Predictor Of Neurological Recovery Research Articles

Premorbid frailty predicts short- and long-term outcomes of reperfusion treatment in acute stroke

Frailty is the most important short- and long-term predictor of disability in the elderly and, thus, might influence the clinical outcome of acute treatment of stroke. To evaluate whether frailty predicts short- and long-term all-cause mortality and neurological recovery in elderly patients who underwent reperfusion acute treatment of stroke. The study included consecutive patients older than 65years who underwent reperfusion treatment in a single stroke unit from 2015 to 2016. Predictors of stroke outcomes were assessed including demographics, baseline NIHSS, time to needle, treatment and medical complications. Premorbid frailty was assessed with a comprehensive geriatric assessment including functional, nutritional, cognitive, social and comorbidities status. At three and twelve months, all-cause death and clinical recovery (using modified Rankin scale, mRS) were evaluated. One-hundred and two patients who underwent acute reperfusion treatment for stroke entered the study (mean age 77.5, 65-94years). Frailty was diagnosed in 32 out of 102 patients and associated with older age (p = 0.001) but no differences in baseline NIHSS score, vascular risk profile or treatment management strategy. Frailty status was associated with worse improvement at 24h and higher in-hospital mortality. At follow-up, frail patients showed poorer survival at 3 (25% vs 3%, p = 0.008) and 12 (38% vs 7%, p = 0.001) months. Frailty was the best predictor of neurological recovery at one year follow-up (mRS 3.2 ± 1.9 vs 1.9 ± 1.9). Frailty is an important predictor of efficacy of acute treatment of stroke beyond classical predictors of stroke outcomes. Larger longitudinal studies are, thus, warranted to evaluate the risk-benefit of reperfusion treatment in the growing elderly frail population.

Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C.

The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.

Serum albumin as a predictor of neurological recovery after spinal cord injury: a replication study.

This was a secondary analysis on an observational cohort study. To determine if serum albumin significantly associates with long-term neurological outcome (i.e., 1-year post-injury) in a contemporary cohort of individuals with spinal cord injury. Six rehabilitation centers across the United States. A secondary analysis of neurological outcomes and serum albumin concentrations was performed on data from the Spinal Cord Injury Rehabilitation study. Data was accessed from the Archive of Data on Disability to Enable Policy and research (ADDEP). The primary analysis applied unbiased recursive partitioning to examine the relationship between serum albumin, injury severity, and long-term outcomes. The analysis is accessible via https://rpubs.com/AnhKhoaVo/586028 . Serum albumin concentration was significantly associated with lower extremity motor scores (LEMS) and American Spinal Injury Association Impairment Scale (AIS) grade at admission to rehabilitation. Serum albumin concentrations alone were also significantly associated with change of LEMS and marked recovery (improvement of at least 2 AIS grades and/or recovery to walking) at 1-year post injury. However, after adjusting for admission to rehabilitation LEMS and AIS grade, serum albumin was not significant. The current study partially confirms our previous observations that serum albumin concentrations are associated with neurological outcome after spinal cord injury. As a crude prognostic biomarker, serum albumin concentration could be useful in cases where injury severity cannot be accurately assessed.

Observation on Posterior Column Sensations as Predictor of Neurological Recovery in Spinal Cord Injury Patients

Objective: This study evaluated the role of preservation of posterior column in final prognosis of SCI and also compared prognostic values of posterior column and spino-thalamic tract sparing in SCI. Methodology: A prospective observational study was conducted in Department of Physical medicine and Rehabilitation in SVNIRTAR, Odisha, India from July 2017 to Dec 2018. Sample size was 55 and incomplete spinal cord injuries in ASIA B-E, neurological level C5 and below, age >10 yrs were included. Patients were classified into 2 groups of posterior column sparing and spino-thalamic sensory sparing. Patients were evaluated using ASIA scale, Neurological examination by ISNCSCI and functional improvement by SCIM III.2 groups were reassessed after 6, 9, 12 months. Results: Pure posterior column sensory sparing patients were 6 out of 55 and 50% belonged to C6 vertebral level. All 6 remained in ASIA B after 1 yr while 9 of ASIA B converted to C,10 from ASIA C to D and 1 from ASIA D to E. There were significant changes in motor and sensory scores of 2 groups which were statistically significant. SCIM score in Group A increased by 9.7 points after 1yr while there was 31.1 increase in Group B. Conclusion: Pure posterior column sensory sparing in spinal cord injury is poor prognostic indicator for neurological recovery when compared to spino-thalamic sparing patients.

Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury

BackgroundAccurate predictors of neurological recovery after cervical spinal cord injury are needed. Particularly, to tailor adequate rehabilitation plans. However, objective and quantifiable predictors are sparse.MethodsWithin the prospective European Multicenter Study about Spinal Cord Injury (EMSCI) registry, cervical spinal cord injury patients are monitored at fixed follow up visits (2, 4, 12, 24, and 48 weeks after injury) clinically and with ulnar nerve electroneurography. Associations of ulnar nerve compound muscle action potential amplitudes (CMAP) with American Spinal Cord Injury Association (ASIA) impairment scale (AIS) grades over time were analyzed using linear mixed modeling. Applying logistic regression, the prognostic value of within 4-week ulnar nerve CMAP for 1-year AIS was analyzed. To account for missing data, (1) last observation carried forward and (2) multiple imputation methods were applied. For model derivation, our centers’ cohort (EMSCI-HD) was analyzed. For model validation the cohort of other centers (EMSCI-nonHD) was used.ResultsIn the EMSCI-HD cohort, the median age (interquartile range (IQR)) was 52 (34–67) years. 58% were male. The initial AIS distribution was: A = 31%, B = 17%, C = 30%, and D = 22%). In the EMSCI-nonHD cohort, the median age was 49 (32–65) years. Compared to the EMSCI-HD cohort more patients were male (79%, p = 0.0034). The AIS distribution was: A = 33%, B = 13%, C = 21%, and D = 33%).In complete-case mixed model analyses (EMSCI-HD: n = 114; EMSCI-nonHD: n = 508) higher ulnar nerve CMAP were associated with better AIS grades over the entire follow up period. In complete-case logistic regression (EMSCI-HD: n = 90; EMSCI-nonHD: n = 444) higher ulnar nerve CMAP was an independent predictor of better AIS grades. The odds ratio for within 4-week ulnar nerve CMAP to predict 1-year AIS grade D versus A-C in the EMSCI-HD cohort was 1.24 per millivolt (confidence interval 1.07–1.44). The model was validated in an independent cervical spinal cord injury (EMSCI-nonHD) cohort (odds ratio 1.09, confidence interval 1.03–1.17).ConclusionsIn cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties.

Predictors of neurological recovery after surgery of metastatic epidural spinal cord compression

Predictors of neurological recovery after surgery of metastatic epidural spinal cord compression

Clinical Characteristics and Neurologic Recovery of Patients with Cervical Spinal Tuberculosis: Should Conservative Treatment Be Preferred? A Retrospective Follow-Up Study of 115 Cases

To present the clinical characteristics and prognostic factors of neurologic recovery in patients with cervical spinal tuberculosis (CST). General description and multivariate analysis were used to detect possible predictors of the outcome of patients with neurologic deficit. Follow-up data were used to generate a Kaplan-Meier curve of neurologic recovery. Protective factors in neurologic recovery included less involved vertebrae, surgery, and higher Japanese Orthopaedic Association score before treatment; not shorter symptom duration was not a protective factor. Normal neurologic function was present in 30% of patients 6 months after treatment, in 56% of patients 12 months after treatment, and in 93% of patients 28 months after treatment. The cumulative complete neurologic recovery rates at 6 months, 12 months, and 28 months were 44%, 68%, and 91.7% in the surgery group and 16.7%, 38.8%, and 94.4% in the nonsurgery group. Surgery and Japanese Orthopaedic Association score before treatment are important predictors ofneurologic recovery in patients with CST. A neurologic recovery curve could predict neurologic recovery in patients with CST and indicate in patients with neurologic deficit how long it will take to achieve complete neurologic recovery. The effect of surgery is quick, and the effect of conservative treatment is slower, but no difference in neurologic recovery was found in the long-term. Conservative treatment should be tried in every patient with CST with no obvious indication for surgery. In contrast to patients with tuberculosis without cervical spine involvement but with more complications, comprehensive conservative therapy should be preferred for patients with neurologic deficit toavoid unnecessary surgery and overtreatment and to conserve medical resources. Indications for surgical intervention for CST should be carefully selected.

