Lower Initial Glasgow Coma Scale Research Articles

Patients′ Knowledge of Stroke Does Not Influence Time to Hospital Presentation

P143 Purpose: The treatment time window for stroke is narrow. Little is known about patients′ knowledge of stroke, their beliefs, their recognition of warning symptoms, and how these factors affect the time of hospital presentation. Methods: A prospective interview of consecutive patients admitted with acute stroke was conducted over an 8-week period. Data recorded included demographic information, history of previous stroke or transient ischemic attack (TIA), the patient′s knowledge of stroke, recognition of warning symptoms and risk factors, and the delay from symptom onset to hospital arrival. Early arrival was defined as within 6 hours of symptom onset. Statistical comparisons were made using two-tailed student′s t test, Mann-Whitney U test, or Fisher′s exact test, depending on the nature of the data. Results: The patients′ general knowledge of stroke was fair, and early arrival was seen in 40 (56.3%) of 71 patients. Early presentation was associated with male sex (P=0.028) and a lower initial Glasgow coma scale score (P=0.072) but not with age, a better general knowledge of stroke, a previous history of stroke or TIA, Rankin score upon discharge, and level of education. On the other hand, late presentation was associated with a belief in permanent disability (P=0.056). Of 29 patients who claimed to know about stroke, 22 (75.9%) correctly described about stroke. The stroke warning symptoms were recognized by 45.1 to 76.1% of patients, whereas the recognition of individual risk factor was correct in 36.6 to 76.1% of patients. Conclusions: Early arrival was seen in a good proportion of stroke patients in Hong Kong. Nevertheless, our results suggest that improving the general knowledge of stroke among Hong Kong people may not reduce delay in hospital presentation of stroke patients. (Supported by the CRCG Research Grant 10202658 of the University of Hong Kong)

Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.

To determine the prognostic significance and pathophysiologic implication of intraventricular extension of supratentorial intracerebral hemorrhage. Prospective study. Acute stroke and neurointensive care units of a tertiary care hospital. One hundred twenty-nine patients with supratentorial intracerebral hemorrhage, managed medically. Two patients had intraventricular catheters placed for external drainage. No patient received thrombolytics or surgical evacuation of clot. Of the 129 patients, 47 had intraventricular extension of their hemorrhages. These patients had larger intraparenchymal hemorrhages (36.6 cm3 vs. 15.0 cm3) and lower initial Glasgow Coma Scale scores (mean, 9.6 vs. 13.7). Their 30-day mortality rate was 43% compared with only 9% among those without ventricular extension. Univariate and multivariate logistic regression modeling was used to assess the prognostic significance of various measures of intraventricular hemorrhage. The presence of intraventricular hemorrhage, the number of ventricles containing blood, fourth ventricular blood, and intraventricular hemorrhage volume were each related to 30-day mortality in a univariate analysis, but only intraventricular hemorrhage volume contributed significantly to outcome prediction in the presence of Glasgow Coma Scale score. Volume of intraventricular hemorrhage is an important determinant of outcome in supratentorial intracerebral hemorrhage.

Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Prospective assessment.

To identify the demographic and clinical variables related to the duration of posttraumatic amnesia after severe closed head injury; to evaluate the usefulness of posttraumatic amnesia duration in predicting outcome at the time of hospital discharge and at 6 months after injury. Four clinical centers located in primary care hospitals. Three hundred fourteen severely injured subjects aged 16 years or older who did not have trauma as a result of a penetrating injury and came out of coma before hospital discharge. Approximately half of the subjects were administered phenytoin sodium for some period after termination of coma; 17% were administered dexamethasone and 41% morphine sulfate. Galveston Orientation and Amnesia Test scores defined the duration of posttraumatic amnesia. The Glasgow Outcome Scale was used to grade outcome at the time of hospital discharge and at 6 months. Older age, low initial Glasgow Coma Scale score, nonreactive pupil(s), coma duration, and use of phenytoin were associated with a longer duration of posttraumatic amnesia. Poor pupillary response, time in coma, and duration of posttraumatic amnesia and use of phenytoin was predictive of the 6-month outcome. The results support the prognostic usefulness of prospectively measuring duration of posttraumatic amnesia after termination of coma. Pending replication, our findings suggest that posttraumatic amnesia duration may be a useful surrogate outcome measure for clinical trials involving interventions for acute head injury.

Posturographic Measurement of Body Sway in Survivors of Severe Closed Head Injury

Postural imbalance was measured in 39 survivors of severe closed head injury 7 to 66 months after head injury using a posturographic platform. The results were compared with those derived from age-matched healthy control subjects. Severe postural imbalance, particularly in an anteroposterior direction, was found in 16 patients, whereas 9 patients showed moderate imbalance and 14 patients showed normal results in the posturographic investigation. Low initial Glasgow Coma Scale scores and deep parenchymal brain lesions demonstrated by magnetic resonance imaging were shown to be significant indicators of subsequent severe postural imbalance. The duration of posttraumatic amnesia, the localization and size of cortical contusions and subcortical white matter lesions, on the contrary, were not associated with postural imbalance in the long-term outcome.

Corpus callosum lesions after closed head injury in children: MRI, clinical features and outcome.

Thirty-four children who sustained moderate to severe closed head injury underwent magnetic resonance imaging (MRI). Eight (24%) had MRI evidence of corpus callosum injury, most commonly within the posterior body and splenium. In contradistinction to reports in adults, there was no definite relationship between callosal injury and lower initial Glasgow Coma Scale scores, nor was there a significantly higher incidence of primary brain-stem lesions, diffuse axonal shear injury or intraventricular hemorrhage. In none of these 8 children did the initial admission computed tomography show evidence of callosal injury. Callosal injuries on MRI are not necessarily a poor prognostic finding, the majority of the 8 children showing good functional recovery.