Pub Date : 2023-05-15DOI: 10.1177/25166085231166775
Jayaram Bharath, V. N. Reddy, K. Nagarajan, Subathra Adithan, V. Pillai
Calcification in cerebral infarcts has been reported as an uncommon finding. CT hyperdensity in an infarct can also be due to hemorrhagic transformation and in MRI can be mimicked by cortical laminar necrosis seen as gyriform T1 hyper and T2 hypointensities. Susceptibility-weighted imaging (SWI) with phase image has been reported to differentiate calcification and hemorrhage. We report 2 cases of cerebral infarcts with a review of the literature. The first patient showed early gyriform calcification 10 days after the onset and showed partial resolution of the calcification on follow-up. The second patient showed plaque-like calcification within perisylvian infarct that was confirmed by SWI phase imaging.
{"title":"Calcifications in Cerebral Infarcts: Report of Two Cases","authors":"Jayaram Bharath, V. N. Reddy, K. Nagarajan, Subathra Adithan, V. Pillai","doi":"10.1177/25166085231166775","DOIUrl":"https://doi.org/10.1177/25166085231166775","url":null,"abstract":"Calcification in cerebral infarcts has been reported as an uncommon finding. CT hyperdensity in an infarct can also be due to hemorrhagic transformation and in MRI can be mimicked by cortical laminar necrosis seen as gyriform T1 hyper and T2 hypointensities. Susceptibility-weighted imaging (SWI) with phase image has been reported to differentiate calcification and hemorrhage. We report 2 cases of cerebral infarcts with a review of the literature. The first patient showed early gyriform calcification 10 days after the onset and showed partial resolution of the calcification on follow-up. The second patient showed plaque-like calcification within perisylvian infarct that was confirmed by SWI phase imaging.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78281368","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 : 2023-03-30DOI: 10.1177/25166085231158425
I. Sebastian, M. Demers, N. Yeghiazaryan, Wan Asyraf WZ, A. Nasreldein, U. Gopaul, M. Charalambous, S. Thilarajah, Kwah Li Khim, Venugopalan Y Vishnu
Low- and middle-income countries (LMICs) suffer from a higher stroke burden compared to high-income countries with higher mortality and disability due to stroke. However, the availability of resources, both infrastructural and personnel, is widely discrepant. The lack of specialist neurologists or stroke physicians in LMICs makes it imperative to rely on alternative models of stroke care. Task-sharing models such as the physician-led model or the non-specialist model have been evaluated previously with evidence for feasibility and cost-effectiveness. We propose to implement and assess the effectiveness of a non-specialist model of stroke care across 3 LMICs through a structured capacity building program, augmented by a tailored mobile application to guide the non-specialists in delivering optimal stroke care. This study will provide essential information on the effectiveness of a non-specialist driven delivery of stroke care on a larger scale across different regional contexts.
{"title":"Establishing Organized Stroke Care in Low- and Middle-Income Countries: From Training of Non-specialist to Implementation","authors":"I. Sebastian, M. Demers, N. Yeghiazaryan, Wan Asyraf WZ, A. Nasreldein, U. Gopaul, M. Charalambous, S. Thilarajah, Kwah Li Khim, Venugopalan Y Vishnu","doi":"10.1177/25166085231158425","DOIUrl":"https://doi.org/10.1177/25166085231158425","url":null,"abstract":"Low- and middle-income countries (LMICs) suffer from a higher stroke burden compared to high-income countries with higher mortality and disability due to stroke. However, the availability of resources, both infrastructural and personnel, is widely discrepant. The lack of specialist neurologists or stroke physicians in LMICs makes it imperative to rely on alternative models of stroke care. Task-sharing models such as the physician-led model or the non-specialist model have been evaluated previously with evidence for feasibility and cost-effectiveness. We propose to implement and assess the effectiveness of a non-specialist model of stroke care across 3 LMICs through a structured capacity building program, augmented by a tailored mobile application to guide the non-specialists in delivering optimal stroke care. This study will provide essential information on the effectiveness of a non-specialist driven delivery of stroke care on a larger scale across different regional contexts.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89495302","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 : 2023-03-02DOI: 10.1177/25166085231155774
M. Muraleedharan, Alaka Omprakash Chandak
Time management is critical during the acute stage of acute coronary syndrome (ACS) and stroke. To understand the segments of delays and underlying factors which affect the delay, we conducted a questionnaire survey utilizing the segments of delays model, which is still in progress to reach a higher sample size. Variables, including socio-demographic characteristics, diagnosis, symptoms and severity, awareness, and past medical history, are included in the survey. Descriptive analysis and mapping of the delays were conducted to understand the study’s early findings. A comparison of delays during ACS and stroke shows a higher delay in stroke, especially during decision-making of the victim or family members to seek treatment. Also, the socioeconomic difference between ACS and stroke and the severity of symptoms in stroke are associated with delay.
