Predicting clinical status of patients after an acute ischemic stroke using random forests

2017 ◽  
Author(s):  
Adela Vrtkova
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Random Forests ◽  
Clinical Status

scholarly journals Evaluation of the efficacy of recombinant tissue plasminogen activators in improving clinical status of acute ischemic stroke: A randomized clinical trial in Iran

2018 ◽  
Vol 5 (9) ◽  
pp. 2697-2702
Author(s):  
Mojtaba Khazaei ◽  
Zaher Khazaei ◽  
Elham Goodarzi ◽  
Ali Ghadimi
Keyword(s):  
Clinical Trial ◽  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Clinical Status ◽  
Plasminogen Activators ◽  
Control Group ◽  
Tissue Plasminogen ◽  
The Mean ◽  
The Difference

Background: Acute ischemic stroke is caused by blockage of a cerebral artery and is also known as cerebrovascular accident (CVA). Recombinant tissue plasminogen activator (rt-PA) therapy is effective in reducing early and long-term neurologic disabilities if it is started quickly. Therefore, the aim of this study was to determine the efficacy of treatment with recombinant tissue plasminogen activators in improving the clinical status of acute ischemic stroke. Methods: The current study was performed as a clinical trial of two groups- treatment and control (n=20 per group). The treatment group consisted of patients who received rt-PA, while the control group consisted of patients who did not receive rt-PA. For each group, evaluation of neurological disabilities following ischemic stroke was based off the National Institutes of Health Stroke Scale (NIHSS), for early assessment of disability on the third day of treatment), and off the modified Rankin Scale (MRS) at 90 days after stroke. The drug effect criterion was used to reduce the neurological disability or the difference in NIHSS on day 3 after treatment. Also, the duration of onset of symptoms until the arrival of the patients to the emergency room (ER), as well as the risk factors, complications and number of deaths in both groups, were recorded. Data obtained were analyzed by SPSS software. Results: The results of the study showed that the mean of ER arrival time, NIHSS before treatment, and NIHSS on day 3 of treatment in the control group was higher than that of the treatment group; the difference was statistically significant (P<0.05). The results also indicated that the probability of improvement of neurological disabilities in the experimental group was greater than that of the control group (relative risk (RR) =1.25). Additionally, the odds ratio (OR) for receiving rt-PA in the NIHSS positive treatment group compared to the control group was equal to 1/5 (OR=1.5). The results showed that 30% of the patients in the treatment group were treated with a complication. The mean of MRS was higher in the control group at 90 days after the stroke, compared with the treatment group. Conclusion: Treatment with rt-PA reduces the neurological disability in patients with ischemic stroke, since the mean of MRS is lower in the treatment group, compared with the control group, after 90 days of treatment.

scholarly journals A spontaneous cervical epidural hematoma mimicking a stroke – A case report

2020 ◽  
Vol 11 ◽  
pp. 157
Author(s):  
Pedro Teles ◽  
Joaquim Pedro Correia ◽  
Lia Pappamikail ◽  
Artur Lourenço ◽  
Clara Romero ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Epidural Hematoma ◽  
Early Recognition ◽  
Clinical Status ◽  
Anticoagulation Therapy ◽  
Sudden Onset ◽  
Left Shoulder ◽  
Hemorrhagic Diathesis ◽  
The Right

Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence. It usually presents with quadriparesis, but it may present with hemiparesis or hemiplegia and can easily be misdiagnosed as stroke. We present a case of stroke mimicking SCEH with hemiparesis worsened after tissue plasminogen activator therapy (tPA) followed by emergency cervical decompression laminectomy. Case Description: A 63-year-old female presented to the emergency department with sudden onset of posterior neck and left shoulder pain with the right side hemiparesis. On neurological examination, the patient had motor power of the right upper and lower limb of 2/5 Medical Research Council, and her whole left extremities were intact. Her medical history was unremarkable for trauma, hemorrhagic diathesis, or anticoagulation therapy. A head computed tomography was ordered ruling out intracranial hemorrhage. Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. A cervical magnetic resonance was performed revealing a right paramedian epidural mass-like lesion between C3-C6. The patient underwent cervical laminectomy C3-C6 with evacuation of epidural hematoma with significant clinical status improvement after surgery. Conclusion: tPA treatment is frequently used as first-line therapy for acute ischemic stroke. Therefore, physicians should be aware of the potential for the SCEH in patients presenting with hemiparesis, as tPA administration may increase cervical hematoma leading to clinical deterioration. With this case, we intended to warn about SCEH as a rare but possible entity, since its early recognition and prompt clinical intervention may improve neurological outcomes.

scholarly journals Post-Stroke Outcomes of Patients with Chronic Obstructive Pulmonary Disease

2022 ◽  
Vol 12 (1) ◽  
pp. 106
Author(s):  
Aleksandra Szylińska ◽  
Katarzyna Kotfis ◽  
Marta Bott-Olejnik ◽  
Paweł Wańkowicz ◽  
Iwona Rotter
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pulmonary Disease ◽  
Clinical Status ◽  
Pulmonary Complications ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk

Introduction: Research has shown that patients with ischemic stroke and coexisting obstructive respiratory disorders have worse clinical status on admission and increased long-term mortality. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of stroke, and the risk is even greater after exacerbation of COPD. Moreover, COPD and stroke share major risk factors, which are advancing age and smoking. The aim of this study was to analyze the incidence of complications and mortality in acute ischemic stroke (AIS) patients with and without COPD. Material and methods: We analyzed prospectively collected data of 1022 patients with acute is-chemic stroke hospitalized in a district general hospital. The patients were divided into two groups—with coexisting COPD and without COPD. Results: Logistic regression analysis, which allowed for potential confounders, showed an association between coexisting COPD and the fol-lowing complications in acute ischemic stroke patients: heart failure (OR = 1.879, p = 0.048), atrial fibrillation (OR = 4.746, p = 0.012), delirium (OR = 2.803, p < 0.001), pneumonia (OR = 2.424, p = 0.005), bronchospasm (OR = 3.400, p = 0.023), and out-hospital mortality (OR = 2.656, p = 0.001). Conclusion: Patients presenting with acute ischemic stroke and coexisting COPD significantly more often had cardiac and pulmonary complications, as well as delirium following stroke. In a long-term follow-up, the probability of one-year survival was significantly lower in AIS patients with co-existing COPD.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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