11 research outputs found
Sonographic Monitoring of Midline Shift Predicts Outcome after Intracerebral Hemorrhage
Background: Spontaneous intracerebral hemorrhage (ICH)
and the evolution of subsequent perihemorrhagic edema
lead to midline shift (MLS), which can be assessed by transcranial
duplex sonography (TDS). In this observational
study, we monitored MLS with TDS in patients with supratentorial
ICH up to day 14 after the ictus, and then correlated
MLS with the outcome 6 months after hospital discharge.
Methods: Sixty-eight patients with spontaneous ICH (volume
1 20 cm 3 ) were admitted during a 1-year period between
April 2009 and April 2010. Sixty-one patients fulfilled
the inclusion criteria and were eligible for analysis. TDS to
measure MLS was performed upon admission and then subsequently,
using serial examinations in 24-hour intervals up
to day 14. Statistical tests were used to determine cut-off values
for functional outcome and mortality after 6 months. Results:
The median National Institutes of Health Stroke Scale
(NIHSS) score upon admission was 21 and the mean hematoma
volume was 52 cm 3 . NIHSS score, functional outcome,
hematoma volume and MLS were correlated in the examined
patient cohort. ICH score upon admission, hematoma
volume and the extent of MLS on days 1–14 were predictive of functional outcome and death. Values of MLS showed two
peaks, the first between day 2 and day 5 and the second between
day 12 and day 14, indicating that edema progresses
not only during the acute but also during the subacute
phase. Depending on the time point, an MLS of 4.5–7.5 mm
or greater indicated an impending failure of conservative
therapy. An MLS of 12 mm or greater at any time indicated
mortality with a sensitivity of 69%, a specificity of 100% and
positive and negative predictive values of 100 and 74%, respectively.
Conclusions: MLS seems to be a crucial factor for
outcome after ICH. Apart from the hematoma volume itself,
edema adds to the intracranial pressure. To monitor MLS in
early patient management after ICH, TDS is a useful noninvasive
bedside alternative, avoiding increased radiation exposure
and repeated transportation of critically ill patients.
Cut-off values may help to reliably predict functional outcome
and treatment failure in patients undergoing maximal neurointensive therapy
Increased Prevalence of Posttraumatic Stress Disorder in Patients After Transient Ischemic Attack
Background and Purpose—
A transient ischemic attack (TIA) involves temporary neurological symptoms but leaves a patient symptom-free. Patients are faced with an increased risk for future stroke, and the manifestation of the TIA itself might be experienced as traumatizing. We aimed to investigate the prevalence of posttraumatic stress disorder (PTSD) after TIA and its relation to patients’ psychosocial outcome.
Methods—
Patients with TIA were prospectively studied, and 3 months after the diagnosis, PTSD, anxiety, depression, quality of life, coping strategies, and medical knowledge were assessed via self-rating instruments.
Results—
Of 211 patients with TIA, data of 108 patients were complete and only those are reported. Thirty-two (29.6%) patients were classified as having PTSD. This rate is 10× as high as in the general German population. Patients with TIA with PTSD were more likely to show signs of anxiety and depression. PTSD was associated with the use of maladaptive coping strategies, subjectively rated high stroke risk, as well as with younger age. Finally, PTSD and anxiety were associated with decreased mental quality of life.
Conclusions—
The experience of TIA increases the risk for PTSD and associated anxiety, depression, and reduced mental quality of life. Because a maladaptive coping style and a subjectively overestimated stroke risk seem to play a crucial role in this adverse progression, the training of adaptive coping strategies and cautious briefing about the realistic stroke risk associated with TIA might be a promising approach. Despite the great loss of patients to follow-up, the results indicate that PTSD after TIA requires increased attention.
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Antibody-Mediated Status Epilepticus: A Retrospective Multicenter Survey
Background: In recent years, an increasing number of autoantibodies
(AB) have been detected in the CSF and serum of
patients with new onset epilepsy. Some of these patients develop
convulsive or nonconvulsive status epilepticus (ABSE),
necessitating intensive medical care and administration
of multiple antiepileptic and immunomodulatory treatments
of uncertain effectiveness. Objectives: In this retrospective
multicenter survey we aimed to determine the
spectrum of gravity, the duration and the prognosis of the
disorder. In addition, we sought to identify the antibodies
associated with this condition, as well as determine whether
there is a most effective treatment regime. Methods: 12 European
Neurology University Clinics, with extensive experience
in the treatment of SE patients, were sent a detailed questionnaire regarding symptoms and treatment of AB-SE
patients. Seven centers responded positively, providing a total
of 13 patients above the age of 16. Results: AB-SE affects
mainly women (12/13, 92%) with a variable age at onset (17–
69 years, median: 25 years). The duration of the disease is also
variable (10 days to 12 years, median: 2 months). Only the 3
oldest patients died (55–69 years). Most patients were diagnosed
with anti NMDAR encephalitis (8/13) and had oligoclonal
bands in the CSF (9/13). No specific treatment regimen
(antiepileptic, immunomodulatory) was found to be clearly
superior. Most of the surviving 10 patients (77%) recovered
completely or nearly so within 2 years of index poststatus.
Conclusion: AB-SE is a severe but potentially reversible condition.
Long duration does not seem to imply fatal outcome;
however, age older than 50 years at time of onset appears to
be a risk factor for death. There was no evidence for an optimal
antiepileptic or immunomodulatory treatment. A prospective
multicenter study is warranted in order to stratify
the optimal treatment algorithm, determine clear risk factors of unfavorable outcome and long-term prognosis