Radiological Eye Deviation as a Predictor of Large Vessel Occlusion in Acute Ischaemic Stroke

McCluskey, Gavin; Hunter, Annemarie; Best, Elizabeth; McKee, Jacqueline; McCarron, Mark O.; McVerry, Ferghal

doi:10.1016/j.jstrokecerebrovasdis.2019.05.029

Cited by 14 publications

(11 citation statements)

References 19 publications

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“…The current organization of stroke services in Northern Ireland, where dedicated acute stroke units are provided in each Trust, has yielded better (but still not perfect) equity for iv-tPA treatment for AIS than for the single center MT, as shown by the geographical inequity gradient for MT. Looking to the future, stroke research in Northern Ireland and elsewhere is actively pursuing ways to streamline time-dependent treatments to minimize delays and neurodisparities for geographically-remote patients (25,26).…”

Section: Discussionmentioning

confidence: 99%

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

McCarron

Clarke²,

Burns

et al. 2021

Front. Neurol.

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Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways—intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32–0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38–0.66) for MT in AIS patients, 0.78 (95%CI 0.67–0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99–1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities.

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Section: Discussionmentioning

confidence: 99%

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

McCarron

Clarke²,

Burns

et al. 2021

Front. Neurol.

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“…Out of the 5 studies observing stand-alone physical symptoms included in this review, 2 studies focused on eye deviation (66,67), 1 study focused on cortical symptoms ( 68), 1 study focused on complete hemiplegia (69), and 1 study focused on neurological symptoms for predicting LVO (70).…”

Section: Physical Symptomsmentioning

confidence: 99%

Section: Physical Symptomsmentioning

confidence: 99%

“…Radiological eye deviation predicted LVO in patients with stroke-like symptoms with sensitivity and specificity scores of 71 and 78% (67). However, CTA scans were not performed for every patient in the study's cohort, so patient selection bias cannot be excluded (67). There may have also been other underlying causes of eye deviation, such as seizures, which may have increased the incidence rate of LVO being detected (67).…”

Section: Physical Symptomsmentioning

confidence: 99%

“…However, CTA scans were not performed for every patient in the study's cohort, so patient selection bias cannot be excluded (67). There may have also been other underlying causes of eye deviation, such as seizures, which may have increased the incidence rate of LVO being detected (67).…”

Section: Physical Symptomsmentioning

confidence: 99%

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Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review

et al. 2022

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Background: Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and can account for up to 46% of acute ischaemic strokes (AIS) when both the A2 and P2 segments are included (from the anterior and posterior cerebral arteries). It is of paramount importance that LVO is promptly recognised to provide timely and effective acute stroke management. This review aims to scope recent literature to identify new emerging detection techniques for LVO. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO.Methods: Four electronic databases (Medline via OVID, CINAHL, Scopus, and Web of Science), and grey literature using OpenGrey, were systematically searched for published literature investigating developments in detection methods for LVO, reported from 2015 to 2021. The protocol for the search was published with the Open Science Framework (10.17605/OSF.IO/A98KN). Two independent researchers screened the titles, abstracts, and full texts of the articles, assessing their eligibility for inclusion.Results: The search identified 5,082 articles, in which 2,265 articles were screened to assess their eligibility. Sixty-two studies remained following full-text screening. LVO detection techniques were categorised into 5 groups: stroke scales (n = 30), imaging and physiological methods (n = 15), algorithmic and machine learning approaches (n = 9), physical symptoms (n = 5), and biomarkers (n = 3).Conclusions: This scoping review has explored literature on novel and advancements in pre-existing detection methods for LVO. The results of this review highlight LVO detection techniques, such as stroke scales and biomarkers, with good sensitivity and specificity performance, whilst also showing advancements to support existing LVO confirmatory methods, such as neuroimaging.

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Etiology and clinical characteristics of patients with severely impaired consciousness in prehospital settings: A retrospective study

Mizu

Matsuoka

Nishida

et al. 2023

Acute Medicine & Surgery

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AimTo examine the causes of patients with severely impaired consciousness and the clinical characteristics in prehospital settings that are useful for differential diagnosis, especially stroke.MethodsWe retrospectively examined patients aged ≥16 years with Japan Coma Scale III‐digit codes during paramedic contact and transported to our hospital between January 2018 and December 2018. Furthermore, we examined background and physical findings of patients at final diagnosis, and also examined factors associated with stroke.ResultsOverall, 227 patients were included in this study. One hundred and twelve patients (49.3%) were male, and the median age was 71 years (interquartile range, 50–83 years). Stroke was the most common cause (30%). Intoxication and psychiatric disorders were significantly more common in younger patients (p < 0.01). Systolic blood pressure was the highest in patients with stroke. Mortality was the highest in stroke (55.9%). Systolic blood pressure, airway compromise, and ocular abnormalities were factors associated with stroke, with odds ratios of 1.03 (95% confidence interval [CI], 1.02–1.04), 6.88 (95% CI, 3.02–15.64), and 3.86 (95% CI, 1.61–9.27), respectively.ConclusionStroke was the most common cause of severely impaired consciousness. Age could be a useful indicator to consider intoxication and psychiatric disorders. Systolic blood pressure, airway compromise, and ocular abnormalities were factors associated with stroke in the prehospital setting.

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Radiological Eye Deviation as a Predictor of Large Vessel Occlusion in Acute Ischaemic Stroke

Cited by 14 publications

References 19 publications

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review

Etiology and clinical characteristics of patients with severely impaired consciousness in prehospital settings: A retrospective study

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