Intraoperative sensory cortical mapping is a reliable and safe method for the functional localization of the central sulcus (CS). It is utilized during neurosurgical procedures performed near eloquent brain tissue. It helps in identifying the somatosensory cortex and CS, hence preventing any postoperative neurological deficits. When executed properly, this method can identify the somatosensory cortex for both the upper and lower limbs by locating the CS. This technical report outlines the benefits of cortical sensory mapping (CsM) and detailed methodology. With the help of a properly trained intraoperative neuromonitoring staff who can accurately interpret the signals being monitored, CsM can help in injury prevention during brain surgeries.
Background: Post-stroke delirium (PSD) is associated with increased mortality and worse long-term functional outcomes. Patients who receive reperfusion therapies in the hospital are frequently kept from regular sleep-wake cycles the first 24 hrs after treatment, and this disruption could lead to an increase in PSD. In this study, we evaluate the effect of PSD on immediate and long-term outcomes in AIS patients receiving reperfusion therapies. Methods: Between September 2019 and June 2021, pts diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for PSD using the Confusion Assessment Method (CAM)-ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Reperfusion therapies were defined as any IV thrombolytic, IA thrombolytic, or mechanical thrombectomy (MT). The primary outcome was considered a 90-day mRS score of 0-2. Results: Of 179 patients assessed with the CAM-ICU, 89 (49.7%) had PSD. We identified 94 patients that had undergone one or both reperfusion therapies; 52 (55.3%) had delirium. Patients who received tPa had a higher risk for delirium (42 vs 29, p = 0.04), but no difference was observed with MT (Table 1). Patients with PSD had a longer hospital length of stay and a higher median admission NIHSS. Patients with delirium who received tPA were more likely to be discharged to inpatient rehabilitation facilities than home (p-value 0.004, OR 10.1 95%CI 2.1,48). No significant difference was found in 90-day modified ranking scale (mRS) scores of 0-2 in those with or without PSD. Conclusion: AIS patients with PSD after reperfusion therapy had no significant difference in 90-day good outcomes despite having longer hospital admissions and being less likely to be discharged home. Further evaluation into how reperfusion therapies convey protection to patients is necessary.
Background: Post stroke cognitive impairment (PSCI) can be as high as 15-70% after stroke depending on the patient population and diagnostic tool. Few studies on PSCI have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI in the current population. Methods: We analyzed Cerner Health Facts® EMR database, which is comprised of de-identified EHR data from over 700 hospitals and clinics in the US from 2000-2018. We evaluated patients ≥40 years of age with a first time acute ischemic stroke (AIS) diagnosis using ICD9/10 codes. PSCI was defined as pts with ICD 9/10 codes for dementia, mild cognitive impairment, or on medications for dementia. Pts with first stroke in the Cerner database and no pre-existing cognitive impairment were included; those with no follow-up visits in the system were excluded. We compared hazard ratios for developing PSCI for patient characteristics. Results: A total of 211,622 AIS pts were evaluated, of which 153,078 had follow-up data in the system and no prior diagnosis of PSCI. Among these, the rate of PSCI was 9.29%. Most pts qualified under PSCI using dementia ICD codes (15,280) compared to mild cognitive impairment codes (4,321) or medication usage (1,032). Median time to PSCI diagnosis was at their first follow-up visit within the first year after stroke. Pts ≥65 years of age at time of stroke (HR 2.95, 95% CI 2.83,3.07) and of African American race (HR 1.37, 95% CI 1.31,1.46) were more likely to develop dementia. There were no disparities for developing PSCI between Hispanic and non-Hispanic pts (HR 0.89, 95% CI 0.69, 1.16). Male pts were less likely to develop PSCI than female counterparts (HR 0.84, 95% CI 0.81,0.87). Conclusion: Our analyses highlight the viability of utilizing large administrative databases to assess trends in PSCI diagnosis. The number of pts with PSCI may be underestimated however, given the importance of EHR records in patient care, this suggests PSCI is under-diagnosed in the community. Previously described racial disparities for black survivors persisted but male patients had less PSCI. Further study into other administrative databases is necessary to assess if these data are consistent in other EHR systems and to evaluate new trends in PSCI diagnosis and treatment.
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