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1.
J Coll Physicians Surg Pak ; 30(1): S42-S45, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33650425

RESUMEN

The aim of this retrospective observational study was to describe the neuroimaging manifestations of patients with COVID-19. This study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March to July 2020. COVID-19 patients with neurological symptoms and positive neuroimaging were included after confirmation of COVID-19 by polymerase chain reaction test (PCR). In the 12 included patients, seizures and altered mentation were predominant neurological manifestations. Three cases had acute watershed infarcts (25%), two cases had posterior cerebral artery territorial infarcts (16.7%), two cases had periventricular corona radiata infarcts (16.7%), three cases had hypoxic ischemic encephalopathy (25%), two cases had posterior reversible encephalopathy syndrome (16.7%), and there was one case each of cerebral venous sinus thrombosis, pontine infarct, and bithalamic lesions (8.3%). This study highlights the diagnostic approaches in COVID-19-associated encephalopathy and the variable imaging features that clinicians and neuroradiologists should be aware of, as the pandemic progresses.  Key Words: COVID-19, Neuroimaging, Encephalopathy, Magnetic resonance imaging, Coronavirus.


Asunto(s)
Encefalopatías/diagnóstico , Neuroimagen/métodos , Pandemias , Encefalopatías/epidemiología , Comorbilidad , Humanos
2.
Zhonghua Er Ke Za Zhi ; 59(4): 316-321, 2021 Apr 02.
Artículo en Chino | MEDLINE | ID: mdl-33775052

RESUMEN

Objective: To analyze the clinical and genetic characteristics, diagnosis and treatment of hemiplegic migraine (HM) manifested as acute encephalopathy in children, so as to improve the understanding of this disease. Methods: The clinical data of 5 children diagnosed with HM characterized by acute encephalopathy who were admitted to Beijing Children's Hospital affiliated to Capital Medical University from August 2018 to June 2020 were retrospectively analyzed. Results: Among the 5 cases, 3 were males and 2 females with an age of 9.7 (3.9-12.7) years. The age of disease onset was 7.0(2.1-12.7) years. The peak symptoms of 5 children showed encephalopathy such as drowsiness and coma, as well as other clinical manifestations including headache, visual abnormality, hemiplegia, aphasia, convulsions, and fever, etc. The time to reach the peak was on the 2nd-6th day of the course of the disease. Before the onset of the disease 2 cases were found to have mild brain trauma and 2 cases had similar attacks in the past. Brain magnetic resonance imaging (MRI) showed hemispheric or partial cerebral cortex swelling and restricted diffusion of subcortical white matter in all cases, and cerebellar atrophy in 3 cases. All children received symptomatic treatment, and 2 of them were also treated with low-dose corticosteroids in the meantime. Finally all cases recovered clinically from the attack, but one had atrophic changes left in the affected area on brain MRI. Whole exon sequencing revealed variations of CACNA1A gene in all cases, among which 4 were de novo mutations and 1 case inherited from the mother who had migraine without aura. After the diagnosis, the 5 children were treated with long-term flunarizine and followed up for 22(7-29) months by telephone or in the outpatient clinic. Before the last follow-up, none of them showed weakness or encephalopathy, but one still had intermittent headaches and occasional transient right limb numbness. Conclusions: Hemipleg is often accompanied by impaired consciousness in addition to headache, hemiplegia, aphasia, visual abnormality, etc. Most patients recover completely after a short period, while a few recover slowly and may suffer sequelae such as brain atrophy and cognitive impairment and even death. CACNA1A gene variation is the most common genetic variation. Flunarizine could prevent recurrence of severe attack.


Asunto(s)
Encefalopatías , Trastornos Migrañosos , Migraña con Aura , Encefalopatías/diagnóstico , Encefalopatías/genética , Niño , Femenino , Hemiplejía/diagnóstico , Hemiplejía/genética , Humanos , Masculino , Trastornos Migrañosos/genética , Migraña con Aura/genética , Estudios Retrospectivos
3.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762283

RESUMEN

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.


