Stroke outcome

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. 

Lodder J, van Raak L, Hilton A, Hardy E, Kessels A. Diazepam to improve acute stroke outcome results of the early gaba-ergic activation study in stroke trial. A randomized double-blind placebo-controlled trial. Cerebrovasc Dis 2006 21 120-127. 

Yoon SS, Dambrosia J, Chalela J, Ezzeddine M, Warach S, Haymore J, Davis L, Baird AE. Rising statin use and effect on ischemic stroke outcome. BMC Med 2004 2 4. 

Moonis M, Kane K, Schwiderski U, Sandage BW, Fisher M. HMG-CoA reductase inhibitors improve acute ischemic stroke outcome. Stroke 2005 36 1298-1300. 

Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome a metaanalysis of studies in patients. Stroke 2000 31(2) 410-414. 

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... 

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. 

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. 

The use of full-dose unff actionated heparin in the acute stroke period has not been proven to positively affect stroke outcome, and it significantly increases the risk of intracerebral hemorrhage. Trials of low-molecular-weight heparins and heparinoids have been largely negative and do not support their routine use in stroke patients. 

In a prospective study of 725 consecutive patients, 5 84 with cerebral infarcts and 141 with intracerebral hemorrhages, admitted to an acute stroke unit within 6 h of stroke onset, Boysen and Christensen measured body temperature on admission and every 2 h during the first 24 h after stroke onset (16). They found that, in patients with a major stroke (defined as having a Scandinavian Stroke Scale Score <25), a significant rise in temperature occurred hours after stroke onset. While severe infarcts and intracerebral hemorrhages caused temperature rises, elevated body temperature on admission within 6 h of stroke onset had no prognostic influence on stroke outcome at 3 mo. It is important to... 

Prediction of stroke outcome with echoplanar perfusion-and diffusion-weighted MRI. Neurology 51 418-426... 

Perfusion computed tomography prediction of final infarct extent and stroke outcome. Annals of Neurology 58 672-679... 

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... 

Pulsiuelli, W., Waldman, S., Sigbee, B., Rawlinson, D., Scherer, P., Plum, F. (1980). Experimental hyperglycemia and diabetes mellitus worsen stroke outcome. Trans. Am. Neurol. Assoc. 105 21. ... 

Endocrine Diabetes increases risk of stroke, may worsen stroke outcomes, and causes peripheral neuropathy. Thyroid disorders may contribute to mental status changes. Is the patient postmenopausal, increasing stroke risk ... 

A number of experimental studies have shown that caspase inhibition reduces ischemic injury [51]. Caspase-3 inhibitors [52], gene deletions of Bid or caspase-3 [53], and the use of peptide inhibitors, viral vector-mediated gene transfer, and antisense oligonucleotides that suppress the expression and activity of apoptosis genes have all been found to be neuroprotective [51]. However, caspase inhibitors do not reduce infarct size in all brain ischemia models, perhaps related to the greater severity of ischemia, limited potency or inability of the agent to cross the blood-brain barrier, relatively minor impact of apoptosis on stroke outcome, and upregulation of caspase-independent or redundant cell-death pathways. Ultimately, it may be necessary to combine caspase inhibitors and other inhibitors of apoptosis with therapies directed toward other pathways, for successful neuroprotection. 

Table 3.5 NCCT predictors of poor stroke outcome Hyperdense MCA or basilar artery sign on early NCCT Parenchymal hypoattenuation >1/3 of the MCA territory ASPECTS <7...

Iodinated Contrast. Our current protocol employs 35 5 mL iodinated contrast material for the CTP cine acquisitions, in addition to the contrast required for the CTA acquisition. This is a not insignificant dose of iodinated contrast, particularly in the relatively older population most at risk for stroke, and the dose may be of even higher concern if the patient subsequently requires additional contrast for endovascular intervention. However, nonionic iodinated contrast has been shown to not worsen stroke outcome [99-101]. In patients with preexisting renal dysfunction (abnormally elevated creatinine) or insuUn-dependent diabetes, our protocol calls for nonionic, iso-osmolar contrast administration, minimizing the chance of nephrotoxicity [102]. 

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