (SWI), is typically described as a dark blooming artifact. Objective SVS, which can be seen on T2*-weighted gradient echo imaging, is typically described as a dark blooming artifact. The hypointense vessel’s diameter is thus larger on imaging than the opposing vessel’s diameter. We conducted a study to investigate the reliability of this sign on SWI in the principal intracranial arteries in 156 individuals with acute stroke and to assess the 3-month outcome using the modified Rankin Scale (mRS) in these patients. Results Among the 106 patients with large vessel occlusion (LVO) on magnetic resonance angiography (MRA), 73 patients demonstrated a positive SVS on magnetic resonance imaging (MRI), while 33 patients did not. Among the 50 patients without LVO, only 4 patients showed a false-positive SVS, while 46 patients showed a negative SVS. The sensitivity, specificity, positive predictive value, and negative predictive value of SVS as a screening tool were 67.05%, 90.7%, 93.65%, and 57.35% in anterior circulation LVO, and 77.8%, 100%, 100%, and 63.6% in posterior circulation LVO, respectively. The chi-square test showed p < .05, demonstrating a significant association. With a modified thrombolysis in cerebral infarction (mTICI) score of 2B or 3, 83.3% of SVS-positive patients had a successful recanalization, while 64.4% had an mRS score of less than 3. Interpretation SVS is a good screening tool for the presence of intracranial LVO, with good sensitivity, high specificity, and positive predictive value for LVO (posterior > anterior). SVS positivity may also indicate successful recanalization and a good 90-day mRS outcome.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136072669","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 : 2023-08-07DOI: 10.1177/25166085231186921
Suhaila Parveen, Aiswarya Raj, N. Basheer, Paul J. Alapatt, S. Janardhanan, Abdurehiman Kp, KG Ramakrishnan
Acute stroke is one of the leading causes of death globally. Imaging remains the most common modality to diagnose and predict outcomes in patients with stroke. Conventionally, computed tomography (CT) was the preferred choice; however, imaging has expanded to include newer modalities such as Dynamic Susceptibility Contrast (DSC), Dynamic Contrast-Enhanced MRI (DCE), and Arterial Spin Labelling MRI. An alternative method of assessing perfusion, ASL uses the spins of endogenous water protons as a tracer rather than administering a contrast agent. In this manner, endogenous water in the arterial blood is labelled electromagnetically and employed as a freely diffusible tracer. ASL, as opposed to CT, DSC or DCE, allows estimation of cerebral blood flow without exposure to radiation or the administration of contrast material, which is advantageous for patients with impaired renal function or repetitive perfusion imaging. Thus a prospective study was conducted to explore the use of Arterial Spin Labelling MRI in the setting of acute ischemic stroke in both pre and post-thrombectomy patients. Our study is significant as there are no existing prospective studies comparing the cerebral perfusion measured using ASL with neurological outcomes.
{"title":"Analyzing the Role of Arterial Spin Labelling in Patients Undergoing Endovascular Thrombectomy for Large Vessel Occlusion—a Prospective Single Center Study","authors":"Suhaila Parveen, Aiswarya Raj, N. Basheer, Paul J. Alapatt, S. Janardhanan, Abdurehiman Kp, KG Ramakrishnan","doi":"10.1177/25166085231186921","DOIUrl":"https://doi.org/10.1177/25166085231186921","url":null,"abstract":"Acute stroke is one of the leading causes of death globally. Imaging remains the most common modality to diagnose and predict outcomes in patients with stroke. Conventionally, computed tomography (CT) was the preferred choice; however, imaging has expanded to include newer modalities such as Dynamic Susceptibility Contrast (DSC), Dynamic Contrast-Enhanced MRI (DCE), and Arterial Spin Labelling MRI. An alternative method of assessing perfusion, ASL uses the spins of endogenous water protons as a tracer rather than administering a contrast agent. In this manner, endogenous water in the arterial blood is labelled electromagnetically and employed as a freely diffusible tracer. ASL, as opposed to CT, DSC or DCE, allows estimation of cerebral blood flow without exposure to radiation or the administration of contrast material, which is advantageous for patients with impaired renal function or repetitive perfusion imaging. Thus a prospective study was conducted to explore the use of Arterial Spin Labelling MRI in the setting of acute ischemic stroke in both pre and post-thrombectomy patients. Our study is significant as there are no existing prospective studies comparing the cerebral perfusion measured using ASL with neurological outcomes.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82081321","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 : 2023-08-07DOI: 10.1177/25166085231186377
N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon
Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.
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