Higher mRS Scores Research Articles

Retrospective Evaluation of Patients with Spontaneous Intracerebral Hematomas

To investigate the relationship among the modified Rankin scores of patients who had intracerebral hematomas at discharge, demographic characteristics of the patients, and the characteristics of the hematoma. In this study, patients diagnosed with intracerebral hematoma and treated at the Ministry of Health Ankara Training and Research Hospital Neurosurgery Clinic between January 2010 and December 2020 were examined retrospectively. The age, gender, comorbidity, anticoagulant?antiaggregant use, and Glasgow Coma Scale score of the patients were obtained from hospital records. The modified Rankin scale (mRS) was used to assess patients at discharge. Herein, a total of 114 patients with supratentorial intracerebral hematoma were evaluated. The modified Rankin score ranged from 0 to 6, with a mean score of 3.47 ± 2.26. When the patients were evaluated based on their discharge status, the mortality rate was 33.3% (n=38). Fifty percent of the patients who used anticoagulant?antiaggregant died. High mRS scores were seen more frequently in advanced age. Among the other diseases of the patients, hypertension and the use of anticoagulant? antiaggregant were found to be statistically significant with high mRS scores (p < 0.001). Patients with low Glasgow Coma Scale score at the time of admission had significantly higher mRS scores (p < 0.001). Patients with advanced age, hypertension, and anticoagulant?antiaggregant use had a higher mRS score after hematoma formation. Preventable risk factors for spontaneous intraparenchymal hematomas are among the leading causes of disability, and early detection and treatment of underlying diseases are critical for hematoma prevention. Awareness about risk factors should be the priority to improve early diagnosis and reduce treatment disability rates.

A study of the prognostic significance of platelet distribution width, mean platelet volume, and plateletcrit in cerebral venous sinus thrombosis.

Platelets play a key role in thrombus formation and propagation and are thus implicated in the pathogenesis and morbidity of cerebral venous sinus thrombosis (CVST). A whole blood count can be used to objectively measure platelet function through platelet indices, namely, platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit. This study examined how platelet indices (PDW,MPV, and plateletcrit) affect the CVST severity and functional outcome. In this prospective, longitudinal, and observational study, 66 patients with CVST from a tertiary care referral center were enrolled. A complete blood count including platelet indices was obtained using an automated hematology analyzer. Patients with and without parenchymal abnormalities on brain imaging were classified as having severe and non-severe CVST, respectively. The modified Rankin Scale (mRS) was used to examine functional outcomes at admission and after 90 days. The patients were categorized into low mRS (0-1) and high mRS (2-6) functional groups. The patients with severe CVST were older (P < 0.05) and exhibited abnormally large PDW (P < 0.05) which were statistically significant. Severe CSVT also had poor functional outcome score both at admission (P < 0.05) and 90 days later (P < 0.05) which were statistically significant. Multiple logistic regression analysis concluded age and PDW as the independent predictors of severe CVST (P < 0.05). In receiver operating characteristic curve analysis, a cutoff value of 16.5 for PDW could predict CVST severity (P < 0.05). Patients with high mRS scores at admission had significantly larger PDW. At 90 days, no association was noted between PDW and mRS scores. MPV and plateletcrit levels were similar in both the severe and non-severe CVST groups and exerted no effect on functional outcomes. PDW was significantly and inversely related to plateletcrit (P < 0.05). Severe CVST and PDW had a positive correlation. During the early phases of admission, PDW levels above a particular threshold were associated with poor functional outcomes; however, no such association was observed after 90 days. MPV and plateletcrit exerted no effect on CVST severity and prognosis.

Effect of blood pressure on the prognosis of acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization

