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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 5-9, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016670

RESUMO

OBJECTIVE: The timely diagnosis of atrial fibrillation (AF) in patients with cardiac embolism with implantable loop recorders (ILR). MATERIAL AND METHODS: Twenty-nine patients, hospitalized within 6 months after stroke (n=19) or transient ischemic attack (n=10), were included in the study. ILR were implanted in all cases. The mean time of follow-up was one year. RESULTS: Five hundred and thirteen transmissions were detected during the whole follow-up period. Symptomatic episodes were recorded in 165 cases. Such episodes as bradycardia, asystole, AF, atrial tachycardia and ventricular tachycardia were recorded in 98 cases out of 348 planned transmissions. All transmissions were analyzed by an operator. However, 70 cases were false-positive because of ILR over-sensing. In total, arrhythmias were detected in 5 patients, including sick sinus syndrome (1), supraventricular tachycardia (1), ventricular tachycardia (1) and atrial fibrillation (3). Anticoagulant therapy was started immediately after the diagnosis of AF. CONCLUSION: Loop recording monitoring is an effective strategy in patients with cardiac embolism for timely diagnosis and further treatment of arrhythmia.


Assuntos
Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Anticoagulantes , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia Ambulatorial , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 17-23, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016672

RESUMO

OBJECTIVE: To evaluate the hemostasis of plasma aminothiols in different subtypes of ischemic stroke (IS). MATERIAL AND METHODS: The study included 177 patients, aged 62 (55-68) years, admitted in the first 8-24 hours since IS onset. The pathogenetic subtype of IS was clarified according to the results of clinical and instrumental examination by the Trial of ORG 10172 in Acute Stroke Treatment criteria. Determination of the total plasma aminothiols levels, their reduced forms and redox status was performed using the ultra-efficient Acquity H-Class UPLC liquid chromatograph (Waters, CSHA). RESULTS: Large-artery atherosclerosis was diagnosed in 24.3% patients, cardioembolic stroke in 20.3%, lacunar stroke in 55.4%. Significant differences in total levels of cysteine (Cys), glutathione (Gsh) and homocysteine (Hcy) were identified in patients with different IS subtypes. Patients with large-artery atherosclerosis and lacunar stroke showed the highest level of Hcy, patients with cardioembolic stroke had the lowest levels of Cys and Gsh. CONCLUSION: Total levels of plasma aminothiols are associated with different subtypes of IS.


Assuntos
Aterosclerose , Isquemia Encefálica/complicações , Cisteína , Glutationa , Homocisteína , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/sangue , Cisteína/sangue , Glutationa/sangue , Homocisteína/sangue , Humanos , Pessoa de Meia-Idade , Oxirredução
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 24-29, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016673

RESUMO

OBJECTIVE: To identify the likelihood of developing systemic inflammation (SI) as a general pathological process in severe haemorrhagic intracerebral stroke with and without the phenomenon of ineffective cerebral blood flow. MATERIAL AND METHOD: Three groups were examined: 1) 89 blood donors (controls), 2) 15 patients with severe haemorrhagic stroke without the phenomenon of ineffective brain blood flow; 3) 26 patients with severe haemorrhagic stroke with ineffective cerebral blood flow. Ineffective cerebral blood circulation was recorded on the basis of transcranial Doppler ultrasound data; 87% of patients had clinical signs of brain death. All patients in the groups with haemorrhagic stroke had signs of multiple organ dysfunction according to the Sepsis-related Organ Failure scale, all of them received intensive care. An integrated scale based on the determination of plasma concentrations of cytokines (IL-6, IL-8, IL-10, TNF-α), procalcitonin, cortisol, D-dimers, myoglobin, troponin I was used to verify systemic inflammation. RESULTS AND CONCLUSION: Systemic inflammation or borderline state (pre-SI) was identified in all patients of the second group both on 1-3 days from the onset of haemorrhagic stroke, and on 5-8 days. On the contrary, in the third group, there were no signs of SI on 1-3 days. On 5-8 days, signs of SI and pre-SI were recorded only in 18.2% of patients. Apparently, the reason for these differences is the blockade of the passage of tissue decay products and other pro-inflammatory factors into the bloodstream from the damaged brain in the third group.