{"title":"Early Findings of Segments of Delays Model Study: Delay in Seeking Treatment During Acute Coronary Syndrome and Stroke","authors":"M. Muraleedharan, Alaka Omprakash Chandak","doi":"10.1177/25166085231155774","DOIUrl":"https://doi.org/10.1177/25166085231155774","url":null,"abstract":"Time management is critical during the acute stage of acute coronary syndrome (ACS) and stroke. To understand the segments of delays and underlying factors which affect the delay, we conducted a questionnaire survey utilizing the segments of delays model, which is still in progress to reach a higher sample size. Variables, including socio-demographic characteristics, diagnosis, symptoms and severity, awareness, and past medical history, are included in the survey. Descriptive analysis and mapping of the delays were conducted to understand the study’s early findings. A comparison of delays during ACS and stroke shows a higher delay in stroke, especially during decision-making of the victim or family members to seek treatment. Also, the socioeconomic difference between ACS and stroke and the severity of symptoms in stroke are associated with delay.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75879648","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 : 2023-02-12DOI: 10.1177/25166085221150411
S. Verma, Puja Gulati, Sanjali Ratra, J. Pandian
Background Complexity of interventions and lack of methodological clarity makes process evaluations (PEs) challenging. Assessment of PEs conducted for complex stroke rehabilitation and nonpharmacologic secondary stroke prevention interventions is lacking with only one study conducted for the latter. To address this gap, we conducted a scoping review. Methods Development and reporting of review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Research questions were identified and search phrases developed according to keywords on 3 electronic databases: PubMed, Web of Science, and Cochrane Library. All titles and available abstracts were independently reviewed by 2 authors and disagreements settled by other authors. Inclusion criteria centered on complex secondary stroke nonpharmacologic prevention or a rehabilitation trial. Results Selected studies (n = 11) were derived from (n = 24) articles reporting on PE of main trial (n = 10). Studies are from 2015 onward with 9 studies for stroke rehabilitation and 1 from secondary stroke prevention, out of these 7 are randomized clinical trials. Medical Research Council’s framework was most widely used with common data collection method being interviews, surveys and log records. More than half of the studies are mobile health based which reveals future for stroke rehabilitation and stroke prevention interventions. We identified 3 themes on qualitative analysis of articles. Conclusion Paucity of relevant research studies indicates that more research should be carried out for PEs in stroke rehabilitation and prevention. Researchers in future may find guidance from this review where we support clarity on framework and its elements that helped to evaluate methodology.