PurposeTo explore the effect of blood pressure on the prognosis of acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization. MethodsAcute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization were retrospectively collected. All patients were divided into the functional independent group and non-functional independent group, death group and non-death group based on the 90-day mRS score. Logistic regression was applied to analyze the relationship between the highest systolic blood pressure, the average systolic blood pressure, the lowest systolic blood pressure, the highest diastolic blood pressure, the average diastolic blood pressure, the lowest diastolic blood pressure in the first 24 h after admission and the functional prognosis as well as the complications after 90 days. The independent impact factors selected from regression analysis were used to investigate the blood pressure with prognostic value by receiver operating characteristic curve (ROC). ResultsA total of 70 patients were recruited in this study. Among them, 39 cases (55.71%) were male and 31 cases (44.29%) were female, with a mean age of 61.83 ± 15.24 years old. 15 cases (21.43%) had a favorable 90-day outcome, and the other 55 cases (78.57%) had a higher mRS Score. After a 90-day follow-up, univariate analysis showed that hypertension and hyperlipidemia, highest systolic blood pressure, mean systolic blood pressure and NIHSS score were statistically significant in two groups with or without functional independence, while the NIHSS score at admission, systolic blood pressure at admission, average systolic blood pressure, highest systolic blood pressure and diastolic blood pressure were statistically significant in patients with death outcomes (P < 0.05). Multivariate regression analysis suggested that the highest systolic blood pressure was statistically significant (P < 0.05), the further ROC curve results showed the cut-off value of the highest systolic blood pressure was 180.5 mmHg, with a sensitivity of 82.35% and a specificity of 81.13%. The highest Youden's index was 0.6348. ConclusionFor acute ischemic stroke patients caused by anterior circulation large vessel occlusion without recanalization, the appropriate reduction of blood pressure within 24 h after admission may have a positive effect on the clinical prognosis. The 90-day mortality of acute ischemic stroke patients without revascularization was independently related to the highest systolic blood pressure. The risk of death was increased when the highest systolic blood pressure was greater than 180.5 mmHg.

Long-Term Functional Outcome and Quality of Life After Surgical Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Results from a Swedish Nationwide Cohort

To investigate long-term survival, neurologic outcome, and quality of life in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) treated with craniotomy and hematoma evacuation. A nationwide multicenter retrospective analysis of 341 patients who underwent craniotomy and evacuation of supratentorial ICH between January 1, 2011, and December 31, 2015, was performed. Baseline characteristics associated with 6-month mortality and long-term mortality were investigated. Survivors received a questionnaire about their state of health from which EuroQol 5D (EQ-5D) and modified Rankin scale (mRS) were obtained. Predictors of mortality, unfavorable outcome, and life quality were analyzed. The mean follow-up time was 55.2 months. Predictors of 6-month mortality in multiple regression analysis were age ≥75 years, previous myocardial infarction, lower level of consciousness, and mechanical ventilation. Predictors of long-term mortality were higher age and mechanical ventilation. At follow-up, 49.5% of survivors had a favorable neurologic outcome (mRS ≤3). Predictors of an unfavorable functional outcome were higher age and ICH volume ≥50 mL. The mean EQ-5D health index was 0.719, and the mean EQ-5D visual analog scale score was 53.9. In multiple regression, only a higher mRS score was significantly associated with worse life quality. Knowledge about survival, functional outcome, and life quality as well as their predictors in this specific patient group is previously primarily described in short-term follow-up. This multicenter study provides novel information in the long-term perspective, which is important for improved surgical decision-making and prognostication.

COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience.

The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases. A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality. Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months. Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.

Impact of delirium on the outcome of stroke: a prospective, observational, cohort study

IntroductionDelirium is an acute fluctuating disorder of attention and awareness, which often complicates the clinical course of several conditions, including acute stroke. The aim of the present study was to determine whether delirium occurrence impacts the outcome of patients with acute stroke.MethodsThe study design is single center, prospective, observational. We consecutively enrolled patients admitted to the stroke unit from April to October 2020. Inclusion criteria were age ≥ 18 years and diagnosis of acute stroke. Exclusion criteria were stroke mimics, coma, and terminal conditions. All patients were screened for delirium upon admission, within 72 h, and whenever symptoms suggesting delirium occurred by means of the Confusion Assessment Method for Intensive Care Unit and the Richmond Agitation Sedation Scale. Outcomes were evaluated with the 90-days modified Rankin Scale (mRS) by telephone interview.ResultsThe final study cohort consisted of 103 patients (62 men; median age 75 years, interquartile range 63–81). Thirty-one patients (30%) developed delirium. In the multivariate ordinal logistic regression, patients with delirium had higher mRS scores at 3 months (DLR + : mRS = 4 (3–6); DLR–: mRS = 1 (1–3); adjusted odds ratio = 4.83; CI = 1.88–12.35; p = 0.006). Delirium was a risk factor for death (mRS = 6) in the univariate logistic regression (OR 4.5, CI = 1.44–14.07; p = 0.010), but not in the adjusted analysis (OR 3.45; CI = 0.66–17.95; p = 0.142). Survival time during 90-days follow-up was shorter in the delirium group (Log Rank χ2 3.89; p = 0.048).ConclusionDelirium negatively impacts the prognosis of patients with acute stroke. Patients with post-stroke delirium have a worse functional outcome and a shorter survival.

