BackgroundWe aimed to develop a tool, the hemorrhagic transformation (HT) index (HTI), to predict any HT within 14 days after middle cerebral artery (MCA) stroke onset regardless of the intravenous recombinant tissue plasminogen activator (IV rtPA) use. That is especially important in the light of missing evidence-based data concerning the timing of anticoagulant resumption after stroke in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed 783 consecutive MCA stroke patients. Clinical and brain imaging data at admission were recorded. A follow-up period was 2 weeks after admission. The patients were divided into derivation (DC) and validation (VC) cohorts by generating Bernoulli variates with probability parameter 0.7. Univariate/multivariate logistic regression, and factor analysis were used to extract independent predictors. Validation was performed with internal consistency reliability and receiver operating characteristic (ROC) analysis. Bootstrapping was used to reduce bias.ResultsThe HTI was composed of 4 items: Alberta Stroke Program Early CT score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), hyperdense MCA (HMCA) sign, and AF on electrocardiogram (ECG) at admission. According to the predicted probability (PP) range, scores were allocated to ASPECTS as follows: 10–7 = 0; 6–5 = 1; 4–3 = 2; 2–0 = 3; to NIHSS: 0–11 = 0; 12–17 = 1; 18–23 = 2; >23 = 3; to HMCA sign: yes = 1; to AF on ECG: yes = 1. The HTI score varied from 0 to 8. For each score, adjusted PP of any HT with 95% confidence intervals (CI) was as follows: 0 = 0.027 (0.011–0.042); 1 = 0.07 (0.043–0.098); 2 = 0.169 (0.125–0.213); 3 = 0.346 (0.275–0.417); 4 = 0.571 (0.474–0.668); 5 = 0.768 (0.676–0.861); 6 = 0.893 (0.829–0.957); 7 = 0.956 (0.92–0.992); 8 = 0.983 (0.965–1.0). The optimal cutpoint score to differentiate between HT-positive and negative groups was 2 (95% normal-based CI, 1–3) for the DC and VC alike. ROC area/sensitivity/specificity with 95% normal-based CI for the DC and VC were 0.85 (0.82–0.89)/0.82 (0.73–0.9)/0.89 (0.8–0.97) and 0.83 (0.78–0.88)/0.8 (0.66–0.94)/0.87 (0.73–1.0) respectively. McDonald’s categorical omega with 95% bias-corrected and accelerated CI for the DC and VC was 0.81 (0.77–0.84) and 0.82 (0.76–0.86) respectively.ConclusionsThe HTI is a simple yet reliable tool to predict any HT within 2 weeks after MCA stroke onset regardless of the IV rtPA use.
We present five cases of syringomyelia associated with Chiari I or other causes of partial obstructions at the cervicomedullary junction, with spontaneous disruption of the wall of a cervical syrinx and formation of a communication between the cavity and the subarachnoid space, shown on axial MRI. MRI can be used to investigate the hydrodynamics, showing the liquid inside the disrupted syrinx wall and the pathway of drainage. The finding of spontaneous drainage may be important for understanding the pathogenesis of syringomyelia and may be helpful for choosing a surgical approach.
org/10.14412/2074-2711-2015-4-37-41 Необычная причина инсульта: церебральная дуральная артериовенозная фистула У пациентов с острым нарушением мозгового крово-обращения без значимых факторов риска всегда трудно оп-ределить причину заболевания, особенно если имеющиеся рутинные тесты не выявляют какого-либо этиологического фактора. В таких случаях, как правило, сложно выработать правильную стратегию вторичной профилактики, что ведет к высокой частоте рецидивов, стойкой утрате трудоспособ-ности и смерти. Осведомленность о необычных причинах инсульта важна для дифференциальной диагностики и пла-нирования дальнейшего диагностического поиска. Одной из таких причин является дуральная артериовенозная фис-тула (ДАВФ) -заболевание, диагностика которого базиру-ется исключительно на методах нейровизуализации.Церебральная ДАВФ -это патологический шунт меж-ду артериями твердой мозговой оболочки (ТМО) и веноз-ными синусами, менингеальными или кортикальными ве-нами. Среди всех интракраниальных артериовенозных мальформаций (АВМ) ДАВФ встречаются в 10-15% случа-ев, хотя точная ее частота неизвестна -в большинстве на-блюдений заболевание протекает бессимптомно. Фистулы следует отличать от паренхиматозных или пиальных АВМ по наличию питающей артерии от ТМО и отсутствию сосу-дистого клубка в паренхиме мозга. Большинство ДАВФ ма-нифестируют в зрелом возрасте и располагаются в попереч-ном, сигмовидном или кавернозном синусах. Дебют ДАВФ с агрессивных неврологических симптомов более характе-
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