{"title":"Assessment of Process Evaluations of Complex Stroke Rehabilitation and Secondary Stroke Prevention Trials—A Scoping Review","authors":"S. Verma, Puja Gulati, Sanjali Ratra, J. Pandian","doi":"10.1177/25166085221150411","DOIUrl":"https://doi.org/10.1177/25166085221150411","url":null,"abstract":"Background Complexity of interventions and lack of methodological clarity makes process evaluations (PEs) challenging. Assessment of PEs conducted for complex stroke rehabilitation and nonpharmacologic secondary stroke prevention interventions is lacking with only one study conducted for the latter. To address this gap, we conducted a scoping review. Methods Development and reporting of review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Research questions were identified and search phrases developed according to keywords on 3 electronic databases: PubMed, Web of Science, and Cochrane Library. All titles and available abstracts were independently reviewed by 2 authors and disagreements settled by other authors. Inclusion criteria centered on complex secondary stroke nonpharmacologic prevention or a rehabilitation trial. Results Selected studies (n = 11) were derived from (n = 24) articles reporting on PE of main trial (n = 10). Studies are from 2015 onward with 9 studies for stroke rehabilitation and 1 from secondary stroke prevention, out of these 7 are randomized clinical trials. Medical Research Council’s framework was most widely used with common data collection method being interviews, surveys and log records. More than half of the studies are mobile health based which reveals future for stroke rehabilitation and stroke prevention interventions. We identified 3 themes on qualitative analysis of articles. Conclusion Paucity of relevant research studies indicates that more research should be carried out for PEs in stroke rehabilitation and prevention. Researchers in future may find guidance from this review where we support clarity on framework and its elements that helped to evaluate methodology.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84836258","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 : 2023-02-07DOI: 10.1177/25166085231153237
G. Kuruttukulam, K. Sundar, Lomesh B Bhirud, Ajay Panwar, Paul J. Alapatt
Background The Indian data concerning the endovascular mechanical thrombectomy (MT) in acute ischemic strokes (AIS) with large vessel occlusion (LVO) is still scarce and evolving. Tenecteplase (TNK) has been recently approved for intravenous stroke thrombolysis prior to the MT. Methods This study is a single-center retrospective study. We performed data analysis of the AIS patients who consecutively presented during the study period with LVO and underwent thrombectomy. Procedural success was defined by the post-thrombectomy angiographic picture of grades 2b and 3 on modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary efficacy outcome was defined as an improvement of ≥4 points in National Institute of Health Stroke Scale (NIHSS) score at 24 h. Secondary efficacy outcome was based on modified Rankin Scale (mRS) score at 90 days. We also performed a comparative analysis of TNK and alteplase subgroups. Results Successful recanalization (mTICI 2b/3) was achieved in 65 (86.67%) patients. There was a significant mean difference between the NIHSS scores on admission and at 24 h (P < .001). Likewise, mRS score at 3 months also showed a significant mean difference as compared to baseline (P < .001). A faster recanalization was observed in those who were thrombolyzed with TNK, needed fewer number of passes, and if the procedure was performed under conscious sedation. Conclusion This study further strengthens the Indian data on efficacy and safety of MT in LVO ischemic strokes. Besides, whether the observation of TNK resulting in a faster revascularization is due to some factors unaccounted in our study, or an actual effect on thrombus due to a high fibrin specificity, needs to be tested further in larger randomized studies with matched sample sizes.
{"title":"Does Tenecteplase Before Mechanical Thrombectomy Result in a Faster Revascularization as Compared to Alteplase? Observations From a Comprehensive Stroke Care Center in Southern India","authors":"G. Kuruttukulam, K. Sundar, Lomesh B Bhirud, Ajay Panwar, Paul J. Alapatt","doi":"10.1177/25166085231153237","DOIUrl":"https://doi.org/10.1177/25166085231153237","url":null,"abstract":"Background The Indian data concerning the endovascular mechanical thrombectomy (MT) in acute ischemic strokes (AIS) with large vessel occlusion (LVO) is still scarce and evolving. Tenecteplase (TNK) has been recently approved for intravenous stroke thrombolysis prior to the MT. Methods This study is a single-center retrospective study. We performed data analysis of the AIS patients who consecutively presented during the study period with LVO and underwent thrombectomy. Procedural success was defined by the post-thrombectomy angiographic picture of grades 2b and 3 on modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary efficacy outcome was defined as an improvement of ≥4 points in National Institute of Health Stroke Scale (NIHSS) score at 24 h. Secondary efficacy outcome was based on modified Rankin Scale (mRS) score at 90 days. We also performed a comparative analysis of TNK and alteplase subgroups. Results Successful recanalization (mTICI 2b/3) was achieved in 65 (86.67%) patients. There was a significant mean difference between the NIHSS scores on admission and at 24 h (P < .001). Likewise, mRS score at 3 months also showed a significant mean difference as compared to baseline (P < .001). A faster recanalization was observed in those who were thrombolyzed with TNK, needed fewer number of passes, and if the procedure was performed under conscious sedation. Conclusion This study further strengthens the Indian data on efficacy and safety of MT in LVO ischemic strokes. Besides, whether the observation of TNK resulting in a faster revascularization is due to some factors unaccounted in our study, or an actual effect on thrombus due to a high fibrin specificity, needs to be tested further in larger randomized studies with matched sample sizes.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78493956","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 : 2022-11-14DOI: 10.1177/25166085221129024
Bryan Dalton, Mark Coyle, Paul Tansey, Clare Fallon, Vivek Raman, U. Healy
Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.