A Study of the Prognostic Significance of Platelet Distribution Width, Mean Platelet Volume, and Plateletcrit in Cerebral Venous Sinus Thrombosis

Abstract Background Platelets play a vital role in thrombus formation and propagation and are thus implicated in the pathogenesis and morbidity of cerebral venous sinus thrombosis (CVST). A whole blood count can be used to objectively measure platelet function through platelet indices, namely platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit. Objective This study examined how platelet indices (PDW, MPV, and plateletcrit) affect the CVST severity and functional outcome. Methodology In this prospective, longitudinal, observational study, 66 patients with CVST from a tertiary care referral center were enrolled. A complete blood count including platelet indices was obtained using an automated hematology analyzer. Patients with and without parenchymal abnormalities on brain imaging were classified as having severe and nonsevere CVST, respectively. The modified Rankin Scale (mRS) was used to examine functional outcomes at admission and after 90 days. The patients were categorized into low mRS (0–1) and high mRS (2–6) functional groups. Results The patients with severe CVST were older (p &lt; 0.05) and exhibited abnormally large PDW (p &lt; 0.05) which were statistically significant. Severe CSVT also had poor functional outcome score both at admission (p &lt; 0.05) and 90 days later (p &lt; 0.05) which were statistically significant. Multiple logistic regression analysis concluded age and PDW as the independent predictors of severe CVST (p &lt; 0.05). In receiver operating characteristic curve analysis, a cut-off value of 16.5 for PDW could predict CVST severity (p &lt; 0.05). Patients with high mRS scores at admission had significantly larger PDW. At 90 days, no association was noted between PDW and mRS scores. MPV and plateletcrit levels were similar in both the severe and nonsevere CVST groups and exerted no effect on functional outcomes. PDW was significantly and inversely related to plateletcrit (p &lt; 0.05). Conclusion Severe CVST and PDW had a positive correlation. During the early phases of admission, PDW levels above a particular threshold were associated with poor functional outcomes; however, no such association was observed after 90 days. MPV and plateletcrit exerted no effect on CVST severity and prognosis.

Clinical Characteristics and Short-Term Prognosis of Children With Antibody-Mediated Autoimmune Encephalitis: A Single-Center Cohort Study.

BackgroundThe incidence and prevalence of autoimmune encephalitis (AE) is gradually increasing in pediatric patients (between the ages of 3 months and 16 years). The aim of this retrospective observational study was to investigate the clinical characteristics and short-term prognosis of children with antibody-mediated AE at Hunan Children's Hospital.MethodsAntibody analysis of blood and/or cerebrospinal fluid was performed in suspected AE patients admitted to the Department of Neurology, Hunan Children's Hospital from June 2014 to June 2021. Ultimately, 103 patients were diagnosed with antibody-mediated AE and were enrolled in this study. Clinical data and corresponding demographic, clinical characteristics, laboratory and imaging data, treatment, and prognosis data were collected and analyzed.ResultsIn our study, 103 AE patients with antibody-positive were identified. The main subtype of AE in our cohort was anti-NMDAR encephalitis. Few patients have anti-CASPR2 encephalitis, anti-GABABR encephalitis, or anti-LGI1 encephalitis. In our AE patients, the most common clinical manifestations were behavioral symptoms, seizures, and involuntary movements, with seizures being the most common initial symptom. All patients underwent brain magnetic resonance imaging (MRI) and electroencephalography (EEG). Forty-five (43.7%) patients had abnormal MRI findings. And 96 (93.2%) patients had abnormal EEG results. All 103 patients were given first-line immunotherapy, 21 of which were also treated with the combination of the second-line immunotherapy. All surviving patients were followed up for at least 6 months. Seventy-seven patients recovered completely, 23 had sequelae of different degrees, and 3 died. Eight patients had one or more relapses during the follow-up period.ConclusionsAE is a treatable disease that can occur in children of all ages. The mortality rate is low, as most patients have a good response to immune therapy. Compared with the older children, infants and young children (≤ 3 years old) with anti-NMDAR encephalitis have a higher incidence of fever and status epilepticus, more severe condition, higher PICU admission rate and worse prognosis. AE patients with high maximum mRS scores and PICU admissions may require second-line immunotherapy.