Asunto(s)
Encefalopatías/etiología , Convulsiones/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Adulto , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Encefalopatías/diagnóstico , Encefalopatías/terapia , /terapia , Confusión/complicaciones , Humanos , Inmunización Pasiva/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Reacción en Cadena de la Polimerasa , Radiografía/métodos , Convulsiones/terapia , Resultado del Tratamiento
6.
Neurology ; 96(6): 274-286, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33361266

RESUMEN

BACKGROUND: Meningioangiomatosis is a poorly studied, rare, benign, and epileptogenic brain lesion. OBJECTIVE: To demonstrate that surgical resection and a short-time interval to surgery improves epileptic seizure control, we performed a systematic review and meta-analysis of meningioangiomatosis cases. METHODS: Using PRISMA-IPD guidelines, the authors performed a systematic review and meta-analysis of histopathologically-proven meningioangiomatosis cases. Literature search in French and English languages (PubMed, Embase, the Cochrane Library, and the Science Citation Index) including all studies (January 1981 to June 2020) dealing with histopathologically-proven meningioangiomatosis, without age restriction. We assessed clinical, imaging, histomolecular, management, and outcome findings of patients with meningioangiomatosis. RESULTS: Two-hundred and seven cases of meningioangiomatosis from 78 studies were included. Most meningioangiomatosis was sporadic, preferentially concerned male patients, younger than 20 years old, and allowed a functionally independent status. Epileptic seizure was the main symptom, with 81.4% of patients having uncontrolled seizures at the time of surgery. Meningioangiomatosis mainly had frontal (32.3%) or temporal (30.7%) locations. Imaging presentation was heterogeneous, and the diagnosis was often missed preoperatively. The histopathologic pattern was similar whatever the clinical presentation, and immunohistochemistry had limited diagnostic value. On molecular analysis, allelic loss at 22q12 was more frequent in samples of meningioangiomatosis-associated meningioma (37.5%) than in isolated meningioangiomatosis (23.1%). Time interval from diagnosis to surgery (p = 0.011) and lack of surgical resection of the meningioangiomatosis (p = 0.009) were independent predictors of postoperative seizure control. CONCLUSIONS: Owing to low scientific evidence, a multicentric prospective study should help refining the management of meningioangiomatosis.


Asunto(s)
Angiomatosis , Encefalopatías , Epilepsia , Meninges , Angiomatosis/complicaciones , Angiomatosis/diagnóstico , Angiomatosis/cirugía , Encefalopatías/complicaciones , Encefalopatías/diagnóstico , Encefalopatías/cirugía , Epilepsia/etiología , Epilepsia/cirugía , Humanos , Meninges/patología
7.
Rev. neurol. (Ed. impr.) ; 71(12): 431-437, 16 dic., 2020. tab
Artículo en Español | IBECS | ID: ibc-195510

RESUMEN

INTRODUCCIÓN: La enfermedad por coronavirus 2019 (COVID-19) causó el colapso de muchos hospitales. El objetivo de este estudio es analizar la utilidad del electroencefalograma (EEG) en el tratamiento del paciente neurológico durante la pandemia de COVID-19. PACIENTES Y MÉTODOS: El Servicio de Neurofisiología Clínica del Hospital Central de la Defensa Gómez Ulla fue disuelto debido a la situación de saturación hospitalaria. En consecuencia, se realizó un EEG excepcionalmente a los pacientes a los que tenía mayor probabilidad de aportar un beneficio en su tratamiento. Se describen siete pacientes (cuatro en cuidados intensivos y tres hospitalizados) diagnosticados con COVID-19 a quienes se les realizó un EEG. RESULTADOS: El EEG mostró anormalidades en todos los casos, incluyendo un caso de muerte cerebral. El EEG supuso un cambio en el tratamiento clínico en cuatro de los pacientes (57%) y ayudó al clínico a informar a la familia. En los otros tres casos, se sospechó un origen tóxico-metabólico previo al EEG, por lo que no implicó un cambio en el tratamiento ya propuesto, aunque facilitó una orientación pronóstica. Se evidenciaron ondas lentas polimorfas en cinco casos. Actualmente, un paciente permanece hospitalizado y cuatro han fallecido. CONCLUSIONES: El EEG fue de utilidad y facilitó la toma de decisiones en los pacientes con COVID-19 en los que se solicitó. Orientó al diagnóstico en casos en los que la tomografía computarizada no contribuyó y supuso un cambio en el tratamiento terapéutico en la mayoría de los pacientes. Los hallazgos más frecuentes fueron signos de encefalopatía y descargas epileptiformes


INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a collapse situation in many hospitals around the world. The aim of this study is to analyse the utility of the electroencephalogram (EEG) in the management of the neurological patient during the COVID-19 pandemic. PATIENTS AND METHODS: The Clinical Neurophysiology Department of the Hospital Central de la Defensa Gómez Ulla was dissolved due to the hospital collapse situation. Therefore, the EEG was performed exceptionally in those cases with the greatest probability of providing a benefit in its management. We describe seven patients (four in ICU and three hospitalized) diagnosed with COVID-19, who underwent through an EEG. RESULTS: The EEG showed abnormalities in all cases, including one case of brain death. The EEG resulted in a change in clinical management in four of the patients (57%) and helped the clinician provide information to the family. In the other three cases, a toxic-metabolic origin was suspected before the EEG was performed, so it did not imply a change in the clinical management already proposed, although it facilitated a prognostic orientation. Slow polymorphic waves were evident in five cases. Five patients were unresponsive. Currently, one patient remain hospitalized and four have died. CONCLUSIONS: The EEG was useful and facilitated decision making in COVID-19 patients in whom it was requested. It guided the diagnosis in cases where CT was non-contributory and led to a change in therapeutic management in most patients. The most frequent findings were signs of encephalopathy and epileptiform discharges


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Electroencefalografía/métodos , Infecciones por Coronavirus/diagnóstico , Encefalopatías/diagnóstico , Encefalopatías/virología , Estudios Retrospectivos , Encefalopatías/terapia , Infecciones por Coronavirus/terapia , Distribución por Edad y Sexo , Reproducibilidad de los Resultados
9.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-33318255

RESUMEN

Influenza-associated encephalopathy/encephalitis (IAE) can result in serious neurological complications. We report a 4-year-old healthy female child with the diagnosis of IAE. Her clinical course was complicated by temporary visual impairment and significant motor deficits. Her unique ophthalmological findings have little precedent in previous literature.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/virología , Gripe Humana/complicaciones , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/virología , Encéfalo/patología , Encéfalo/virología , Encefalopatías/fisiopatología , Preescolar , Femenino , Humanos , Virus de la Influenza B , Imagen por Resonancia Magnética , Trastornos de la Visión/fisiopatología
10.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334746

RESUMEN

A 28-year-old man presented with a progressive inward deviation of the left eye in the last 4 years. Examination revealed -3 abduction and elevation deficit in the left eye with 50 prism diopters (PD) esotropia and 12 PD of hypotropia. The patient had multiple fibromas on the forearms with pulsatile globe and was diagnosed as neurofibromatosis type 1. Myopic strabismus fixus was suspected. MRI revealed left temporal lobe herniation through a dysplastic sphenoid wing, compressing the posterior half of the superior rectus and lateral rectus muscles, resulting in an esotropia-hypotropia complex. Surgical treatment involved suture myopexy (Yokoyama's technique) of the left superior rectus and lateral rectus muscles with a 6.5 mm left medial rectus recession. Two months postoperatively, the patient had minimal residual esotropia and hypotropia. MRI orbits should always be performed in high myopes with strabismus to assess extraocular muscle pathways.


Asunto(s)
Encefalopatías/diagnóstico , Esotropía/cirugía , Hernia/etiología , Miopía/cirugía , Neurofibromatosis 1/diagnóstico , Músculos Oculomotores/cirugía , Adulto , Encefalopatías/etiología , Diagnóstico Diferencial , Esotropía/diagnóstico , Esotropía/etiología , Hernia/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Miopía/diagnóstico , Miopía/etiología , Neurofibromatosis 1/complicaciones , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/patología , Lóbulo Temporal/diagnóstico por imagen , Resultado del Tratamiento , Agudeza Visual
11.
BMJ Case Rep ; 13(12)2020 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-33376089

RESUMEN

Altered mental status can have many causes ranging from emergent intracranial pathologies to more insidious, systemic toxic aetiologies. We report a rare case of dermato-neuro syndrome in a 71-year-old man with a known history of scleromyxoedema. The patient initially presented with encephalopathy which quickly progressed to generalised tonic-clonic seizures and coma. While his presentation fits with other, although rare, cases of dermato-neuro syndrome, it is imperative to rule out lethal, more common causes of altered mentation. Due to the rarity and difficulty in diagnosis of dermato-neuro syndrome, there is a significant debate regarding the optimal management as there are no standardised treatment protocols. In our case, the patient was successfully treated with plasmapheresis resulting in improved neurologic function.


