Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome

Akhtar, Naveed; Kamran, Saadat; Elkhider, Hisham; Al-Makki, Soha; Mhjob, Noha; ElShiekh, Lubna; AlHussain, Hassan; Ali, Musab; Khodair, Rola; Wadiwala, Faisal; Salam, Abdul; Deleu, Dirk; Francis, Reny; Shuaib, Ashfaq

doi:10.1371/journal.pone.0231448

Cited by 2 publications

(3 citation statements)

References 39 publications

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“…Moreover, it is coherent with the previously detailed size issue [33]. Akhtar et al [20] reported the administration of rtPA among RSSI patients as follows: 213 did not receive rtPA, and 45 received it. In Eckert [17], 84 patients were included <3 h and 23 >3 h; rtPA was administered in 51 patients, 30 ≤ 3 h and 11 > 3 h. Interestingly, Rudilosso [23] reported false negatives in 37.5% of treated patients vs 18.8% of not treated patients.…”

Section: Discussionsupporting

confidence: 81%

“…The mean age ranges from 59.8 [6] to 72 years [16], with a women percentage ranging from 32 [14] to 53.1% [6], but with the half of studies ( 7) not reporting the information. In three studies [9,14,17], CTP was performed with a 16 rows scanner; in one study [17], a 40 rows scanner was used; in five studies [6,9,15,16,18], a 128 rows scanner was declared; in two studies [15,21], a 320 rows scanner was used allowing a whole brain perfusion approach and in one study [20] no technical detail was provided. A great variety of postprocessing software was reported, ranging from vendor machines tools [9,[16][17][18][19][23][24][25] to commercially available tools not related to individual vendor machines, such as Vitrea [21,21], RAPID [14], MIStar [15,23], F-STROKE [13].…”

Section: Resultsmentioning

confidence: 99%

“…If a mild variability emerges in the timing of CTP study from symptom onset because most patients were enrolled within routine hyperacute stroke pathways management, the eligibility for CTP was not the same in all studies. In Akhtar [20], 92 + 38 patients were studied by CTP, and the main reason for not doing CTP was a clinical diagnosis of small vessel (lacunar) stroke. In Campbell [10], the rate of patients undergoing CTP increased during the enrollment period.…”

Section: Discussionmentioning

confidence: 99%

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CT Perfusion in Lacunar Stroke: A Systematic Review

et al. 2023

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Background. The main theory underlying the use of perfusion imaging in acute ischemic stroke is the presence of a hypoperfused volume of the brain downstream of an occluded artery. Indeed, the main purpose of perfusion imaging is to select patients for endovascular treatment. Computed Tomography Perfusion (CTP) is the more used technique because of its wide availability but lacunar infarcts are theoretically outside the purpose of CTP, and limited data are available about CTP performance in acute stroke patients with lacunar stroke. Methods. We performed a systematic review searching in PubMed and EMBASE for CTP and lacunar stroke with a final selection of 14 papers, which were examined for data extraction and, in particular, CTP technical issues and sensitivity, specificity, PPV, and NPV values. Results. A global cohort of 583 patients with lacunar stroke was identified, with a mean age ranging from 59.8 to 72 years and a female percentage ranging from 32 to 53.1%.CTP was performed with different technologies (16 to 320 rows), different post-processing software, and different maps. Sensitivity ranges from 0 to 62.5%, and specificity from 20 to 100%. Conclusions. CTP does not allow to reasonable exclude lacunar infarct if no perfusion deficit is found, but the pathophysiology of lacunar infarct is more complex than previously thought.

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Section: Discussionsupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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CT Perfusion in Lacunar Stroke: A Systematic Review

et al. 2023

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Predictors of Early Neurological Deterioration Following Intravenous Thrombolysis

Somarajan¹,

Nair²,

Pillai³

et al. 2022

Annals of Indian Academy of Neurology

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Background: Prevention of early neurological deterioration (END) is becoming an important therapeutic target in acute ischemic stroke management. The aim of the study is to ascertain the causes and predictors of early neurological deterioration following thrombolysis and determine the predictive value of IScore. Methods: In this single center prospective study, we analyzed clinical, imaging and outcome data in 168 patients thrombolyzed intravenously ≤4.5 hours from onset of stroke. Early neurological deterioration was defined as worsening ≥2 points in the NIHSS score at 24 hours. Results: END occurred in 34 patients (20%) and caused significantly worse short term outcome. Ischemic END (ENDi) (n = 23) was twice as common as symptomatic hemorrhage (ENDh) (n = 11). Ischemia progression (n = 15) was the most common cause. Early malignant edema was another major cause. On multivariate analysis, significant predictors (p <.05) were proximal artery occlusion [all END (p <.001), ENDi and ENDh], previous ischemic insults (all END) and raised diastolic blood pressure (ENDh). ENDi was more common in those with carotid artery occlusion, large vessel disease and previous ischemic insults. ENDh was more common in those with raised diastolic blood pressure and NIHSS-ASPECTS mismatch. For patients with NIHSS <14, IScore >105 and for NIHSS ≥14, IScore >175 was associated with higher risk of END. Conclusion: END occurs in one fifth of patients after intravenous thrombolysis; ENDi outnumbers ENDh. Proximal artery occlusion is a major predictor for END. Potentially modifiable risk factors include admission hyperglycemia and elevated blood pressures. Distinct factors characterize ENDh and ENDi and can guide prevention and management strategies. IScore identifies patients at risk for END.

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Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome

Cited by 2 publications

References 39 publications

CT Perfusion in Lacunar Stroke: A Systematic Review

CT Perfusion in Lacunar Stroke: A Systematic Review

Predictors of Early Neurological Deterioration Following Intravenous Thrombolysis

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