Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture.
Materials and methods:This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated.
Results:The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSD of the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship was determined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and 81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm.
Conclusion:This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used to support the diagnosis and evaluation of patients with acute stroke.
Introduction and Aim
Stroke is the leading cause of disability in adults and the second most common cause of death, at a rate of 11.8% worldwide. The purpose of this study was to examine the aetiological, demographic, and clinical characteristics of patients admitted to hospital because of acute strokes.
Materials and Methods
This multicentre study retrieved information for all patients admitted to hospital because of an acute cerebrovascular event over a six‐month period, and sociodemographic, aetiological, and clinical characteristics were recorded.
Results
A total of 1136 patients, 520 of whom were women (45.7%), with a mean age of 70.3 ± 12.8 years, were included in the study. Of these, 967 were diagnosed with ischaemic stroke (IS) (85.1%), 99 with haemorrhagic stroke (HS) (8.7%), and 70 with transient ischaemic attack (6.1%). The most common risk factor for stroke was hypertension (73%). Carotid disease and hyperlipidaemia rates were higher in patients with HS. Numbers of functionally dependent patients with severe neurological status according to the National Institutes of Health Stroke Scale and modified Rankin scale were significantly higher in the HS group (P < .001). When IS was classified according to the Trial of Org 10172 in Acute Stroke Treatment, small vessel disease emerged as the most common cause (41%). The most common lesion localisations were the parietal lobe (23%) in the IS group and the thalamus (35.3%) in the HS group. Eighty‐eight patients (7.7%), 62 (6.4%) in the ischaemic subgroup, and 26 (26.3%) in the haemorrhagic subgroup, died within the first month.
Conclusion
Current and accurate evaluations of stroke aetiology are essential for stroke prevention and treatment planning. This study, shows that no change occurred in the aetiology of stroke and epidemiological characteristics and that accurate identification of modifiable stroke risk factors is still a major goal.
Aim of study
The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department.
Patients and methods
The study was designed as a multicentre cross‐sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients’ laboratory tests performed at the time of presentation to the emergency department.
Results
Seven hundred and thirty‐five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P = .001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR.
Conclusion
The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke’ severity.
Background/aim: To investigate the consistency between stroke and general neurologists in subtype assignment using Trial of ORG-10172 using Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems.
Materials and methods: Fifty consecutive, acute ischemic stroke patients admitted to Stroke Unit were recruited. Patients were classified two stroke and two general neurologists, each from different medical centers, according to TOAST followed by CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using Kappa(ĸ)-value.
Results: Kappa(ĸ)-value of diagnostic compliance between stroke neurologists was 0.61 (95%CI 0.45-0.77) for TOAST and 0.78 (95%CI 0.62-0.94) for CSS-5. Kappa(ĸ)-value was 0.64 (95%CI 0.48–0.80) for TOAST and 0.75 (95%CI 0.60–0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ:0.59 (95%CI 0.52–0.65)] in TOAST and was strong [ĸ:0.75 (95%CI 0.68–0.81)] in CCS-5 for all 4 neurologists. ‘Cardioembolism’(91.04%) has reached the highest compliance in both systems. The frequency of group with ‘undetermined etiologies’ was less in CCS (26%) compared to TOAST.
Conclusions: The CCS system improved the compliance in both stroke and general neurologists compared with TOAST. These suggest that automatic, evidence-based, easily reproducible CCS system was superior to TOAST system.
Keywords: TOAST, CCS, Ischemic stroke, Etiology
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