ABSTRACT
BACKGROUND AND PURPOSE: Proteinuria and estimated glomerular filtration rate (eGFR) are indicators of renal function. Whether proteinuria better predicts outcome than eGFR in stroke patients treated with intravenous thrombolysis (IVT) remains to be determined. METHODS: In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m2 ) and the coexistence of both with regard to (i) poor 3-month outcome (modified Rankin Scale score 3-6), (ii) death within 3 months and (iii) symptomatic intracranial hemorrhage (ECASS-II criteria) were compared. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals were calculated. RESULTS: Amongst 3398 patients, 881 (26.1%) had proteinuria and 623 (18.3%) reduced eGFR. Proteinuria [ORadjusted 1.65 (1.37-2.00) and ORadjusted 1.52 (1.24-1.88)] and reduced eGFR [ORadjusted 1.26 (1.01-1.57) and ORadjusted 1.34 (1.06-1.69)] were independently associated with poor functional outcome and death, respectively. After adding both renal markers to the models, proteinuria [ORadjusted+eGFR 1.59 (1.31-1.93)] still predicted poor outcome whilst reduced eGFR [ORadjusted+proteinuria 1.20 (0.96-1.50)] did not. Proteinuria was associated with symptomatic intracranial hemorrhage [ORadjusted 1.54 (1.09-2.17)] but not reduced eGFR [ORadjusted 0.96 (0.63-1.62)]. In 234 (6.9%) patients, proteinuria and reduced eGFR were coexistent. Such patients were at the highest risk of poor outcome [ORadjusted 2.16 (1.54-3.03)] and death [ORadjusted 2.55 (1.69-3.84)]. CONCLUSION: Proteinuria and reduced eGFR were each independently associated with poor outcome and death but the statistically strongest association appeared for proteinuria. Patients with coexistent proteinuria and reduced eGFR were at the highest risk of poor outcome and death.
Subject(s)
Intracranial Hemorrhages/etiology , Proteinuria/complications , Stroke/drug therapy , Thrombolytic Therapy/adverse effects , Administration, Intravenous , Aged , Aged, 80 and over , Female , Glomerular Filtration Rate/physiology , Humans , Male , Middle Aged , Prognosis , Stroke/complications , Treatment OutcomeABSTRACT
BACKGROUND: The decision to treat with intravenous (i.v.) rt-PA a patient with acute cerebral ischaemia is based on clinical and imaging criteria recorded in emergency. In such an emergency situation stroke mimics may sometimes be misdiagnosed, and lead to an erroneous prescription of rtPA. The objective of this study was to determine the baseline profile and the outcome in patients with stroke mimics who received i.v. rtPA. METHODS: We analysed clinical characteristics, and outcomes in patients diagnosed at discharge as having a stroke mimic who received rtPA in the university hospitals of Lille and Belgrade. RESULTS: Amongst 488 patients, seven (1.4%) were diagnosed at discharge with stroke mimics: four had somatoform disturbances, one had migraine aura, one had Bell palsy, and one had a probable Todd's palsy. Patients with stroke mimics were younger, and had milder deficits. Six were investigated by computed tomographic-scan and the only one who had an emergency magnetic resonance imaging, had no abnormality on diffusion weighted images. Five patients had a modified Rankin scale 0-1 and there was no case of intracranial bleeding. CONCLUSION: Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.
Subject(s)
Diagnostic Errors , Stroke/diagnosis , Stroke/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/adverse effects , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnosis , Brain Ischemia/drug therapy , Diagnostic Errors/adverse effects , Female , Humans , Injections, Intravenous/adverse effects , Injections, Intravenous/methods , Male , Middle Aged , Prospective Studies , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Retrospective Studies , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/geneticsABSTRACT
The Dexamethasone Suppression Test (DST), supposed to effectively distinguish between endogenous and nonendogenous depression, was performed in a group of 34 patients with Parkinson's disease. Abnormal DST results were observed in 50% of the patients. The patients were clinically divided into subgroups of depressed and nondepressed parkinsonians. Abnormal DST results were significantly more frequent in depressed (75%) than in nondepressed parkinsonians (27.7%).