Outcome neurological

Oliveira-Filho J, Ezzedine MA, Segal AZ, Buonanno FS, Chang Y, Ogilvy CS, Rordorf G, Schwamm LH, Koroshetz WJ, McDonald CT. Fever in subarachnoid hemorrhage relationship to vasospasm and outcome. Neurology 2001 56(10) 1299-1304. 

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Georgiadis D, Oehler J, Schwarz S et al. (2004). Does acute occlusion of the carotid T invariably have a poor outcome Neurology 63 22-26... 

Parsons MW, Li T, Barber PA et al. (2000). Combined (1)H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome. Neurology 55 498-505... 

Ito M, Aiba H, Hashimoto K, Kuroki S, Tomiwa K, Okuno T, Hattori H, Go T, Sejima H, Dejima S, Ikeda H, Yoshioka M, Kanazawa O, Kawamitsu T, Ochi J, Miki N, Noma H, Oguro K, Ozaki N, Tamamoto A, Matsubara T, Miyajima T, Fujii T, Konishi Y, Okuno T, Hojo H. Low-dose ACTH therapy for West syndrome initial effects and long-term outcome. Neurology 2002 58(1) 110-14. 

Tisherman, S.A., Safar, P., Radovsky, A., Peirzman, A., Marrone, G., Kuboyama, K., Weinrauch, V. (1991). Profound hypothermia (< 10 °C) compared to deep hypothermia (15 °C) improves neurologic outcome in dogs after two hours circulatory arrest induced to enable resuscitative surgery. J. Trauma 31, 1051-1062. 

Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology 1998 51 418 26. 

Palesch YY, Hill MD, Ryckborst KJ, Tamariz D, Ginsberg MD. The alias pilot trial a dose-escalation and safety study of albumin therapy for acute ischemic stroke—II neurologic outcome and efficacy analysis. Stroke 2006 37 2107-2114. 

The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002 346 549-556. 

Roos JA, Jackson-Friedman C, Lyden P. Effects of hyperbaric oxygen on neurologic outcome for cerebral ischemia in rats. Acad Emerg Med 1998 5 18-24. 

For patients who demonstrate continued neurological deterioration despite anticoagulation, local intrathrombus thrombolysis may be beneficial. In case series in which most patients received urokinase, favorable outcome with no major therapeutic morbidity has been described.In one study, 29 patients with angiogram-proven CVST were reviewed retrospectively. Of the 18 who received local urokinase, 17 recovered completely, and 1 was left with a mild neurological deficit. Heparin was given to four patients, three of whom made a complete recovery. Six presented in a comatose state with severe CVST and only supportive measures were used. It is difficult to draw conclusions from these data, as only patients with mild or moderately severe disease were selected for thrombolytic treatment. 

Excellent biological arguments exist for a direct impact of fever specifically on neurological outcome. On a local level, fever produces increased levels of excitatory amino acids (e.g., glutamate and dopamine), free radicals, lactic acid, and pyr-uvate. There is an increase in cell depolarizations and BBB breakdown. Enzymatic function is impaired and cytoskeletal stability reduced. These events lead to increased cerebral edema, with a possible reduction in CPP as well as larger volumes of ischemic injury. " ... 

Many clinicians are concerned about the use of DC for dominant hemisphere strokes, but Kastrau et al. found in a retrospective review of 14 dominant hemisphere stroke patients with aphasia that significant improvement (13/14 patients) was achieved in these preselected younger patients who underwent early poststroke DC. In contrast, a retrospective study by Foerch et al. found that older patients fared quite poorly in terms of functional outcome and quality of life, especially in those with severe neurological deficit at admission. These results were replicated by Curry et al., who also found that younger patients also were more likely to require reoperations for continued herniation. Uhl et al. ° found no prognostic value to the side of infarction in their analysis of 188 patients who underwent DC for massive hemispheric infarction. 

Bushnell CD, Phillips-Bute BG, Laskowitz DT, Lynch JR, Chilukuri V, Borel CO. Survival and outcome after endotracheal intubation for acute stroke. Neurology 1999 52(7) 1374-1381. 

Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurological status, cough, secretions and extubation outcomes. Intensive Care Med 2004 30(7) 1334 1339. 

Zeiner A, Holzer M, Sterz F, Schorkhuber W, Eisenburger P, Havel C, KUegel A, Laggner AN. Hyperthermia after cardiac arrest is associated with an unfavorable neurological outcome. Arch Intern Med 2001 161(16) 2007-2012. 

The severity of the neurological deficit at the time of stroke onset is a major predictor of stroke outcome. In an analysis of the placebo-treated patients in the National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue-plasminogen activator (rt-PA) study, the best acute predictor of a poor outcome at 1 year was an National Institute of Health Stroke Scale (NIHSS) score >17 for patients over 70 years. These criteria had a high specificity (98%), but sensitivity was only 31%. The low sensitivity of the acute NIHSS score alone in predicting... 

Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley Jr. EC, Lewandowski CA, Kwiatkowski TP. Early stroke treatment associated with better outcome the NINDS rt-PA stroke study. Neurology 2000 55 1649-1655. 

Buchan AM, Barber PA, Newcommon N, Rarbalai HG, Demchuk AM, Ho3de RM, Rlein GM, Feasby TE. Effectiveness of t-PA in acute ischemic stroke outcome relates to appropriateness. Neurology 2000 54 679-684. 

Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.40... 

Stroke outcomes are measured based on the neurologic status and functioning of the patient after the acute event. The National Institutes of Health Stroke Scale (NIHSS) is a measure of daily functioning and is used to assess patient status following a stroke. 

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