Factors influencing prognosis of thoracolumbar spinal injury combined with spinal cord injury

Objective To investigate the factors influencing prognosis in surgical treatment of thoracolumbar spinal injury combined with spinal cord injury so as to assist in the clinical treatment.Methods A retrospective study was made on 77 cases of acute thoracolumbar spinal injury combined with spinal cord injury admitted from July 2005 to April 2011.There were 66 men and 11 women,aged 14-66 years (mean,36.5 years).Neurological performance evaluated using American Spinal Injury Association (ASIA) scale was grade A in 31 cases,grade B in 11 cases,grade C in 10 cases,and grade D in 25 cases.Potential factors affecting the prognosis of spinal cord injury were identified using univariate analysis and incorporated into the Logistic regression equation to filter out the main influencing factors.Results Fifteen cases dropped out at a mean 55.5-month follow-up (range,24-96 months) and follow-up rate was 81％.Univariate analysis selected fracture or dislocation types (P ＜ 0.01),combined injury (P ＜ 0.05),use of glucocorticoid within 8 hours postinjury (P ＜ 0.05),standard transport by medical professionals (P ＞ 0.1),complete injury (P ＜ 0.01),visiting time (P =0.055),cause of disease before operation (P ＜ 0.05) and canal encroachment rate (P ＜ 0.01) as predictors of neurologic recovery in spinal cord injury (P ＜ 0.1).Logistic regression analysis revealed significant prognostic factors were canal clearance (P ＜ 0.01) and use of steroids within 8 hours postinjury (P ＜ 0.05).Conclusion Glucocorticoid pulse therapy within 8 hours postinjury and adequate spinal cord decompression may effectively improve the neurologic prognosis in thoracolumbar spinal injury with spinal cord injury. Key words: Spinal injuries; Spinal cord injuries; Prognosis; Influence factors

Assessment of Adverse Events and Predictors of Neurological Recovery After Therapeutic Hypothermia

Therapeutic hypothermia improves neurological recovery after witnessed cardiac arrest from ventricular fibrillation or tachycardia. Its application is expanding despite associated adverse events. To assess the occurrence of adverse events and predictors of good versus poor neurological recovery after therapeutic hypothermia. A single-center, retrospective review of medical records of 91 patients who received therapeutic hypothermia for ≥6 hours. Adverse events included laboratory abnormalities, shivering, acute kidney injury, or infection. Cerebral performance categories (CPC) scores delineated good (CPC of 1-3) or poor (CPC of 4 or 5) neurological outcomes. Groups were compared and parameters evaluated for effect on neurological recovery using backward logistic regression analysis. Therapeutic hypothermia was used for several indications, and 42 patients (46.2%) had good neurological recovery. Demographic parameters were similar between groups. Common adverse events were hypoglycemia (98.9%), shivering (84.6%), bradycardia (58.2%), electrolyte abnormalities (26.4%-91.2%), acute kidney injury (52.8%), infection (48.4%), and coagulopathy (40.7%). Characteristics independently associated with neurological recovery included faster return of spontaneous circulation (ROSC), quicker initiation of cooling, and the occurrence of infections. Pulseless electrical activity, faster achievement of goal cooling temperature, seizure, and the administration of insulin or epinephrine were inversely related to neurological recovery. Adverse events of therapeutic hypothermia were numerous and frequent, necessitating monitoring. Neurological recovery is primarily driven by the type of arrest, the rapidity of ROSC, the time needed to provide and achieve therapeutic hypothermia, the development of seizures or infection, and the use of insulin or epinephrine.

Abstract 2925: DWI-ASPECTS As A Predictor Of Neurological Recovery In Acute Stroke Patients With The Middle Cerebral Artery Occlusion Treated With IV t-PA.