Assuntos
Circulação Cerebrovascular , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Encéfalo/diagnóstico por imagem , Humanos , Inflamação
4.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 30-36, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016674

RESUMO

BACKGROUND: The issue of the diagnostic significance and clinical value of neuron-specific enolase (NSE) and brain-derived neurotropic factor (BDNF) in the acute period of stroke remains controversial. Therefore, it is advisable to study the correlation of biomarkers with the clinical characteristics of stroke in the time period of early recovery. OBJECTIVE: To monitor NSE and BDNF levels in peripheral blood, to analyze the clinical and laboratory correlations in patients with ischemic stroke at the stages of medical rehabilitation in the early recovery period. MATERIAL AND METHODS: Forty-nine patients with ischemic stroke in the middle cerebral artery were examined. The observation period is 90 days. Observation Points are Day 1; Day 14; Day 45; Day 90. The National Institute of Health Stroke Scale (NIHSS), the Fugle-Meyer Scale (FMA), the Modified Rankin Scale (mRS) were administered. NSE was determined in blood serum by enzyme-linked immunosorbent assay, BDNF was analyzed on a multiplex analyzer. RESULTS AND CONCLUSION: NSEDay1 in patients was significantly higher than in the comparison group (pDay1-comparison group<0.001) with a trend to a maximum decrease on the 90th day of stroke (pDay1-90<0.001). BDNFDay1 turned out to be lower than in the comparison group (pDay1-comparison group=0.006) and significantly increased by the 14th day of the stroke (pDay1-14<0.001; pDay14-comparison group=0.637). A negative correlation was found between a decrease in NSEDay14 and an increase in BDNFDay14 (r= -0.349; p=0.05). A positive correlation was found between an increase in BDNFDay14 and a decrease in mRS scores Day90 (r=0.499, p=0.035). Outcomes in patients in group 1 (after stages I and II of rehabilitation) on the assessment scales were significantly better than in patients discharged after stage I for outpatient monitoring - group 2 (p<0.05). In group 1, BDNFDay90 did not differ from BDNFDay14 (pDay14-90-Group1=0.17), and in group 2 it was significantly lower by the end of the early recovery period (pDay14-90-Group2=0.002).


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Encéfalo , Fator Neurotrófico Derivado do Encéfalo , Humanos , Fosfopiruvato Hidratase , Reabilitação do Acidente Vascular Cerebral
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 73-80, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016680

RESUMO

OBJECTIVE: To compare the efficacy of walking function recovery in patients in the early recovery period of ischemic stroke (IS) using an exoskeleton for the lower extremities and an active-passive pedal exercise bike. MATERIAL AND METHODS: An open randomized study of 47 patients in the early recovery period of IS was conducted. The rehabilitation course included exercises on an ExoAtlet exoskeleton in group 1 and exercises on a pedal simulator for active-passive training (5 days a week for 2 weeks) in group 2. Several tests were used to evaluate treatment results, including the Hauser walking index, the 10-meter walking test, the Berg balance scale, stabilometry, and biomechanics of walking. The complete training course was completed by 20 patients of group 1 and 21 of group 2. RESULTS: There was a significant increase in strength in paretic muscles, postural stability, functional level and walking speed in patients of both groups, but in patients of group 1, the dynamics of recovery was more pronounced (p<0.05). In group 1, there was a significant decrease in the level of disability and an increase in daily activity, which was higher compared to group 2. An analysis of the main indicators of the statokinesiogram showed the more pronounced positive shifts in patients of group 1, but significant differences were found only in the dynamics of the length and area of the curve in the test with eyes open. When studying the biomechanics of walking, it was found that the function of walking was changed: there was a significant decrease in the speed of movement by 2.2 times, the length of a double step by 1.6 times, and the pace of walking by 1.3 times compared to normal indicators. After the end of exercises, a significant increase in the length of the double step, speed and pace of walking as well as a decrease in the period of the locomotor cycle were found in group 1. CONCLUSION: The study revealed a positive impact of hardware rehabilitation on locomotion, both with the use of an exoskeleton and an active-passive pedal simulator. The use of an exoskeleton, have the advantages resulting in a significantly greater recovery of strength, stability, speed and symmetry of walking over the same period of training. A significant increase in postural stability in vertical position was revealed.