{"title":"Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation","authors":"Bryan Dalton, Mark Coyle, Paul Tansey, Clare Fallon, Vivek Raman, U. Healy","doi":"10.1177/25166085221129024","DOIUrl":"https://doi.org/10.1177/25166085221129024","url":null,"abstract":"Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82434489","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 : 2022-11-03DOI: 10.1177/25166085221131221
R. Bailey
Objective: To estimate adherence to the Mediterranean diet in a sample of chronic community-dwelling stroke survivors. Design: Cross-sectional survey. Participants: Convenience sample of 63 chronic (≥6 months) community-dwelling stroke survivors. Main Outcome Measure: MedDiet Score, a self-report screening tool that measures adherence to the Mediterranean diet based on consumption of 11 dietary components (ie, whole grains, potatoes, fruits, vegetables, legumes and nuts, fish and shellfish, red meat products and processed meat, poultry, full fat dairy, olive oil, and alcohol beverages), measured using a 6-point Likert scale (0 = low adherence, 5 = high adherence, max score = 55). Results: The mean MedDiet score was 27.2 ± 4.7; males scored higher than females (28.5 ± 4.9 vs 26.0 ± 4.2, P = .031). Participants reported more adherence for red meat products and processed meat, poultry, and full fat dairy and less adherence for whole grains, potatoes, fruits, vegetables, fish and shellfish, and alcoholic beverages. Conclusions: Adherence to the Mediterranean diet, a healthy dietary pattern recommended for secondary stroke prevention, was moderate in this sample of stroke survivors, and results were consistent with previous research on quality of dietary intake. Findings indicate the need for effective dietary interventions for stroke survivors to improve cardiometabolic health and reduce recurrent stroke risk.