Background and Purpose: Diffusion-weighted imaging-Alberta Stroke Programme Early CT Score (DWI-ASPECTS) has been associated with short-term and long-term neurological recovery and outcome in acute stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). However, previous reports did not analyze the DW-ASPECTS based on the presence of major arterial occlusion. We investigated whether initial DWI-ASPECTS can predict the short-term neurological recovery in acute stroke patients with the middle cerebral artery occlusion (MCAO) treated with IV t-PA. Methods: Consecutive acute stroke patients with MCAO treated with IV t-PA within 3 hours of onset were enrolled from 2005 October to 2011 May. All patients were examined using DWI and magnetic resonance angiography on admission. Only patients with horizontal MCAO were included. Neurological deficits were assessed using National Institutes of Health Stroke Scale (NIHSS) score on admission and day 7. On day 7, dramatic recovery (DR) was defined as a ≥10 point reduction or a total NIHSS score of 0 or 1. Good recovery (GR) was a ≥4 point reduction, excluding DR. Worsening was a ≥4 point increase. Results: Seventy-one patients (median age [quartiles]; 77 [70-83], male; 44 [62%]) were enrolled into the study. The median NIHSS score was 18 (12-22). The median DWI-ASPECTS was 4 (6-9). Median DWI-ASPECTS was 7 (6-9) in 27 patients with DR group, 5 (4-9) in 13 with GR group, and 3 (2-6) in 17 with worsening (p<0.001). Median DWI-ASPECTS was 4 (3-6) in 4 (6%) patients with type2-parencymal hematoma within 7 days. Using ROC curve, the optimal cut-off DWI-ASPECTS to differentiate DR group from others was >5 (sensitivity of 85% and specificity of 57%, area under curve [AUC] 0.692, p=0.007), and that for worsening group was <4 (sensitivity of 96% and specificity of 59%, AUC 0.785, p<0.001). Multivariate regression analysis demonstrated that initial DWI-ASPECTS of >5 was significantly associated with DR (OR 9.75, 95%CI 1.41-67.67, p=0.021), and <4 with worsening (OR 15.94, 95%CI 4.01-63.25, p<0.001). Conclusion: DWI-ASPECTS can predict the short-term outcome in acute stroke patients with MCAO treated with IV-tPA.

Levels of Spinal Cord Injury and Predictors of Neurologic Recovery

A comprehensive physical examination of the patient with acute spinal cord injury is essential in determining the initial level of injury and is the most accurate method of prognosticating neurologic recovery. Understanding neurologic recovery helps predict ultimate functional capability and needs, and helps evaluate the effectiveness of pharmacologic and therapeutic interventions.

Inflammatory Disorders of the Cervical Spine

The most common inflammatory disorders affecting the cervical spine include adult and juvenile rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and psoriatic arthritis. These disorders are characterized by typical deformities and instabilities of the cervical spine that result from the destruction caused by synovitis in bony and ligamentous structures in the neck. The treatment of these inflammatory lesions differs from the treatment of similar lesions found in the posttraumatic or degenerative spine. This article attempts to outline the epidemiology, clinical manifestations, and natural history of these conditions. Various radiographic parameters for evaluating disease progression have been used over the years, and their usefulness is reviewed in the context of recent studies better defining the radiographic natural history of these lesions. An algorithm for the use of the various imaging methods including magnetic resonance scanning is provided, and recent progress in delineating the proper timing of surgical intervention and the predictors of neurologic recovery is presented. The current surgical procedures available to treat these conditions are discussed with emphasis on distinguishing those cases in which stabilization alone is required from those in which a decompression procedure is also necessary.

General diseases of the spine in rheumatoid arthritis

The past year has contributed to a better understanding of the management of cervical spine instability in patients with rheumatoid arthritis. Neurologic recovery after surgery is better and the percentage of recurrence is lower in cases of isolated atlantoaxial subluxation (AAS) compared with cases of AAS associated with basilar invagination or with subaxial subluxation. This suggests that the sooner surgery is undertaken in limited AAS, the better the outcome. The atlantoaxial posterior interval seems to be the best predictor of neurologic recovery following posterior fusion for AAS. Osteoporosis is a major problem in patients with rheumatoid arthritis. Recent studies show that corticosteroids, even in a low dosage, contribute to spinal bone loss. This bone loss may be partially reversible after ceasing corticoid therapy. A new corticosteroid, deflazacort, which does not inhibit intestinal absorption of calcium, seems to limit bone loss.