Neurologist最新文献_第4页

Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings. 缩短NIHSS快速卒中评估在紧急护理设置。

IF 1.1 4区医学

Neurologist Pub Date : 2024-12-18 DOI: 10.1097/NRL.0000000000000608

Sama Rahnemayan, Alireza Ala, Nasrin Taghizadeh, Elyar Sadeghi-Hokmabadi, Ipak Entezari, Samad Shamsvahdati

{"title":"Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings.","authors":"Sama Rahnemayan, Alireza Ala, Nasrin Taghizadeh, Elyar Sadeghi-Hokmabadi, Ipak Entezari, Samad Shamsvahdati","doi":"10.1097/NRL.0000000000000608","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000608","url":null,"abstract":"Objectives: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting.Methods: A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated.Results: The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity.Conclusions: NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction. 急性孤立性脑桥梗死的基底动脉粥样硬化和早期临床恶化。

IF 1.1 4区医学

Neurologist Pub Date : 2024-12-13 DOI: 10.1097/NRL.0000000000000606

Dogan D Oge, Ethem M Arsava, Mehmet A Topcuoglu

{"title":"Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction.","authors":"Dogan D Oge, Ethem M Arsava, Mehmet A Topcuoglu","doi":"10.1097/NRL.0000000000000606","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000606","url":null,"abstract":"Objectives: Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied.Methods: In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as \"branch length (BL).\" ECW was defined as any increase in NIHSS.Results: ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P=0.007), higher atrial fibrillation (18% vs. 7%, P=0.067), more common anteromedial infarct location (77% vs. 49%, P=0.025), and Smoker category-3 BA height (32% vs. 10%, P=0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P=0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P=0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P=0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P=0.044), and BA height-category-3 (β±SE=1.711±0.645, P=0.008) as independent predictors for ECW.Conclusions: Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke. 替罗非班联合血栓抽吸及支架取栓治疗缺血性大血管闭塞性脑卒中的疗效观察。

IF 1.1 4区医学

Neurologist Pub Date : 2024-12-06 DOI: 10.1097/NRL.0000000000000603

Yang Jiao, Xiaoli Wang, Yaxin Guan, Xinxin Wang, Zhaosheng Li, Xiuzhi Xiang, Zhongmin Zhang

{"title":"Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.","authors":"Yang Jiao, Xiaoli Wang, Yaxin Guan, Xinxin Wang, Zhaosheng Li, Xiuzhi Xiang, Zhongmin Zhang","doi":"10.1097/NRL.0000000000000603","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000603","url":null,"abstract":"Objective: This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS).Methods: Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment.Results: A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference (P>0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group.Conclusions: Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction: A Retrospective Study. 脑梗死扩张性动脉重构及其危险因素的回顾性研究。

IF 1.1 4区医学

Neurologist Pub Date : 2024-12-02 DOI: 10.1097/NRL.0000000000000600

Bingzheng Gong, Ying Pian, Qichao Yang, Jingjun Zhang

{"title":"Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction: A Retrospective Study.","authors":"Bingzheng Gong, Ying Pian, Qichao Yang, Jingjun Zhang","doi":"10.1097/NRL.0000000000000600","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000600","url":null,"abstract":"Objective: Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to investigate the significance of the carotid artery system and aortic arch (AA) remodeling for the prevention and treatment of CI.Methods: We collected data from 821 patients who underwent computed tomography angiography at our hospital, performed statistical analysis, and compared it with various clinical data.Results: We found that the diameters and detection rates of the common carotid artery (CCA), internal carotid artery (ICA), carotid bifurcation, and AA were significantly greater in the CI group than in the without CI group (P<0.05). The number of carotid sinus plaque (CSP) and the length of aortic arch plaque (AAP) were considered to be 2 important factors in predicting CCA remodeling. Moreover, the thickness of AAP was considered to be an important factor in predicting AA remodeling.Conclusions: Patients with CI exhibited a significant increase in the diameter of the carotid system and AA, which correlated with certain features of arterial plaque. Hence, early detection of arterial plaques, along with interventions to delay or potentially reverse expansive arterial remodeling, may be effective in preventing and treating CI.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review. CADASIL患者短期频繁复发的缺血性脑卒中后迅速进展的痴呆：病例报告与文献综述

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-26 DOI: 10.1097/NRL.0000000000000601