目的:评估慢性社区卒中幸存者对地中海饮食的依从性。设计:横断面调查。参与者:63例慢性(≥6个月)社区居住卒中幸存者的便利样本。主要结果测量:MedDiet评分，这是一种自我报告筛选工具，根据11种饮食成分(即全谷物、土豆、水果、蔬菜、豆类和坚果、鱼类和贝类、红肉产品和加工肉类、家禽、全脂乳制品、橄榄油和酒精饮料)的摄入量来衡量地中海饮食的依从性，采用6分李克特量表(0 =低依从性，5 =高依从性，最高分= 55)进行测量。结果:MedDiet评分平均为27.2±4.7分;男性评分高于女性(28.5±4.9 vs 26.0±4.2,P = 0.031)。参与者报告说，他们更坚持食用红肉产品、加工肉类、家禽和全脂乳制品，而不太坚持食用全谷物、土豆、水果、蔬菜、鱼类和贝类以及酒精饮料。结论:地中海饮食是一种推荐用于二级卒中预防的健康饮食模式，在该卒中幸存者样本中，地中海饮食的依从性中等，结果与先前关于饮食摄入质量的研究一致。研究结果表明，需要对中风幸存者进行有效的饮食干预，以改善心脏代谢健康并降低卒中复发风险。
{"title":"Stroke Survivor Adherence to the Mediterranean Diet","authors":"R. Bailey","doi":"10.1177/25166085221131221","DOIUrl":"https://doi.org/10.1177/25166085221131221","url":null,"abstract":"Objective: To estimate adherence to the Mediterranean diet in a sample of chronic community-dwelling stroke survivors. Design: Cross-sectional survey. Participants: Convenience sample of 63 chronic (≥6 months) community-dwelling stroke survivors. Main Outcome Measure: MedDiet Score, a self-report screening tool that measures adherence to the Mediterranean diet based on consumption of 11 dietary components (ie, whole grains, potatoes, fruits, vegetables, legumes and nuts, fish and shellfish, red meat products and processed meat, poultry, full fat dairy, olive oil, and alcohol beverages), measured using a 6-point Likert scale (0 = low adherence, 5 = high adherence, max score = 55). Results: The mean MedDiet score was 27.2 ± 4.7; males scored higher than females (28.5 ± 4.9 vs 26.0 ± 4.2, P = .031). Participants reported more adherence for red meat products and processed meat, poultry, and full fat dairy and less adherence for whole grains, potatoes, fruits, vegetables, fish and shellfish, and alcoholic beverages. Conclusions: Adherence to the Mediterranean diet, a healthy dietary pattern recommended for secondary stroke prevention, was moderate in this sample of stroke survivors, and results were consistent with previous research on quality of dietary intake. Findings indicate the need for effective dietary interventions for stroke survivors to improve cardiometabolic health and reduce recurrent stroke risk.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90628909","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 : 2022-10-20DOI: 10.1177/25166085221122393
M. Nedunchelian, S. Varadharajan, Parvathy G, R. Iyer, M. Cherian, P. Mehta, Santosh Poyyamoli, Karthikeyan Ma, H. R. Nikhil
Recent studies have shown that diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI (DWI-FLAIR) mismatch is useful for thrombolytic treatment decisions in acute ischemic stroke. However, the role of partial mismatch in strategic locations among patients with evolving stroke has not been described before. Partial imaging mismatch involving strategic locations might indicate reversible ischemia, enabling thrombolysis even in those patients presenting in the extended time windows. In this report, we describe the partial strategic concept of DWI-FLAIR mismatch with case examples.
{"title":"DWI-FLAIR Mismatch in Stroke: “P.S.” (Partial Strategic Concept) for Clinical Practice","authors":"M. Nedunchelian, S. Varadharajan, Parvathy G, R. Iyer, M. Cherian, P. Mehta, Santosh Poyyamoli, Karthikeyan Ma, H. R. Nikhil","doi":"10.1177/25166085221122393","DOIUrl":"https://doi.org/10.1177/25166085221122393","url":null,"abstract":"Recent studies have shown that diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI (DWI-FLAIR) mismatch is useful for thrombolytic treatment decisions in acute ischemic stroke. However, the role of partial mismatch in strategic locations among patients with evolving stroke has not been described before. Partial imaging mismatch involving strategic locations might indicate reversible ischemia, enabling thrombolysis even in those patients presenting in the extended time windows. In this report, we describe the partial strategic concept of DWI-FLAIR mismatch with case examples.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88479125","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 : 2022-10-19DOI: 10.1177/25166085221126273
E. A., Satyam A., Sanchit Gupta, Prince Das, G. Krishna
Association between trivial head trauma and basal ganglia infarct has been reported frequently in the recent years. We present the case of an infant who presented with neurological deficits following trivial head trauma and in whom all the routine hematological and laboratory investigations were unremarkable. Nonenhanced computed tomography imaging of the brain demonstrated calcification of lenticulostriate arteries in bilateral gangliothalamic complexes with a hypodense area in the left lentiform nucleus centered around one of the calcified vessels consistent with an infarct. It is hypothesized that a severe persistent form of fetal sonographic lenticulostriate vasculopathy that later undergoes mineralization predisposes infants to thrombosis following infarct, precipitating an infarct. Mineralizing microangiopathy is an underlying cause of infantile stroke and generally carries a good prognosis.