Assuntos
Exoesqueleto Energizado , Procedimentos Cirúrgicos Robóticos , Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Caminhada
6.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 81-87, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016681

RESUMO

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Betacoronavirus , Humanos
7.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 851-855, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047718

RESUMO

OBJECTIVE: Mitochondrial deoxyribonucleic acid (mtDNA) 8344 A>G (m.8344A>G) mutation is the common mutation associated with mitochondrial myoclonus epilepsy with ragged-red fibers (MERRF) syndrome. Herein we report a rare case with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes/MERRF/Leigh (MELAS/MERRF/Leigh) overlap syndrome caused by m.8344A>G mutation. METHODS: The clinical and imaging data of the patient were collected and an open muscle biopsy was carried out. We further employed molecular genetic analyses to detect mtDNA mutation in the proband and his mother. And then a clinical and neuroimaging follow-up was performed. RESULTS: This patient was a 25-year-old male, who developed exercise intolerance since the age of 6. At age 10, he suffered from acute episodes of hemianopia, and cranial magnetic resonance imaging (MRI) showed occipital stroke-like lesions and cranial magnetic resonance spectroscopy (MRS) revealed a lactate peak corresponding to the lesion. After that the patient presented slowly progressive psychomotor decline. He had myoclonic seizures and cerebellar ataxia since the age of 12. At age 21, he was admitted to our hospital because of confusion and cranial MRI revealed symmetrical lesions in bilateral posterior putamen, thalami and midbrain. Then repeated MRI showed progression of original lesions and new frontal multiple stroke-like lesions. Symptomatic and rehabilitation treatment relieved his condition. Follow-up cranial MRI at age 24 showed the lesions in basal ganglia and thalami diminished, and the midbrain lesions even completely vanished. Muscle pathology indicated the presence of numerous scattered ragged-red fibers (RRF), suggestive of a mitochondrial disorder. Polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) detected the m.8344A>G mutation of the MT-TK gene encoding mitochondrial transfer RNA for lysine in the patient's blood. Next generation sequencing (NGS) of the whole mitochondrial genome identified that the proportion of m.8344A>G was 90%, and no other mtDNA mutation was detected. Sanger sequencing further identified this mutation both in the proband and his mother's blood, although the mutation load was much lower in his mother's blood with approximately 10% heteroplasmy. CONCLUSION: The present study is the first to describe a patient with m.8344A>G mutation in association with the MELAS/MERRF/Leigh overlap syndrome, which expands the phenotypic spectrum of the m.8344A>G mutation.


Assuntos
Acidose Láctica , Acidente Vascular Cerebral , Adulto , Criança , DNA Mitocondrial/genética , Humanos , Masculino , Encefalomiopatias Mitocondriais , Mutação , Adulto Jovem
8.
Rev Prat ; 70(6): 610-613, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058599

RESUMO

When to think early about a stroke and what to do ? Rapid recognition of stroke symptoms leads to early treatment and improved clinical outcomes, with direct impact on stroke survival and functional outcome. The typical clinical presentation of a stroke consists of a sudden onset of a focal neurological deficit of maximum intensity at onset. Typical warning symptoms, that have been promoted in public awareness campaigns, are the sudden unilateral numbness or weakness of face, arm, or leg, especially on one side of the body, speech difficulty and visual trouble. It may also happen that a stroke has an unusual clinical presentation, 'false negatives' are called 'stroke chameleons', because the clinical presentation suggests another disorder. The call of the emergency number (number 15 in France) is the first thing to do in case of stroke symptom recognition. Stroke code allows to stroke management anticipation and significantly reduces the delays for early treatment.


Assuntos
Conscientização , Acidente Vascular Cerebral , França , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
9.
Rev Prat ; 70(6): 617-620, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058601

RESUMO

Prehospital management of acute stroke patients. In France, prehospital management of patients with suspected acute stroke relies on emergency medical communication centers (Samu), which provides first-line telephone assessment and dispatches the most appropriate emergency vehicle. Such tasks are not straightforward because many clinical symptoms may correspond to stroke and alternative diagnoses - stroke mimics - are common. It is crucial to reduce both prehospital and hospital delays in patients eligible for reperfusion therapies, namely intravenous thrombolysis and/or mechanical thrombectomy. Because mechanical thrombectomy only applies to patients with acute ischemic stroke and large-vessel occlusion, prehospital triage is important. However, clinical prediction of large-vessel occlusion is difficult and whether a specific patient should be sent to the nearest primary stroke center (drip and ship paradigm) or a comprehensive stroke center with thrombectomy capability (mothership paradigm) remains uncertain. Prehospital notification of the hospital-based stroke teams by the emergency medical system crews is crucial in reducing delays to achieve reperfusion.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , França/epidemiologia , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Trombectomia , Triagem
10.
Rev Prat ; 70(6): 621-625, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058602