Yumei Geng, Chang Cai, Huimin Li, Qing Zhou, Mengying Wang, Huicong Kang

{"title":"Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review.","authors":"Yumei Geng, Chang Cai, Huimin Li, Qing Zhou, Mengying Wang, Huicong Kang","doi":"10.1097/NRL.0000000000000601","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000601","url":null,"abstract":"Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease with slow natural progression. Ischemic stroke and cognitive impairment are its most common clinical symptoms. Here, we report a rare 50-year-old woman who had rapid disease progression with c.457C>T, p.Argl53Cys heterozygous mutation in exon 4 of NOTCH3 and discuss the possible reasons. Furthermore, we summarized the clinical and neuroimaging characteristics of 14 CADASIL patients with Arg153Cys mutation in exon 4.Case report: The proband suffered acute ischemic stroke 5 times in 5 months, followed by rapidly progressive dementia (RPD) and inability to live independently, though she didn't have vascular risk factors and had been under standardized secondary prevention therapy since the first stroke. Magnetic resonance imaging showed extensive white matter hyperintensities, numerous ischemic infarcts and microbleeds, and severe brain atrophy. Her elder brother and other patients with Arg153Cys mutation in exon 4 all did not progress so quickly. Her multiple strokes may be associated with the poor self-regulation of vessels, which may promote the occurrence of RPD. Antiplatelet and anticoagulant drugs were difficult to prevent ischemic strokes. Severe imaging findings may indicate rapid progression of CADASIL. In addition, we found that headache was a very frequent symptom in CADASIL patients with Arg153Cys mutation in exon 4, accounting for 76.9%.Conclusions: CADASIL can also appear to have rapid progression, as illustrated by our proband, which is worthy of clinicians' attention and intervention timely. Headache may present in a relatively higher proportion of CADASIL patients with Arg153Cys mutation in exon 4.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enoxaparin Failure in Patient With Cerebral Venous Sinus Thrombosis and Prothrombin G20210A Mutation: Case Report. 脑静脉窦血栓和凝血酶原 G20210A 突变患者的依诺肝素治疗失败：病例报告。

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-06 DOI: 10.1097/NRL.0000000000000591

Adithya Polavarapu, Anita Bhushan, Walter Duarte-Celada, Thomas Windisch, Bharat Bhushan

{"title":"Enoxaparin Failure in Patient With Cerebral Venous Sinus Thrombosis and Prothrombin G20210A Mutation: Case Report.","authors":"Adithya Polavarapu, Anita Bhushan, Walter Duarte-Celada, Thomas Windisch, Bharat Bhushan","doi":"10.1097/NRL.0000000000000591","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000591","url":null,"abstract":"Introduction: Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be one of the etiologies of CVST. The optimal heparinoid medication for treatment remains a topic of debate.Case report: This case report describes a young woman with CVST who did not respond to low-molecular-weight heparin (LMWH). The patient was initially treated with LMWH; however, her symptoms and clot burden in the sagittal sinus worsened, and coagulation studies showed no evidence of therapeutic anticoagulation despite good compliance. Unfractionated heparin was then initiated, and the patient's symptoms improved dramatically within 24 hours, along with the recanalization of the cerebral venous sinuses. Genetic testing revealed a heterozygous mutation in the prothrombin gene (G20210A). This mutation is a known risk factor for CVST. However, it is unclear why the patient did not respond to LMWH but responded appropriately to unfractionated heparin.Conclusion: This case report highlights the potential for LMWH resistance in patients with CVST and prothrombin gene mutations. These findings also emphasize the importance of close monitoring of coagulation parameters and clinical response in patients with CVST receiving LMWH.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhanced Preoperative Planning for Intracranial Aneurysms Through Multimodal Image Fusion of Silent/Time-of-Magnetic Resonance Angiography and Computed Tomography Using 3DSlicer: A Comparative Efficacy Analysis With Computed Tomography Angiography. 使用 3DSlicer 通过静默/磁共振血管造影和计算机断层扫描的多模态图像融合增强颅内动脉瘤的术前规划：与计算机断层扫描血管造影的疗效比较分析》。

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-01 DOI: 10.1097/NRL.0000000000000582