Increased Neutrophil elastase and proteinase 3 are closely associated with occurrence and severity of stroke and acute myocardial infarction in patients with type 2 diabetes mellitus

AimsThe role of Neutrophil elastase (NE) and proteinase 3 (PR3) in the occurrence and severity of stroke and acute myocardial infarction (AMI) have not been explored in type 2 diabetes mellitus (T2DM). This study aimed to investigate the relationship and predictive ability of NE and PR3 in the development of stroke and AMI in patients with T2DM, and to explore the pattern of NE and PR3 in atherosclerotic plaques. Methods465 patients with T2DM (stroke or AMI, n = 234; non stroke or AMI, n = 231) were recruited. Clinical characteristics, and NE and PR3 concentration were measured in all subjects. Semi-quantitative analysis of immunohistochemistry staining for NE and PR3 was performed in detached emboli and stable plaques. ResultsPatients with stroke or AMI had a higher level of NE and PR3, with a more pronounced increase in more severe cases (higher mRS score in stroke and Gensini score in AMI) and associated with clinical markers. An increase in NE and PR3 was an independent risk factor for stroke (OR = 4.318, P = 0.017; OR = 2.979, P = 0.048, respectively) and AMI (OR = 8.385, P = 0.015; OR = 5.540, P = 0.047). Finally, immunohistochemistry staining revealed that the NE and PR3 positive area increased significantly in detached emboli compared with stable plaques. ConclusionIncreased NE and PR3 was associated with occurrence and severity of stroke and AMI in patients with T2DM. Enriched NE and PR3 in detached emboli may be associated with plaque vulnerability.

Free Triiodothyronine Is Associated with Poor Outcomes after Acute Ischemic Stroke.

Aims It is unclear whether thyroid hormones are associated with functional outcomes after ischemic stroke. We aimed to investigate the impact of serum levels of thyroid hormones at admission on functional outcomes at 3 months after acute ischemic stroke. Methods A total of 480 consecutive patients with ischemic stroke who were admitted to our hospital within 48 h of onset were enrolled. The levels of thyroid hormones, including thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine, were measured at admission, and functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with scores ranging from 0 to 6. Poor outcome was defined as mRS score ≥3. Results FT3 levels at admission were considerably lower in patients with poor outcomes than in those with good outcomes at 3 months (3.53 ± 0.70 pmol/L vs. 4.04 ± 0.68 pmol/L; P < 0.001). Lower FT3 levels were observed in patients with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with a risk of poor outcomes at 3 months, independent of conventional risk factors such as age, National Institutes of Health Stroke Scale score, and recanalized therapy. In addition, patients in FT3 levels in the lowest quartile had a 2.56-fold higher risk of poor outcomes than those with FT3 levels in the highest quartile (odds ratio = 2.56, 95% confidence interval = 1.15–5.69, P=0.021). The sensitivity and specificity of FT3 level ≤3.69 pmol/L for predicting poor outcomes were 62.70% and 72.03%, respectively. Conclusion Our study suggests that FT3 levels at admission are significantly and independently associated with a risk of poor outcomes after ischemic stroke and that lower FT3 levels can be considered as a prognostic biomarker for poor outcomes at 3 months.

Abstract 115: Predictors Of Post-stroke Depression And Suicidal Ideation Among Acute Stroke Survivors