{"title":"Mineralizing Microangiopathy of Lenticulostriate Arteries with Basal Ganglia Infarct in an Infant Following Trivial Trauma: A Case Report","authors":"E. A., Satyam A., Sanchit Gupta, Prince Das, G. Krishna","doi":"10.1177/25166085221126273","DOIUrl":"https://doi.org/10.1177/25166085221126273","url":null,"abstract":"Association between trivial head trauma and basal ganglia infarct has been reported frequently in the recent years. We present the case of an infant who presented with neurological deficits following trivial head trauma and in whom all the routine hematological and laboratory investigations were unremarkable. Nonenhanced computed tomography imaging of the brain demonstrated calcification of lenticulostriate arteries in bilateral gangliothalamic complexes with a hypodense area in the left lentiform nucleus centered around one of the calcified vessels consistent with an infarct. It is hypothesized that a severe persistent form of fetal sonographic lenticulostriate vasculopathy that later undergoes mineralization predisposes infants to thrombosis following infarct, precipitating an infarct. Mineralizing microangiopathy is an underlying cause of infantile stroke and generally carries a good prognosis.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88056205","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}
Introduction: Spontaneous intracerebral hemorrhage is the second most common type of stroke with high morbidity and mortality. Outcome prediction is very important in this disease, to enable us tailor treatment strategies especially in a low- and middle-income countries. Today, prediction is predominantly limited to few clinical factors and may not be very accurate. We explore the application of an artificial intelligence-based platform for outcome prediction with a combination of clinical, radiological, and biochemical parameters. Methods: Data from our prospectively maintained stroke register was cleaned and processed using the XGBoost machine learning (ML) algorithm to predict outcome at discharge and 90 days using the modified Rankin scale. A total of 1,000 patients were included in the study, 129 variables were pruned to 19 significant features during the phase of preprocessing. Results: The data set was split 9:1 with 900 cases being used for training and the remaining 100 for validation. The models were evaluated based on the mean absolute error (MAE). Model-1 trained for predicting “mRS_Discharge” had a MAE of 0.34 and model-2 trained for predicting “mRS_3months” had a MAE of 0.63. Conclusion: ML algorithms can be successfully applied for the prediction of outcome in intracerebral hemorrhage.
{"title":"Development of an Artificial Intelligence-Based Machine Tool to Predict Outcome in Intracerebral Hemorrhage","authors":"Girish Menon, Hareesha Ks, Karthik Gajula, Sampath Kumar, Ajay Hegde","doi":"10.1177/25166085221127861","DOIUrl":"https://doi.org/10.1177/25166085221127861","url":null,"abstract":"Introduction: Spontaneous intracerebral hemorrhage is the second most common type of stroke with high morbidity and mortality. Outcome prediction is very important in this disease, to enable us tailor treatment strategies especially in a low- and middle-income countries. Today, prediction is predominantly limited to few clinical factors and may not be very accurate. We explore the application of an artificial intelligence-based platform for outcome prediction with a combination of clinical, radiological, and biochemical parameters. Methods: Data from our prospectively maintained stroke register was cleaned and processed using the XGBoost machine learning (ML) algorithm to predict outcome at discharge and 90 days using the modified Rankin scale. A total of 1,000 patients were included in the study, 129 variables were pruned to 19 significant features during the phase of preprocessing. Results: The data set was split 9:1 with 900 cases being used for training and the remaining 100 for validation. The models were evaluated based on the mean absolute error (MAE). Model-1 trained for predicting “mRS_Discharge” had a MAE of 0.34 and model-2 trained for predicting “mRS_3months” had a MAE of 0.63. Conclusion: ML algorithms can be successfully applied for the prediction of outcome in intracerebral hemorrhage.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88432712","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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