Xiaolin Hou, Tao Wu, Dingjun Li, Yuan Yao, Lin Zeng

{"title":"Enhanced Preoperative Planning for Intracranial Aneurysms Through Multimodal Image Fusion of Silent/Time-of-Magnetic Resonance Angiography and Computed Tomography Using 3DSlicer: A Comparative Efficacy Analysis With Computed Tomography Angiography.","authors":"Xiaolin Hou, Tao Wu, Dingjun Li, Yuan Yao, Lin Zeng","doi":"10.1097/NRL.0000000000000582","DOIUrl":"10.1097/NRL.0000000000000582","url":null,"abstract":"Objective: This study evaluates the effectiveness of multimodal image fusion (MIF) using silent and time-of-flight (TOF) magnetic resonance angiography (MRA) and computed tomography (CT) for preoperative planning in patients with intracranial aneurysms who have contraindications to contrast media.Materials and methods: A retrospective study included 40 patients with intracranial aneurysms, diagnosed using three-dimensional computed tomography angiography (CTA). These patients underwent both Silent and TOF MRA scans, followed by a CTA scan. The multi-image fusion (MIF) technique, applied using 3DSlicer software, integrated the silent/TOF-MRA with CT images for preoperative assessment. This study compared the image quality, aneurysm detection sensitivity, and anatomic accuracy of the MIF images with those of three-dimensional CTA.Results: Silent-MRA-CT fusion images demonstrated higher sensitivity (95.5%) and lower false negative rates (4.5%) compared with TOF-MRA-CT. Furthermore, silent-MRA-CT fusion images outperformed TOF-MRA-CT in terms of signal homogeneity, venous signal interference suppression, and aneurysm visibility (all P < 0.05). The interclass correlation coefficient and kappa values for aneurysm morphology and shape indicated superior measurement consistency and shape concordance of silent-MRA-CT with CTA compared with TOF-MRA-CT (all P < 0.01).Conclusion: This study supports the use of silent/TOF-MRA-CT fusion imaging as a reliable alternative to CTA, noting that silent-MRA-CT closely mirrors CTA. Contrast-free MRA-CT fusion images have the potential to be used for preoperative planning in patients with intracranial aneurysms who have contraindications to contrast.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"343-350"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isolated Primary Central Nervous System Lymphoma of the Optic Nerve: A Case Report and Review of the Literature. 视神经孤立性原发性中枢神经系统淋巴瘤：病例报告和文献综述。

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-01 DOI: 10.1097/NRL.0000000000000581

Keertana Jain, Nicholas J Volpe, Karan Dixit

{"title":"Isolated Primary Central Nervous System Lymphoma of the Optic Nerve: A Case Report and Review of the Literature.","authors":"Keertana Jain, Nicholas J Volpe, Karan Dixit","doi":"10.1097/NRL.0000000000000581","DOIUrl":"10.1097/NRL.0000000000000581","url":null,"abstract":"Introduction: Optic nerve involvement in primary central nervous system lymphoma (PCNSL) has been reported only a few times in the literature, with generally dismal outcomes. We focused on an extremely rare presentation of PCNSL in an immunocompetent patient with isolated manifestations of the optic nerve.Case report: A 72-year-old man presented with subacute vision loss in his left eye and optic disc swelling. Initial magnetic resonance imaging (MRI) of the orbits revealed a T2 hyperintense signal with enhancement of the left prechiasmatic optic nerve, suggestive of optic neuritis. He experienced visual improvement after 6 weeks of prednisone. However, 2 months after steroid tapering, he presented with worsening left-eye vision loss and new right-eye vision loss with imaging showing a peripherally enhancing chiasm lesion. A biopsy of the left optic nerve confirmed diffuse large B-cell lymphoma and negative systemic imaging was consistent with PCNSL. He was treated with high-dose methotrexate, rituximab, procarbazine vincristine (R-MVP), and cytarabine (AraC) with some visual improvement in the right eye and resolution of previously seen enhancement on MRI. The patient is in remission with no further deterioration of his vision.Conclusion: This is the first reported case of isolated optic nerve involvement with a durable response to chemotherapy. This case emphasizes the importance of considering malignancy and maintaining a low threshold for optic nerve biopsy in patients with atypical cases of severe steroid-refractory vision loss with enhancement or enlargement of the optic nerve on MRI. Standard chemotherapy regimens for PCNSL can potentially achieve a curative response in these patients.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"351-355"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Gender and Marital Status on Door-to-Treatment (DTT) Time and Acute Stroke Outcome. 性别和婚姻状况对治疗前（DTT）时间和急性中风预后的影响

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-01 DOI: 10.1097/NRL.0000000000000580