RESUMO

Acute stroke imaging. Imaging, within the first 24 hours of stroke, supports its clinical diagnosis and allows a careful patient selection for treatment. It excludes hemorrhage and stroke mimics, provides an estimate of potentially salvageable brain tissue, locates and characterizes the intra-arterial thrombus before treatment decision in acute ischaemic stroke. In cerebral hemorrhage, it plays a pivotal role in establishing the diagnosis and identifying causes and complications. We outline the role of neuroimaging applied to patients presenting with acute stroke within the first 24 hours.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Encéfalo , Hemorragia Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Terapia Trombolítica
11.
Rev Prat ; 70(6): 626-628, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058603

RESUMO

Recanalization after cerebral ischemia. Acute ischemic stroke (AIS) management is based on stroke unit admission and arterial recanalization. Recanalization therapies include the endovascular approach (also called mechanical thrombectomy) and intravenous (IV) alteplase (i.e. thrombolysis). In the setting of AIS consecutive to large vessel occlusion of the anterior circulation (i.e. internal carotid and/or middle cerebral arteries), IV alteplase is associated to endovascular approach. IV alteplase alone being devoted to AIS without large vessel occlusion. The therapeutic window is of 4h30 for IV alteplase administration and 6 hours for endovascular approach. Using MRI and perfusion brain imaging, the therapeutic window may be individualized and extended up to 24 hours. Although this extended time window is an opportunity to treat more patients, the rapidity of recanalization remains critical, as it is a major predictor of clinical outcome, emphasizing the need to reduce, as much as possible, treatment delays.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual , Resultado do Tratamento
12.
Angiol Sosud Khir ; 26(3): 167-171, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063764

RESUMO

Extracranial carotid artery aneurysms belong to uncommon and dangerous vascular diseases. Reported herein are the results of successive surgical treatment of a patient presenting with an extracranial aneurysm of the internal carotid artery. Given anatomical peculiarities (large dimensions of the aneurysm, tortuosity of the internal carotid artery), it was decided to perform resection of the aneurysm with an end-to-end anastomosis established. The patient examined at 12 months postoperatively was found to be free from the syncopal states, with no restenosis of the zone of the anastomosis revealed. The chosen therapeutic policy provided effective prevention from the development of ischaemic stroke and aneurysmal rupture, as well as improved the patient's quality of life. An open reconstructive operation is an optimal method of treatment of patients presenting with extracranial carotid artery aneurysms.


Assuntos
Isquemia Encefálica , Doenças das Artérias Carótidas , Acidente Vascular Cerebral , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Humanos , Qualidade de Vida
13.
Am Surg ; 86(9): 1062-1066, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33049165

RESUMO

BACKGROUND: Direct oral anticoagulants (DOACs) have overtaken warfarin as the preferred anticoagulants for stroke prevention with atrial fibrillation and for treatment of venous thromboembolism. Despite the increased prevalence of DOACs, literature studying their impact on trauma patients with intracranial hemorrhage (ICH) remains limited. Most DOAC reversal agents have only been recently available, and concerns for worse outcomes with DOACs among this population remain. This study aims to assess the outcomes of patients with traumatic ICH taking DOACs compared with those taking warfarin. METHODS: A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, medication, and outcome data were collected for each patient. Patients taking warfarin and DOACs were compared. RESULTS: 736 patients had traumatic ICH over the study period, 75 of which were on either DOACs (25 patients) or warfarin (50 patients). The median age of the anticoagulated patients was 78 years; 52% were female, and 91% presented secondary to a fall. DOACs were reversed at close to half the rate of warfarin (40% vs 77%; P = .032). Despite this, the 2 groups had similar rates of worsening examination, need for operative intervention, and in-hospital mortality. In the follow-up, fewer patients taking DOACs had died at 6-months postinjury compared with those taking warfarin (8% vs 30%; P = .041). DISCUSSION: Despite DOACs being reversed at nearly half the rate of warfarin, patients presenting with traumatic ICH on warfarin had higher 6-month mortality suggesting a potential survival advantage for DOACs over warfarin in this population.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Hemorragia Intracraniana Traumática/complicações , Acidente Vascular Cerebral/prevenção & controle , Varfarina/administração & dosagem , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Coagulação Sanguínea/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Hemorragia Intracraniana Traumática/sangue , Hemorragia Intracraniana Traumática/mortalidade , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 264-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017979