Introduction: Approximately a third of stroke survivors are diagnosed with Post-Stroke Depression (PSD) and half are more likely to commit suicide compared to the general population. The aim of this study was to examine the relationship between demographic and clinical variables and PSD and suicidal ideation among post-stroke survivors. Methods: This was a retrospective review of a clinical registry from a comprehensive stroke center between 10/2018 and 3/2020. Patients were eligible if a Patient Health Questionnaire 9-Item (PHQ-9) was available. Question 9 of the PHQ-9 was screened for suicidal ideation. Results: The study cohort consisted of a total of 194 patients who had an acute (primarily ischemic or intracerebral) stroke who completed a 90-day telephonic PHQ-9. The mean age (years) and NIH Stroke Scale were 64 ± 15 and 7.4 ± 7.3, respectively. The sample was comprised of 56% men, 39% Whites, 31% Blacks, 27% Asians, and 10% Hispanics. The mean PHQ-9 score was 5.9 ± 6.3. Seven percent reported suicidal ideation. Univariate analysis revealed that pre-stroke depression history and 90-day post-dicharge mRS scores were significantly associated with PHQ-9 scores (p=0.005 and p=0.003, respectively). After adjusting for age, stroke type, NIHSS arrival score, pre-morbid mRS score, mRS score at 7 days, and hospital length of stay, multiple linear regression analysis with bootstrap estimates found that pre-stroke depression and 90-day post-dicharge mRS scores remained significant (p&lt;0.001 and p=.004, respectively; see Table 1). Although both days 7 (p=0.014) and 90 (p=0.049) mRS scores were found to be significantly different than those with and without suicidal ideation, the effect size in patients with suicidal ideation was larger for day 90 (d=.66) than for day 7 (d=.36) mRS scores. Conclusion: Patients with a history of depression and those with higher mRS scores at 90 days should be screened for suicidal ideation and actively managed for depression.

Olfactory impairment in autoimmune encephalitis: another piece of the puzzle.

BackgroundDespite being long neglected, olfaction has recently become a focus of intense research in neuroscience, as smell impairment has been consistently documented in both neurodegenerative and neuroinflammatory diseases. Considering the close anatomo-functional correlations between the limbic system and the central olfactory structures, we investigated olfaction in a population of patients with autoimmune encephalitis (AE).MethodsNineteen adult subjects (14 males, median age 64 years) diagnosed with definite (14/19) or possible (5/19) AE and followed for ≥ 6 months were enrolled. The Brief Smell Identification Test (B-SIT), a 12-item, forced-choice, scratch-and-sniff measure, was used to assess the patients’ olfactory function in comparison with a group of sex- and age-matched healthy controls (HC). According to the B-SIT score, subjects were classified as anosmic (< 6), hyposmic (6–8) and normal (≥ 9). Electro-clinical, laboratory and neuroimaging findings were reviewed.ResultsSmell impairment was revealed in 15/19 patients (9 hyposmic, 6 anosmic), compared with 5/19 HC (p = 0.0029). Age, gender and smoking habits did not affect the participants’ performance at B-SIT. Olfactory dysfunction appeared more common among patients with definite AE (p = 0.0374), regardless of autoantibody status. Subjects with higher modified Rankin Scale (mRS) scores at AE onset more likely presented hyposmia/anosmia (p = 0.033), and so did those with bilateral ictal/interictal EEG abnormalities (p = 0.006).ConclusionsWe found olfaction to be impaired in a significantly large proportion of AE cases. Smell deficits appeared more common in subjects with severe AE (as indicated by both definite diagnosis and higher mRS score), and might represent an additional feature of immune-mediated encephalitis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-022-10959-6.

Functional Outcomes of Microsurgical Resection for Cavernous Malformations of the Brainstem.

Long-term functional outcomes of microsurgical resection for cavernous malformations of the brainstem (CMB) have been largely unknown. Favorable outcomes after CMB surgery might be related to the achievement of complete resection and mRS at 1month after the surgery. Preoperative sensory, cerebellar, trigeminal nerve, and lower cranial nerve symptoms tended to improve after surgery.We evaluated 25 consecutive patients with CMB surgically treated at our center between 2006 and 2021. The subjects included 11 men and 14 women, with ages ranging from 13 to 61years (mean±SD=37±12years). Modified Rankin Scale (mRS) scores and neurological symptoms of the patients were evaluated before surgery, 1month after surgery, and at the final follow-up at the outpatient clinic. The mean number of previous hemorrhages was 7±1.0 and the mean lesion size was 21±8 mm. The mRS scores on admission and at the final follow-up were 2.9 points and 1.7 points, respectively. The mRS scores at the final follow-up were significantly improved compared to those on admission. There was no statistical difference between the preoperative mRS and mRS at 1month after the operation. Multivariable analysis indicated that mRS scores at 1month after surgery were the most significant predictive factors for favorable outcomes. Complete resection was achieved in 24 of 33 operations. Incomplete resection was significantly related to the frequency of subsequent recurrent hemorrhage and high mRS scores at the final follow-up. Preoperative sensory, cerebellar, trigeminal nerve, and lower cranial nerve symptoms improved significantly after surgery.