Nurose Karim, Dmitry Tumin, Sehrish Karim

{"title":"Impact of Gender and Marital Status on Door-to-Treatment (DTT) Time and Acute Stroke Outcome.","authors":"Nurose Karim, Dmitry Tumin, Sehrish Karim","doi":"10.1097/NRL.0000000000000580","DOIUrl":"10.1097/NRL.0000000000000580","url":null,"abstract":"Objectives: Delays in acute stroke treatment lead to poor outcomes. Women can present with atypical stroke symptoms, are older at the time of stroke, and tend to be living alone, causing delays in pre-hospital diagnosis and seeking care. It is unclear if gender disparities in ED arrival and stroke assessment are compounded by gender differences after ED arrival. Therefore, we sought to identify if gender and marital status were associated with faster door-to-treatment (DTT) time.Methods: Our single-center stroke database was queried for adults presenting to ED with acute stroke between January 1, 2018 and January 30, 2023 treated with IV thrombolytics (IVT)+/- endovascular thrombectomy (EVT) and a known DTT time. The primary outcome was DTT (door-to-needle+door-to-puncture) time. Data collected includes the National Institutes of Health Stroke Scale (NIHSS) at presentation and discharge, gender, marital status, age, and intervention (IVT alone or IVT+/- EVT).Results: Among 674 patients identified, 35 patients were excluded due to missing data. Of 639 patients (median age 66 y), 25%/18% of patients were married men/women, respectively, and 22%/35% were single men/women. Median DTN time, DTP time, and discharge NIHSS score were 36, 79, and 4 mins, respectively. On multivariable analysis, neither DTT time nor NIHSS score at discharge improved among married men relative to any other combination of gender and marital status.Conclusions: Gender differences in the knowledge of stroke warning signs and gender disparities in ED assessment did not translate into faster DTT time. More work is needed to find ways to accelerate stroke care after ED arrival.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"339-342"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk Factors of Acute Ischemic Stroke and Mortality Among Adults With Endocardial Fibroelastosis. 心内膜纤维细胞增生症成人急性缺血性中风和死亡率的风险因素

IF 1.1 4区医学

Neurologist Pub Date : 2024-11-01 DOI: 10.1097/NRL.0000000000000576

Talal Warsi, Kamleshun Ramphul, Mansimran Singh Dulay, Saddam Jeelani, Renuka Verma, Nomesh Kumar, Jasninder Singh Dhaliwal, Caleb Carver, Hemamalini Sakthivel, Syed Khurram Mushtaq Gardezi, Saurabh Deshpande, Akil A Sherif, Alexander Liu, Raheel Ahmed

{"title":"Risk Factors of Acute Ischemic Stroke and Mortality Among Adults With Endocardial Fibroelastosis.","authors":"Talal Warsi, Kamleshun Ramphul, Mansimran Singh Dulay, Saddam Jeelani, Renuka Verma, Nomesh Kumar, Jasninder Singh Dhaliwal, Caleb Carver, Hemamalini Sakthivel, Syed Khurram Mushtaq Gardezi, Saurabh Deshpande, Akil A Sherif, Alexander Liu, Raheel Ahmed","doi":"10.1097/NRL.0000000000000576","DOIUrl":"10.1097/NRL.0000000000000576","url":null,"abstract":"Objectives: Endocardial fibroelastosis (EFE) is a rare form of restrictive cardiomyopathy associated with high morbidity and mortality. The literature is sparse on information pertaining to risk stratification. Thus, we sought to highlight the risk factors of acute ischemic stroke (AIS) and mortality in adults with EFE.Methods: The National Inpatient Sample (NIS) database was queried from 2001 to 2020 using the International Classification of Diseases 9th Revision (ICD-9) and 10th Revision (ICD-10) codes for adult patients with EFE. Factors associated with AIS and mortality were identified.Results: In all, 18495 cases of EFE fit the inclusion criteria, of which 2370 (12.82%) had AIS. The mean ages for patients with and without AIS were 62.37 and 54.24, respectively. Multivariate regression suggested greater odds of AIS in patients with hypertension (aOR 2.329, P <0.01), dyslipidemia (aOR: 1.566, P <0.01), peripheral vascular disease (PVD) (aOR: 1.736, P <0.01), alcohol abuse (aOR: 1.817, P <0.01), age >60 y (aOR: 1.646, P <0.01), females (vs. males, aOR: 1.238, P <0.01), and smokers (aOR: 1.697, P <0.01). Patients with cirrhosis (aOR: 0.174, P <0.01), CKD (aOR: 0.369, P <0.01), COPD (aOR: 0.402, P <0.01), atrial fibrillation (aOR: 0.542, P <0.01) had lower odds of AIS. 3.1% of EFE patients with AIS died. Diabetes (aOR: 11.665, P <0.01) and COPD (aOR: 3.201, P =0.017) were associated with the greatest odds of all-cause mortality. Dyslipidemia (aOR: 0.387, P =0.010) and females (vs. males, aOR: 0.432, P =0.012) had reduced odds of all-cause mortality.Conclusion: Several risk factors are associated with AIS in EFE, while diabetes, COPD, and being male are associated with mortality in EFE.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"317-322"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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