Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Ng, Yee Sien; Stein, Joel; Ning, MingMing; Black-Schaffer, Randie M.

doi:10.1161/strokeaha.106.475483

Cited by 218 publications

(174 citation statements)

References 24 publications

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“…Um dos principais critérios para decidir o uso da terapia trombolítica em pacientes com AVCI agudo é a quantificação da isquemia. Estudos demonstraram que as áreas de lesões mais extensas na TC estão associadas a sintomas clínicos mais severos, curso clínico menos favorável, maior incidência de transformação hemorrágica e morte, quando comparados a pacientes com exames iniciais normais 9,10,18 . A sintomatologia está relacionada com o local da lesão e à sua extensão.…”

Section: Methodsunclassified

“…A identificação de fatores de risco desencadeantes e a adoção de programas de tratamentos preventivos podem reduzir a recorrência da doença, garantindo melhor qualidade de vida 6,7 . O diagnóstico preciso do foco do AVC é importante para se determinar o manejo do paciente, além de analisar o prognóstico e prevenção de AVC secundário 6,[8][9][10] . O diagnóstico preciso do tipo de AVC (isquêmico ou hemorrágico) permitirá ou não a utilização da terapia trombolítica 10 .…”

Section: R Bras CI Saúde 21(1):44-50 2017unclassified

“…O comprometimento do território de irrigação da artéria cerebral anterior ocasiona déficit motor, sensitivo e frontalização. Os pacientes que apresentam prejuízo na irrigação da artéria cerebral posterior evoluem com rebaixamento do nível de consciência, déficit sensitivo e alterações nos campos visuais 9,10 . Os estudos mais recentes mostraram que o diagnóstico precoce permite resultados eficazes com a utilização dos trombolíticos nas primeiras horas após o início dos sintomas (de 3 a 6 horas) 8,12,13 .…”

Section: R Bras CI Saúde 21(1):44-50 2017unclassified

“…Esse tipo de tratamento apresenta alguns riscos para o paciente e sua indicação deve ser bem avaliada. A utilização de terapia trombolítica deve ser precedida de tomografia computadorizada (TC) para excluir a presença de hemorragia, que é uma contra-indicação da intervenção 9,12,13 .…”

Section: R Bras CI Saúde 21(1):44-50 2017unclassified

“…Tão logo termine o período de tratamento emergencial deve-se instituir o programa de prevenção secundária, com intuito de evitar novos eventos, já que a frequência de recidiva é considerável 6,9,16 . A prevenção secundária baseia-se além da correção de fatores de riscos, na utilização de fármacos como os antiagregantes plaquetários, antihipertensivos, neuroprotetores, dentre outros 10 .…”

Section: R Bras CI Saúde 21(1):44-50 2017unclassified

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Avaliação Clínica E Topográfica Dos Pacientes Diagnosticados Com Acidente Vascular Cerebral No Serviço De Emergência

JÚNIOR¹,

SANTOS²,

MELO³

et al. 2017

Rev. bras. ciênc. Saúde

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Introduction:Stroke is considered the first cause of death worldwide and of permanent incapacity in adults, which demands it to be detected and treated as soon as possible. There are studies describing risk factors for stroke, but it is not clear how these risk factors interfere with the patients' outcomes. Objective: To characterize the epidemiological profile of patients admitted to an emergency unit of a city on the Central-West region of Minas Gerais (Brazil) and diagnosed with stroke. Material and Methods: The clinical prognosis of these patients was evaluated and correlated with the lesions shown (if present) by computed tomography (CT) images through the ASPECT score and NIH Stroke Scale. Results: A total of 59 patients were examined, being observed a high incidence of arterial hypertension (89,8%) and sedentarism (40,3%). CT was undertaken in 27.6% of the admitted patients and the most frequent damaged area was the right brain hemisphere (44%). Patient prognosis evaluated through NIHSS demonstrated that 33.9% of the patients had a score between 0 and 7 (good prognosis). Patients who had a previous history of stroke showed a worse prognosis based on the NIHSS. About 20.3% of the patients were admitted to the emergency unit less than 4 hours and 30 minutes after the ictus. Conclusion: There is a high prevalence of hypertensive, sedentary, dyslipidemic, diabetic, smoker, and alcoholic patients, with previous history of stroke, in the city under study. This profile indicates the need for interventions in the local primary care, in addition to patient follow-up after discharge.

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Section: Methodsunclassified

Section: R Bras CI Saúde 21(1):44-50 2017unclassified

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Avaliação Clínica E Topográfica Dos Pacientes Diagnosticados Com Acidente Vascular Cerebral No Serviço De Emergência

JÚNIOR¹,

SANTOS²,

MELO³

et al. 2017

Rev. bras. ciênc. Saúde

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A Retrospective Cohort Comparing Left and Right Middle Cerebral Artery Ischemic Stroke Functional Outcomes in Acute Inpatient Rehabilitation

Rovito

Park

Goldstein

et al. 2020

PM&R

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Background To date, no large population studies compare left and right middle cerebral artery (MCA) strokes and corresponding patient performance in acute rehabilitation as measured by the Functional Independence Measure (FIM). Objective To compare granular performance data using the six FIM subcategories between left and right MCA territory strokes. This may foster development of individualized rehabilitation programs and affect rehabilitation policy based on phenotypic variations. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities, using Uniform Data System for Medical Rehabilitation data from 2015 to 2017. Patients Individuals with MCA strokes admitted to inpatient rehabilitation facilities (n = 38 812). Main Outcome Measures Mean FIM efficiency and FIM gain within the six FIM subcategories (self‐care, sphincter control, transfers, locomotion, communication, and social cognition) were compared between left and right MCA strokes. All were stratified by admission FIM severity categories (<40, 40–80, >80). The study also examined length of stay and percentage discharged to home. Results Mean FIM efficiency was significantly higher for left MCA strokes compared to right MCA strokes. Left MCA strokes with admission FIM <40 and 40‐80 had significantly higher FIM efficiencies within the majority of FIM subcategories. However, left and right MCA strokes with admission FIM > 80 did not display any significant differences. Overall, patients with left MCA strokes were discharged to home at a significantly higher percentage. Patients with left MCA strokes with admission FIM 40–80 had on average a 2‐day shorter length of stay than those with right MCA strokes. Conclusions Overall, patients with left MCA ischemic strokes had shorter length of stays, higher FIM efficiencies, and larger FIM gains than those with right MCA strokes. These results allow clinicians to counsel patients regarding functional gains based on diagnosis and to tailor rehabilitation programs to impairments encountered in left and right MCA territories. Including laterality of stroke and admission functional status would also improve algorithms for determining reimbursement.

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Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke

Navalkar,

Sandefer,

Nanavati

et al. 2024

PM&R

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BackgroundDespite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited. The objective of the study was to determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke.MethodsData were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40–80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from IPR. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities.ResultsWe enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = −8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77).ConclusionsIn this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.

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Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Cited by 218 publications

References 24 publications

Avaliação Clínica E Topográfica Dos Pacientes Diagnosticados Com Acidente Vascular Cerebral No Serviço De Emergência

Avaliação Clínica E Topográfica Dos Pacientes Diagnosticados Com Acidente Vascular Cerebral No Serviço De Emergência

A Retrospective Cohort Comparing Left and Right Middle Cerebral Artery Ischemic Stroke Functional Outcomes in Acute Inpatient Rehabilitation

Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke

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