RESUMO

Spatial neglect (SN) is a neurological syndrome in stroke patients, commonly due to unilateral brain injury. It results in inattention to stimuli in the contralesional visual field. The current gold standard for SN assessment is the behavioral inattention test (BIT). BIT includes a series of penand-paper tests. These tests can be unreliable due to high variablility in subtest performances; they are limited in their ability to measure the extent of neglect, and they do not assess the patients in a realistic and dynamic environment. In this paper, we present an electroencephalography (EEG)-based brain-computer interface (BCI) that utilizes the Starry Night Test to overcome the limitations of the traditional SN assessment tests. Our overall goal with the implementation of this EEG-based Starry Night neglect detection system is to provide a more detailed assessment of SN. Specifically, to detect the presence of SN and its severity. To achieve this goal, as an initial step, we utilize a convolutional neural network (CNN) based model to analyze EEG data and accordingly propose a neglect detection method to distinguish between stroke patients without neglect and stroke patients with neglect.Clinical relevance-The proposed EEG-based BCI can be used to detect neglect in stroke patients with high accuracy, specificity and sensitivity. Further research will additionally allow for an estimation of a patient's field of view (FOV) for more detailed assessment of neglect.


Assuntos
Lesões Encefálicas , Transtornos da Percepção , Acidente Vascular Cerebral , Eletroencefalografia , Humanos , Redes Neurais de Computação , Transtornos da Percepção/diagnóstico , Acidente Vascular Cerebral/complicações
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018057

RESUMO

Stroke survivors are often characterized by hemiparesis, i.e., paralysis in one half of the body, that severely affects upper limb movements. Continuous monitoring of the progression of hemiparesis requires manual observation of the limb movements at regular intervals and hence is a labour intensive process. In this work, we use wrist-worn accelerometers for automated assessment of hemiparetic severity in acute stroke patients through bivariate Poincaré analysis between accelerometer data from the two hands during spontaneous and instructed movements. Experiments show that while the bivariate Poincaré descriptors CSD1 and CSD2 can identify hemiparetic patients from control subjects, a novel descriptor called Complex Cross-Correlation Measure (C3M) can distinguish between moderate and severe hemiparesis. Further, we justify the use of C3M by showing that it is described by multiple-lag cross-correlations, representing the co-ordination of activity between two hands. The descriptors are compared against the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard for evaluation of hemiparetic severity, and studied using statistical tests for developing supervised models for hemiparesis classification.Clinical relevance-This study establishes the suitability of wrist-worn accelerometers in identifying hemiparetic severity in stroke patients through novel descriptors of hand co-ordination.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Acelerometria , Humanos , Paresia/diagnóstico , Acidente Vascular Cerebral/complicações , Estados Unidos
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1080-1083, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018173

RESUMO

Cerebral vascular territories are related to the clinical progression and outcome of ischemic stroke. The vascular territory map (VTM) helps to understand stroke pathophysiology and potentially the clinical prognosis. A VTM can be generated from the bolus arrival time map. However, previous methods require initial seed points to be chosen manually, and the region inferior to the circle of Willis is not included. In this paper, we propose a method to automatically generate a map of the whole cerebral vascular territory from CT perfusion imaging. We applied the proposed method to 19 cases of ischemic stroke to generate VTM for each case.Clinical Relevance- The proposed map may improve the interpretation of the physiological status of collateral flow for ischemic stroke, and aid in treatment decision making.


Assuntos
Isquemia Encefálica , Sistema Cardiovascular , Acidente Vascular Cerebral , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Mapeamento Encefálico , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1274-1277, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018220

RESUMO

Multiphase computed tomographic angiography (CTA) have been demonstrated to be a reliable imaging tool for evaluating cerebral collateral circulation that can be used to select acute ischemic patients for recanalization therapy. We proposed using bone subtraction techniques to visualize multiphase CTA for clinicians to make fast and consistent decisions in the imaging triage of acute stroke patients. A total of 40 multiphase brain CTA datasets were collected and processed by two bone subtraction methods. The reference method used pre-contrast (phase 0) scans to create ground truth bone masks by thresholding. The tested method used only contrast enhanced (phases 1, 2, and 3) scans to extract bone masks with two versions (U-net and atrous) of 3D multichannel convolution neural networks (CNNs) in a supervised deep learning paradigm for semantic segmentation. Half (n = 20) of the datasets were used to train and half (n = 20) were used to test the conventional 3D U-net and a patch-based 3D multichannel atrous CNN. The tested U-net and atrous CNNs achieved a mean intersection over union (IoU) scores of 90.0% +/- 2.2 and 93.9% +/- 1.2 respectively.Clinical Relevance-This bone subtraction technique helps to visualize CTA volumetric datasets in the form of full brain angiogram-like images to assist the clinicians in the emergency department for evaluating acute ischemic stroke patients.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Angiografia , Angiografia por Tomografia Computadorizada , Humanos , Redes Neurais de Computação , Acidente Vascular Cerebral/diagnóstico por imagem
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1290-1293, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018224