Asunto(s)
Coma , Plasmaféresis/métodos , Escleromixedema , Convulsiones , Anciano , Encefalopatías/diagnóstico , Encefalopatías/etiología , Deterioro Clínico , Coma/diagnóstico , Coma/etiología , Coma/terapia , Diagnóstico Diferencial , Humanos , Masculino , Examen Neurológico/métodos , Manejo de Atención al Paciente/métodos , Respiración Artificial/métodos , Escleromixedema/complicaciones , Escleromixedema/fisiopatología , Convulsiones/diagnóstico , Convulsiones/etiología , Convulsiones/terapia , Síndrome , Resultado del Tratamiento
12.
BMC Infect Dis ; 20(1): 763, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066738

RESUMEN

BACKGROUND: A lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently. CASE PRESENTATION: We described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus. CONCLUSIONS: In critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment.


Asunto(s)
Aspergillus/aislamiento & purificación , Encefalopatías/diagnóstico , Coma/diagnóstico , Cuidados Críticos , Neumonía Bacteriana/diagnóstico , Aspergilosis Pulmonar/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus intermedius/aislamiento & purificación , Corticoesteroides/uso terapéutico , Anciano , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Aspergilosis Pulmonar/tratamiento farmacológico , Aspergilosis Pulmonar/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 99(43): e22940, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120854

RESUMEN

RATIONALE: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) has been reported almost exclusively in the Japanese population. PATIENT CONCERNS: A 17-month-old male patient presented with fever and seizures, and subsequently fell into a coma. On the second day, he recovered consciousness. On the fourth day, he developed complex partial seizures and fell into a coma again. On day 10, the fever and seizures subsided. Head computed tomography on the first day showed no abnormalities. Brain diffusion-weighted images on the fourth day revealed reduced diffusion in the bilateral subcortical white matter. DIAGNOSIS: A diagnosis of AESD was made. INTERVENTIONS: The patient was treated with corticosteroids and intravenous immunoglobulin. OUTCOMES: At the 4-month follow-up, the patient was able to walk independently, and the epileptic seizures were well controlled. LESSONS: AESD is a rare entity, and treatment with corticosteroids and intravenous immunoglobulin can lead to a favorable prognosis. Clinicians should be aware of this condition, and clinicoradiological features can suggest the diagnosis.


Asunto(s)
Encefalopatías/complicaciones , Imagen de Difusión por Resonancia Magnética/métodos , Convulsiones/etiología , Enfermedad Aguda , Corticoesteroides/uso terapéutico , Encefalopatías/diagnóstico , Encefalopatías/tratamiento farmacológico , Coma/diagnóstico , Coma/etiología , Quimioterapia Combinada , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , Masculino , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología
15.
BMC Neurol ; 20(1): 332, 2020 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-32878610

RESUMEN

BACKGROUND: Susac syndrome (SuS) is a rare condition characterized by a clinical triad of sensorineural hearing loss, branch artery occlusion and encephalopathy. This study reports an increased incidence of SuS in Israel. We describe the clinical characteristics of these patients, diagnostic procedures and the use and subsequent outcomes of newly published treatment guidelines. METHODS: This is a single center retrospective study. Patients who were diagnosed with SuS between July 2017 and August 2018 were enrolled in this study. RESULTS: Seven patients were diagnosed with SuS according to the diagnostic criteria in a time period of 13 months. The annual incidence was recently evaluated in Austria to be 0.024/100000, therefore, our case series represent at least a 5.4- fold increase in the annual incidence of SuS expected in Israel and a 7-fold increase in the annual incidence expected in our medical center. Mean time from the onset of the symptoms to diagnosis was three weeks and follow-up time was twenty four months. Recent exposure to cytomegalovirus was serologically evident in three patients and one patient had high titer of anti-streptolysin antibody. All patients underwent brain MRI, fluorescein angiography and audiometry. All patients were treated according to the newly recommended guidelines. All patients achieved clinical and radiological stability. CONCLUSIONS: We report of an increased incidence of SuS in Israel. Infectious serological findings may imply a post infectious mechanism. The use of the recommended diagnostic procedures reduced the time to diagnosis. Newly published treatment guidelines led to favorable clinical outcomes.


