Сравнительный анализ прогностической ценности нейровизуализационных параметров у пациентов со спонтанным супратенториальным внутримозговым кровоизлиянием А. А. КузнецовЦель работы -провести сравнительный анализ информативности нейровизуализационных параметров для определения витального и функционального прогноза исхода острого периода спонтанного супратенториального внутримозгового кро-воизлияния (ССВМК) в зависимости от наличия или отсутствия вторичного внутрижелудочкового кровоизлияния (ВВЖК) в дебюте заболевания. Comparative analysis of predictive significance of neuroimaging parameters in patients with spontaneous supratentorial intracerebral hemorrhage A. A. KuznietsovZaporizhzhіa State Medical University, UkraineThe main purpose of the study was to conduct a comparative analysis of the neuroimaging parameters informative value for the determination of vital and functional outcomes prognosis of the spontaneous supratentorial intracerebral hemorrhage (SSICH) in the acute period, depending on the secondary intraventricular hemorrhage (SIVH) presence or absence at the disease onset. Materials and methods.A prospective cohort study was conducted in 154 patients (88 men and 66 women, mean age 64.4 ± 0.9 years) with SSICH on the basis of conservative treatment. This study included clinical assessment and visualization of cerebral structures. Intracerebral hemorrhage volume (ICHV), average midline shift (AMS) and intraventricular hemorrhage volume (IVHV) were detected. The modified Rankin Scale (mRS) score >3 on the 21 st day of the disease was considered as an unfavourable functional outcome of SSICH in the acute period.Results. Secondary intraventricular hemorrhage was revealed in 70 (45.5 %) patients. It was found that ICHV was less informative than IVHV in patients with SIVH for the vital outcome prognosis of disease in the acute period determination (AUC ICHV = 0.72 ± 0.09 (0.60-0.82) versus AUC IVHV = 0.94 ± 0.04 (0.86-0.98), P = 0.026), whereas the informative value of ICH volume and AMS were not significantly different in patients without SIVH for the vital outcome prognosis determination (AUC ICHV = 0.77 ± 0.11 (0.67-0.86) versus AUC AMS = 0.87 ± 0.05 (0.78-0.94), P = 0.257) in the acute period of disease. It was detected, that IVHS >24.5 mL was the predictor of SSICH lethal outcome in the acute period (Se = 84.6 %, Sp = 96.5 %).Conclusions. Predictive value of the neuroimaging parameters at SSICH onset depends on SIVH presence or absence. Intracerebral hemorrhage volume is less informative than IVHV and AMS for the vital and functional outcomes prognosis determination in the acute period of SSICH with SIVH. The informative value of neuroimaging parameters for the vital outcome prognosis of SSICH in the acute period determination is higher than the one for the functional prognosis determination.Порівняльний аналіз інформативності нейровізуалізаційних параметрів у пацієнтів зі спонтанним супратенторіальним внутрішньомозковим крововиливом А. А. КузнєцовМета роботи -здійснити диференційований порівняльний а...

The purpose of this study was to determine the most informative parameters of the brain bioelectrical activity spectral analysis for the functional outcome of cerebral ischemic supratentorial stroke (CISS) acute period prediction.Materials and methods. Prospective, cohort and comparative study was conducted among 103 patients in CISS acute period (61 men and 42 women, mean age was 67.7 ± 0.8 years). Electroencephalographic study was conducted on the 2 nd -3 rd day of the disease with the use of 19-channel electroencephalographic scanner. The values of absolute spectral rhythm power of delta (0.5-4.0 Hz), theta (4-8 Hz), alpha (8)(9)(10)(11)(12)(13), beta , theta1 (4-6 Hz), theta2 (6-8 Hz), alpha1 (8-10 Hz), alpha2 (10-13 Hz), beta1 (13-25 Hz) and beta2 (25-35 Hz) bands in the affected hemisphere (AH) and intact hemisphere (IH) were determined. The relative spectral rhythm power (RSRP), fronto-occipital rhythm gradient (FORG) and the severity of interhemispheric rhythm asymmetry (IHRA) were calculated. The functional outcome of the disease acute period was assessed on the 21st day on the basis of the modified Rankin Scale (mRS), while the value of mRS score >3 was considered as an unfavourable functional outcome. Results. Unfavourable functional outcome of the CISS acute period was registered in 46 (44.6 %) patients. In accordance with the data of multivariate regression analysis it was determined that RSRP of delta band in the IH (OR 95 % CI = 1.31 (1.13-1.52), P = 0.0004), FORG of alpha band in the AH (OR 95 % CI = 29.07 (1.86-455.15), P = 0.0224) and IHRA of alpha band (OR 95 % CI = 0.01 (0.0001-0.80), P = 0.0402) were independently associated with functional outcome of the CISS acute period. The RSRP of delta band in the IH > 18.4 % (Se = 87.0 %, Sp = 87.7 %, AUC 95 % CI = 0.94 (0.87-0.98), P < 0.0001), FORG of alpha band in the AH >-0.066 (Se = 67.4 %, Sp = 70.0 %, AUC 95 % CI = 0.74 (0.65-0.82), P<0.0001) and IHRA alpha band ≤-0.066 (Se = 60.9 %, Sp = 70.2 % AUC 95 % CI = 0.66 (0.56-0.75), P < 0,0039) were the optimal cut-off values as for the unfavourable functional prognosis of CISS acute period.Conclusions. The RSRP of delta band in the IH, FORG of alpha band in the AH and the IHRA of alpha band are the most informative parameters of the brain bioelectrical activity spectral analysis for the prediction of the functional outcome of cerebral ischemic supratentorial stroke acute period.Прогнозування функціонального виходу гострого періоду мозкового ішемічного супратенторіального інсульту на підставі спектрального аналізу біоелектричної активності головного мозку А. А. Кузнєцов Мета роботи -визначити найбільш інформативні параметри спектрального аналізу біоелектричної активності головного мозку для прогнозування функціонального виходу гострого періоду мозкового ішемічного супратенторіального інсульту (МІСІ).Матеріали та методи. Виконали проспективне, когортне, порівняльне дослідження 103 пацієнтів у гострому періоді МІСІ (61 чоловік і 42 жінки, середній вік -67,7 ± 0,8 року). Рівень неврологічного дефіциту оц...

Criteria for a short-term vital and functional prognosis for cerebral hemorrhagic supratentorial stroke (CHSS) acute period, that would take into account the secondary IVH severity in the onset of the disease, are currently lacking.The main purpose of the study was to develop criteria for the prediction of cerebral hemorrhagic supratentorial stroke acute period outcome on the basis of the assessment of secondary intraventricular hemorrhage (IVH) severity in the onset of the disease. Materials and methods.A complex clinical and paraclinical study was conducted in 70 patients (38 men and 32 women, aged 66 (58; 74) years) who have CHSS and secondary IVH confirmed by a clinical and neuroimaging examination, who were hospitalized within the first 24 hours since the onset of the disease and received conservative therapy. Intraventricular hemorrhage (IVH) severity was assessed in terms of Graeb Scale, IVH Scale and LeRoux Scale. To determine the prediction criteria, ROC analysis was used, calculating sensitivity (Se) and specificity (Sp) parameters.Results. Lethal outcome was registered in 18.6 % cases, unfavorable functional outcome (modified Rankin Scale score (mRS) = 4-5 on the 21 st day of the disease) -in 44.3 % patients. It was determined that IVH Scale (AUC = 0.94, P < 0.05) has a higher informative value than Graeb Scale (AUC = 0.89, P ˂ 0.05) and LeRoux Scale (AUC = 0.88, P ˂ 0.05) for a lethal prognosis of CHSS acute period outcome. It was detected that Graeb Scale, Intraventicular Hemorrhage Scale and LeRoux Scale are more informative for the determination of vital rather than functional prognosis of CHSS acute period outcome (AUC = 0.89 versus AUC = 0.74 for Graeb Scale, P < 0.05; AUC = 0.94 versus AUC = 0.79 for IVH Scale, P < 0.05; AUC = 0.88 versus AUC = 0.72 for LeRoux Scale, P < 0.05). Conclusions.Predictors of the lethal outcome of CHSS acute period are Graeb Scale score ˃5 (Se = 84.6 %, Sp = 77.2 %), IVH Scale score ˃16 (Se = 84.6 %, Sp = 96.5 %) and LeRoux Scale score ˃9 (Se = 84.6 %, Sp = 86.0 %). Graeb Scale score ≤3 (Se = 69.2 %, Sp = 72.7 %), IVH Scale score ˂8 (Se = 69.2 %, Sp = 79.5 %) and LeRoux Scale score ≤3 Se = 69.2 %, Sp = 72.7 %) are the criteria for the favourable functional outcome of CHSS acute period (mRS score ≤3 on the 21st day).Прогнозування виходу гострого періоду мозкового геморагічного супратенторіального інсульту на підставі оцінювання вираженості вторинного внутрішньошлуночкового крововиливу в дебюті захворювання А. А. КузнєцовКритерії короткострокового вітального та функціонального прогнозу виходу гострого періоду мозкового геморагічного супратенторіального інсульту (МГСІ), які враховували би вираженість вторинного внутрішньошлуночкового крововиливу (ВШК) у дебюті захворювання, на теперішній час відсутні.Мета роботи -розробити критерії прогнозування наслідків гострого періоду МГСІ на підставі оцінювання вираженості вторинного ВШК у дебюті захворювання.Матеріали та методи. Здійснили комплексне клініко-параклінічне дослідження 70 пацієнтів (38 чоловіків і 32 жінки, вік -66 (5...

