جستجوی مقالات مرتبط با کلیدواژه « Brain Infarction » در نشریات گروه « پزشکی »

Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.

We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.

Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.

A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.

Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC).

Dizziness is a common scenario in the Emergency Departments (EDs). Among dizziness un-derlying causes, the posterior circulation stroke is especially relevant due to its mobimortality and concerningmisdiagnosis rates. Therefore, we conducted this study to assess dizziness evaluation and baseline characteris-tics of patients with PS in the ED.

We conducted a 3-year retrospective observational study on PS casesconfirmed by magnetic resonance imaging (MRI). Concretely, we analysed the demographic profile of these pa-tients, the initial PS clinical presentation, and diagnostic workup (with emphasis on dizziness evaluation) per-formed at the ED.

During the study period, 85 cases were registered. Risk factors for cardiovasculardisease were present in 85.5% and previous visits to the ED due to dizziness were recorded in 16.5%. The mainclinical presentation was dizziness, concretely as an acute vestibular syndrome (38.8%) with additional neuro-logical signs or symptoms (80%). Evaluation by the otolaryngologist on call was requested in less than 10% ofthe cases and included the HINTS protocol use with a sensitivity of 100% for central nervous system underlyingcausality. A brain CT study was always performed with a sensitivity of 27%. However, 96.47% of patients wereprimarily admitted to the Neurology hospitalization ward and MRI was always performed in a mean time of3.21 days confirming the diagnosis.

Dizziness is the most frequent symptom of PS. Patients usuallypresent an AVS (associated with additional N-SS or not) and HINTS bedside examination is the most adequateprotocol to differentiate a PS from other AVS causes until the diagnostic confirmation via MRI. Interestingly,mainly otolaryngologists seem to use HINTS. However, the use of CT is widespread despite its poor value.

Inflammatory processes have been proposed in the pathophysiology of ischemic stroke. The present study was designed to evaluate the relationship between tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), IL 1 beta (IL-1β), and high sensitivity C-reactive protein (hsCRP) with the prognosis and functional outcome in patients with less severe ischemic stroke.

We measured the level of IL-1β, IL-6, hsCRP, and TNF-α on days 1 and 5 after stroke onset by enzyme-linked immunosorbent assay (ELISA). The infarct volume was assessed using Alberta Stroke Program Early CT Score (ASPECTS) and posterior circulation ASPECTS (pcASPECTS) score in brain computed tomography (CT) scan and magnetic resonance imaging (MRI). The severity of stroke was assessed by applying the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) in 24 hours on day 5and after 3 months from stroke onset. Good outcome was defined as the third month MRS ≤ 2. The association of inflammatory markers and the course of stroke symptoms over time was examined.

Forty-four first-ever stroke patients without concurrent inflammatory diseases with a mean age of 65 years were included. The mean NIHSS and MRS in admission time were 6.5 ± 3.5 and 3.07, respectively. The day 1 and the day 5 levels of IL-1β, IL-6, hsCRP, and TNF-α were not significantly different in good and poor outcome groups (all P-values > 0.05). In addition, they were not significantly associated with the ASPECTS, pcASPECTS, and changes of NIHSS and MRS over time.

The levels of hsCRP, IL-1β, IL-6, and TNF-α are not reliable predictors of functional outcomes in patients with less severe acute ischemic stroke (AIS).

Brain infarction after trauma is uncommon. Injury of the carotid and vertebrobasilar arteries can cause brain infarction due to occlusion of brain blood flow.

Emergency medical service (EMS) brought a 4-year-old girl involved in a car accident to the emergency room. She had had seizure controlled by diazepam. She was unconscious and her Glasgow coma scale (GCS) score was eight. Early vital signs were stable. Her first brain CT scan showed a subdural hematoma (SDH). One day after admission to ICU, her GCS decreased to five; hence, a control brain CT was performed. The brain CT scan showed a brain infarction. Six days after admission, her status worsened and her GCS dropped to three and her pupils became dilated bilaterally and unresponsive to light; she was pronounced dead.

We present an uncommon case of posttraumatic brain infarction and synchronous SDH.