Predictors of outcome in spontaneous intracerebral hemorrhage with special reference to hyponatremia

Objective: The study was done to find the various clinical, biochemical and radiological predictors of outcome in spontaneous intracerebral hemorrhage (SICH) patients and to assess the role of hyponatremia as a predictor of in-hospital mortality. Materials and Methods: This was a hospital based prospective observational study conducted in the department of Medicine, VMMC and Safdarjang Hospital, New Delhi, India on 75 adults (>18 years of age, both male and female) presenting with SICH. Various parameters comprising demographic, clinical, laboratory, and radiological variables along with stroke severity were assessed and studied as predictors of in-hospital outcome, i.e., mortality and disability at the time of discharge as assessed by modified Rankin's Scale (mRS) in 75 SICH patients presenting to the emergency department. Furthermore, the role of hyponatremia as a predictor of in-hospital mortality was studied. Results: Out of 75 patients enrolled in the study, 40% (n = 30) of the patients died in the hospital and 60% (n = 45) were discharged. Out of the discharged category, 80% (n = 36) had mild disability with mRS 1–3 and 20% (n = 9) had moderate-to-severe disability with mRS 4-5. National Institute of Health Stroke Scale (NIHSS) at the time of hospitalization was found to be the significant independent predictor of in-hospital mortality and higher mRS score at discharge. Furthermore, Glasgow Coma Scale (GCS) ≤4 and NIHSS >12 were significantly associated with in-hospital mortality. Hyponatremia was found in 44% (n = 33) of the patients at the time of hospitalization and out of them sodium level got corrected in 15.15% (n = 5). Out of the 42 normonatremic patients 31% (n = 13) developed hyponatremia in subsequent days during hospitalization. No association was found between hyponatremia and in-hospital mortality. Conclusion: Our study highlights the fact that SICH is associated with high in-hospital mortality. NIHSS score at the time of hospitalization is an independent predictor of in-hospital mortality and disability at discharge. Furthermore, GCS ≤4 and NIHSS >12 are significantly associated with in-hospital mortality. Although hyponatremia is a common occurrence in patients with SICH, our study failed to show association between hyponatremia and in-hospital mortality.

Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy

Some patients have poor outcomes despite small infarcts after endovascular therapy (EVT), while others with large infarcts do well. Understanding why these discrepancies occur may help to optimize EVT outcomes. To validate exploratory findings from the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial regarding pretreatment, treatment-related, and posttreatment factors associated with discrepancies between follow-up infarct volume (FIV) and 90-day functional outcome. This cohort study is a post hoc analysis of the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, a double-blind, randomized, placebo-controlled, international, multicenter trial conducted from March 2017 to August 2019. Patients who participated in ESCAPE-NA1 and had available 90-day modified Rankin Scale (mRS) scores and 24-hour to 48-hour posttreatment follow-up parenchymal imaging were included. Small FIV (volume ≤25th percentile) and large FIV (volume ≥75th percentile) on 24-hour computed tomography/magnetic resonance imaging. Baseline factors, outcomes, treatments, and poststroke serious adverse events (SAEs) were compared between discrepant cases (ie, patients with 90-day mRS score ≥3 despite small FIV or those with mRS scores ≤2 despite large FIV) and nondiscrepant cases. Area under the curve (AUC) and goodness of fit of prespecified logistic models, including pretreatment (eg, age, cancer, vascular risk factors) and treatment-related and posttreatment (eg, SAEs) factors, were compared with stepwise regression-derived models for ability to identify small FIV with higher mRS score and large FIV with lower mRS score. Among 1091 patients (median [IQR] age, 70.8 [60.8-79.8] years; 549 [49.7%] women; median [IQR] FIV, 24.9 mL [6.6-92.2 mL]), 42 of 287 patients (14.6%) with FIV of 7 mL or less (ie, ≤25th percentile) had an mRS score of at least 3; 65 of 275 patients (23.6%) with FIV of 92 mL or greater (ie, ≥75th percentile) had an mRS score of 2 or less. Prespecified models of pretreatment factors (ie, age, cancer, vascular risk factors) associated with low FIV and higher mRS score performed similarly to models selected by stepwise regression (AUC, 0.92 [95% CI, 0.89-0.95] vs 0.93 [95% CI, 0.90-0.95]; P = .42). SAEs, specifically infarct in new territory, recurrent stroke, pneumonia, and congestive heart failure, were associated with low FIV and higher mRS scores; stepwise models also identified 24-hour hemoglobin as treatment-related/posttreatment factor (AUC, 0.92 [95% CI, 0.90-0.95] vs 0.94 [95% CI, 0.91-0.96]; P = .14). Younger age was associated with high FIV and lower mRS score; stepwise models identified absence of diabetes and higher baseline hemoglobin as additional pretreatment factors (AUC, 0.76 [95% CI, 0.70-0.82] vs 0.77 [95% CI, 0.71-0.83]; P = .82). Absence of SAEs, especially stroke progression, symptomatic intracerebral hemorrhage, and pneumonia, was associated with high FIV and lower mRS score2; stepwise models also identified 24-hour hemoglobin level, glucose, and diastolic blood pressure as posttreatment factors associated with discrepant cases (AUC, 0.80 [95% CI, 0.74-0.87] vs 0.79 [95% CI, 0.72-0.86]; P = .92). In this study, discrepancies between functional outcome and post-EVT infarct volume were associated with differences in pretreatment factors, such as age and comorbidities, and posttreatment complications related to index stroke evolution, secondary prevention, and quality of stroke unit care. Besides preventing such complications, optimization of blood pressure, glucose levels, and hemoglobin levels are potentially modifiable factors meriting further study.

Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort

Abstract BACKGROUND Vertebral artery dissections (VADs) are rare yet potentially devastating events. While the etiology of these events is either traumatic or spontaneous, there is a paucity of quantitative literature comparing the two. OBJECTIVE To identify differences in predisposing factors, event characteristics, and clinical outcomes between traumatic VADs (tVADs) and spontaneous VADs (sVADs). METHODS We retrospectively identified patients with VADs presenting to our institution at VAD onset with at least a 3-mo follow-up. Demographics, event characteristics, treatment details, and neurological outcomes as modified Rankin scale (mRS) scores were collected. RESULTS Of the 310 patients sustaining 366 VADs total, 187 (60.3%) patients experienced a total of 221 (60.4%) sVADs and 123 (39.7%) patients experienced a total of 145 (39.6%) tVADs. sVADs were more likely to occur in the intracranial course of the artery (P = .042) and have a lower mRS at discharge, 3-month, and last clinical follow-up (P = 003, .002, and .001, respectively). tVADs were more likely associated with concomitant fractures (P &lt; .001). CONCLUSION Despite similar patient populations, tVADs are associated with higher mRS scores at all time points. Although further study is needed, this may suggest other concomitant trauma rather than the VAD itself is contributing to worse neurological status in patients with tVADs.

Modern Look at Transverse Myelitis and Inflammatory Myelopathy

Background and ObjectivesTo characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA).MethodsThis retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria.ResultsWe identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2–4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57–2.40) and tobacco use (OR 1.87, 95% CI, 1.17–2.99).DiscussionThis national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.

Factors predicting pneumonia in patients admitted with spontaneous supratentorial intracerebral hemorrhage in western region of Nepal

Introduction: Despite the well-documented association of stroke-associated complications and infections with increased mortality, morbidity and worse long-term outcome, there are only limited data available on independent predictors of pneumonia in patients with acute intracerebral hemorrhage. In this study, our objective was to evaluate risk factors and comorbid conditions associated with the diagnosis of hospital acquired pneumonia in the patients admitted with spontaneous intracerebral hemorrhage and to determine the independent predictors of pneumonia in these patients. Methods: A retrospective analysis was done in patients admitted in Intensive Care Unit of Nepalgunj Medical College with spontaneous intracerebral hemorrhage. Various clinic-demographic parameters were tested for association with pneumonia or no pneumonia group using chi square or student’s “t” test. Results: A total of 117 patients, 86 men (73.5%) and 31 women (26.5%) with spontaneous intracerebral hemorrhage were included in the study. There were 36 (30.77%) patients with pneumonia. The association Diabetes mellitus (p&lt;0.01), COPD (p&lt;0.01), smoking (p&lt;0.01), mean GCS (p&lt;0.01), ICH volume (p=0.01), ICH score (p&lt;0.01), operated status (p&lt;0.01), Ganglionic (&lt;0.01), Brain stem (p=0.03) and Ventricular (p=0.01) location of hematoma was statistically significant with pneumonia. Outcome in terms of MRS at discharge was also poorer for patients with pneumonia (p=0.01). Conclusion: Diabetes mellitus, COPD, mean GCS, ICH volume, ICH score, operated status, higher MRS score were associated with increased risk of pneumonia in ICH. Similarly, ganglionic hematoma, brainstem hematoma and those having intraventricular hemorrhages are also associated with increased risk of pneumonia. Outcome in patients in terms of MRS were also poorer in those who had pneumonia.