The main purpose of the study was to develop multivariate models for the verification of short-term vital and functional prognosis in patients with hemorrhagic hemispheric stroke in the onset of the disease. Materials and methods.A prospective, cohort, comparative study was conducted in 203 patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) (121 men and 82 women, mean age 65.1 ± 0.8 years), who were hospitalized within the first 12 hours since the onset of the disease and received conservative therapy. National Institute of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale score, Full Outline of UnResponsiveness Scale score, intracerebral hemorrhage volume, displacement of the septum pellucidum and pineal gland, white blood cell count (WBCC), neutrophil count, lymphocyte count, monocyte count, neutrophil-to-lymphocyte ratio (NLR) were detected upon admission to the hospital. The functional outcome (FO) of the acute period of the disease was assessed on the 21 st day in accordance with the modified Rankin Scale (mRS), whereas >3 points on this scale were considered as an unfavourable FO, ≤3 points were considered as a favourable FO. Binary logistic regression method and ROC-analysis were used for the elaboration of prediction criteria. Resultsof research. Lethal outcome (12.3 %), unfavourable FO (37.5 %) and favourable FO (51.2 %) were registered in the structure of acute period outcomes of the disease. In accordance with the data of multivariate regression analysis it was determined that admission NIHSS score >16 (Se = 68.0 %, Sp = 93.3 %), septum pellucidum displacement >3 mm (Se = 84.0 %, Sp = 74.2 %) and admission WBCC >8 600 cells/µL (Se = 84.0 %, Sp = 62.4 %) are independently associated with an increased risk of the lethal outcome of the acute period of SSICH by 12.8 (12.8-26.8) (P < 0.0001), 10.7 (3.8-29.8) (P < 0.0001) and 6.9 (2.4-19.3) (P = 0.0003) times respectively. Admission NIHSS score >9 (Se = 90.5 %, Sp = 66.3 %), septum pellucidum displacement ≥1 mm (Se = 71.6 %, Sp = 71.2 %) and ANLR >2.92 (Se = 86.5 %, Sp = 36.5 %) were independently associated with an increased risk of the unfavourable FO of the acute period of SSICH by 4.9 (2.9-8.3) (P < 0.0001), 2.9 (2.6-3.3) (P < 0.0001) and 2.4 (2.1-2.7) (P < 0.0001) times respectively. Conclusions. Multivariate models for lethal outcome prognosis (AUC = 0.94 (0.89-0.97), Р < 0.01) and unfavourable functional outcome of SSICH prediction (AUC = 0.88 (0.83-0.93), Р < 0.01) were elaborated, which take into consideration the combination of clinical, neuroimaging data and the severity of inflammatory activation in the onset of the disease. Informativeness of elaborated multivariate models, which integrated independent predictors, statistically exceeds informativeness of separate predictors usage in verification of the vital and functional prognosis of SSICH acute period outcome.Розробка мультиваріантних моделей для визначення короткострокового прогнозу в пацієнтів із геморагічним півкульовим інсультом у дебюті захворювання А. А. Кузнє...

Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08–1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17–2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09–1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00–1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88–0.93), p < 0.0001).