RESUMO

Intracranial hemorrhage (ICH) is a life-threatening condition, the outcome of which is associated with stroke, trauma, aneurysm, vascular malformations, high blood pressure, illicit drugs and blood clotting disorders. In this study, we presented the feasibility of the automatic identification and classification of ICH using a head CT image based on deep learning technique. The subtypes of ICH for the classification was intraparenchymal, intraventricular, subarachnoid, subdural and epidural. We first performed windowing to provide three different images: brain window, bone window and subdural window, and trained 4,516,842 head CT images using CNN-LSTM model. We used the Xception model for the deep CNN, and 64 nodes and 32 timesteps for LSTM. For the performance evaluation, we tested 727,392 head CT images, and found the resultant weighted multi-label logarithmic loss was 0.07528. We believe that our proposed method enhances the accuracy of ICH identification and classification and can assist radiologists in the interpretation of head CT images, particularly for brain-related quantitative analysis.


Assuntos
Hemorragias Intracranianas , Acidente Vascular Cerebral , Encéfalo , Estudos de Viabilidade , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3577-3580, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018776

RESUMO

Electrical stimulation of the vagus nerve has been shown to enhance cortical plasticity and may benefit upper extremity rehabilitation following stroke. As an initial step towards assessing the potential of other craniocervical nerves as neuromodulation targets during rehabilitation, we explored the ability of non-invasive stimulation of cervical spine afferents, paired with a proprioceptive discrimination task, to improve sensory function in neurologically intact human subjects. On each trial, subjects' arms were moved by a robot from a test position, along a random path, to a judgment position located 1-4 cm away. Subjects responded 'same' if the judgment position was the same as the test or 'different' if it was not. These responses were used to compute proprioceptive sensitivity and bias. Three groups of 20 subjects received transcutaneous electric nerve stimulation to the C3/C4 cervical spine at one of three frequencies (30 Hz, 300 Hz, 3 kHz) for 10 minutes prior to task performance. A fourth group served as a sham. We found a statistically significant interaction between stimulation frequency and displacement distance on proprioceptive sensitivity. In summary, stimulation of cervical spine afferents may enhance arm proprioceptive function, though in unimpaired subjects these gains depend on both stimulation frequency and discrimination distance.Clinical Relevance- This study provides preliminary data on the potential for non-invasive stimulation of cervical spine afferents to enhance recovery of function following stroke and other neurological disorders.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estimulação Elétrica Nervosa Transcutânea , Braço , Humanos , Extremidade Superior
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3723-3726, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018810

RESUMO

Platelet and fibrin-rich blood clots can respond differently to red blood cell rich clots during ischemic stroke treatment, which includes thrombolysis and mechanical thrombectomy. Currently, there is no accurate way to identify the type of clot in advance of treatment. If the type of blood clot can be identified, the optimum clot removal process can be chosen and patient outcomes can be improved. In this paper we fabricate physiologically relevant blood clot analogues from human blood, that cover a range of red blood cell, fibrin, and platelet concentrations. We characterize the dielectric profile of these formed clots using an open-ended coaxial probe method across a wide frequency range. After the dielectric measurements are completed, histology on each blood clot is performed to determine the concentration of red blood cells present. In total, 32 unique blood clots were measured.With this completed analysis, we investigate the correlation between the dielectric properties across this frequency range and the red blood cell count of the formed blood clots. Furthermore, we develop a model to predict whether an unknown blood clot can be categorized as red blood cell rich or platelet and fibrin-rich based solely on the measured dielectric properties.Clinical Relevance-Using the dielectric profile of a clot we can predict whether a clot is platelet and fibrin-rich or red blood cell rich allowing clinicians to more easily determine treatment methods during an intervention for ischemic stroke.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Trombose , Plaquetas , Isquemia Encefálica/terapia , Fibrina , Humanos , Acidente Vascular Cerebral/terapia , Trombose/terapia
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