Asunto(s)
Encefalopatías/diagnóstico , Imagen por Resonancia Magnética , Síndrome de Susac/diagnóstico , Adulto , Femenino , Angiografía con Fluoresceína , Humanos , Incidencia , Masculino , Radiografía , Estudios Retrospectivos , Síndrome de Susac/diagnóstico por imagen , Adulto Joven
16.
Medicine (Baltimore) ; 99(36): e22052, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899066

RESUMEN

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ±â€Š11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/terapia , Cuerpo Calloso/patología , Músculos Paraespinales/diagnóstico por imagen , Adulto , Encefalopatías/sangre , Encefalopatías/líquido cefalorraquídeo , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/metabolismo , Líquido Cefalorraquídeo/fisiología , Presión del Líquido Cefalorraquídeo , Electroencefalografía/métodos , Femenino , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Músculos Paraespinales/patología , Estudios Retrospectivos , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Sodio/sangre , Síndrome , Resultado del Tratamiento , Vértigo/tratamiento farmacológico , Vértigo/etiología
20.
J Stroke Cerebrovasc Dis ; 29(9): 105022, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32807437

RESUMEN

BACKGROUND: Isolated mental status changes as a presenting sign (EoSC+), are not uncommon stroke code triggers. As stroke alerts, they still require the same intensive resources be applied. We previously showed that EoSC+ strokes (EoSC+ Stroke+) account for 0.1-0.2% of all codes. Whether these result in thrombolytic treatment (rt-PA), and the characteristics/ risk factor profiles of EoSC+ Stroke+ patients, have not been reported. METHODS: Retrospective analysis of stroke codes from an IRB approved registry, from 2004 to 2018, was performed. EoSC+ was defined as a NIHSS>0 for Q1a, 1b, or 1c with remaining elements scored 0. Characteristics and risk factors were compared for EoSC+, EoSC-, EoSC+ Stroke+, and rt-PA (EoSC+ Stroke+TPA+) patients. RESULTS: EoSC+ occurred in 55/2982 (1.84%) of all stroke codes. EoSC+ Stroke+ occurred in 8/55 (14.5%) of EoSC+ codes and 8/2982 (0.27%) of all stroke codes. 6/8 (75%) of EoSC+ Stroke+ scored NIHSS=1. When comparing EoSC++versus EoSC-, Hispanic ethnicity (p=0.009), hypertension (p=0.02), and history of stroke/TIA (p=0.002) were less common in EoSC+. No demographic/risk factor differences were noted for EoSC+ Stroke+ vs. EoSC+ Stroke-. No cases of rt-PA eligibility/treatment were noted. In EoSC+ Stroke+ analysis, imaging positive stroke/intracranial hemorrhage was noted on only 3 cases (3/2982=0.10% of all stroke codes) and none were posterior stroke. CONCLUSIONS: EoSC+ rarely results in stroke/TIA (0.27%) or stroke (0.10%), and in our analysis never (0%) resulted in rt-PA. Sub-analysis did not show missed rt-PA or posterior strokes. Understanding characteristics, and knowing that EoSC+ Stroke+ patients are unlikely to receive rt-PA, may help triage stroke resources.


Asunto(s)
Encefalopatías/diagnóstico , Toma de Decisiones Clínicas , Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Encefalopatías/etiología , Encefalopatías/psicología , Bases de Datos Factuales , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Salud Mental , Selección de Paciente , Valor Predictivo de las Pruebas , Proteínas Recombinantes/administración & dosificación , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/psicología , Triaje , Procedimientos Innecesarios
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