Effect of Sociodemographic Factors, Concomitant Disease States, and Measures Performed in the Emergency Department on Patient Disability in Ischemic Stroke: Retrospective Study from Lebanon.

Background Stroke is a leading cause of death and disability in developed countries. The major factor affecting long-term survival other than age is the disability severity caused by stroke. The modified Rankin Scale (mRS) is a global functional endpoint measurement used in acute stroke to evaluate the degree of disability or dependence in daily life activities. The objective of this study was to assess the effects of sociodemographic factors, concomitant disease states, and some measures performed in the emergency department (ED) on patients' disability. Methods We conducted a retrospective study on ischemic stroke patients admitted to Intensive Care Unit of three Lebanese university hospitals between June and December 2016. Patients were excluded if they had been discharged from ED without hospital admission or if mRS was not performed. The mRS was further subdivided into two categories considered as “good prognosis” (0-2 or 0-3) and “poor prognosis” (>2 or > 3). Results 204 patients were included in the study with mean age of 65.4 ± 11.9 years, hypertension was the most previous concomitant past medical disease (77.1%), and 27.1% of these patients had previous history of stroke. No significant differences were found in both mRS categories for all sociodemographic factors, and past medical history except that arrhythmia was significantly more common in the higher mRS categories > 2 and > 3. Based on multivariable analysis, there was a trend for previous intake of calcium channel blocker to be associated with lower mRS at admission (beta -0.586). However, intracranial arterial stenosis, ED blood glucose > 180 mg/dL, and performing brain imaging above 20 minutes after patient presentation to ED were significantly associated with higher mRS scores at discharge with an ORa and (confidence interval) of 2.986 (0.814, 10.962), 3.301 (1.072, 1.261), and 1.138 (1.071, 9.080), respectively. Conclusion mRS is affected by previous disease states, prescribed medications, and acute measures performed in ED. It is also influenced by intracranial arterial stenosis etiology, which is associated with worse outcome.

Relationship between Nutritional Scales and Prognosis in Elderly Patients after Acute Ischemic Stroke: Comparison of Controlling Nutritional Status Score and Geriatric Nutritional Risk Index

Background/Aims: Undernutrition is common in patients after acute ischemic stroke (AIS) and predicts poor clinical outcomes. We assessed the relationship between undernutrition and prognosis after AIS. Methods: We retrospectively assessed consecutively hospitalized AIS patients aged ≥65 years. A poor prognosis for patients after AIS was defined as a modified Rankin Scale (mRS) score of ≥3 at discharge. Nutritional status was evaluated based on the degree and risk of undernutrition as determined by the Controlling Nutritional Status (UND-CONUT) and Geriatric Nutritional Risk Index (UNR-GNRI) scores. Results: Among 218 patients (male, 62.8%; median age, 77 years), 81 had a poor prognosis. A significant correlation was found between UND-CONUT and UNR-GNRI scores (p < 0.001, r = 0.433). Patients with a poor prognosis showed significant undernutrition based on UND-CONUT (p = 0.003) but not on UNR-GNRI (p = 0.218). Patients with undernutrition based on UND-CONUT showed poor outcomes: higher mRS scores at discharge, higher percentages of mRS scores of ≥2 and ≥3, and more complications associated with pneumonia. No significant differences were seen between cases with and without undernutrition risk based on UNR-GNRI. Conclusion: UND-CONUT appeared to be more useful than UNR-GNRI for predicting the prognosis of elderly patients with AIS at discharge.