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02 September 2009 Archive
Larger population studies are needed to accurately estimate the risk of sSAH during pregnancy, and the associated morbidity and mortality. NIS is one of the largest administrative database and is designed to produce nationally weighted estimates. Pregnancy and maternal diagnosis were identified using pregnancy related ICD codes validated by previous studies. Cochran-Armitage trend test and parametric tests were utilized to analyze temporal trends and group comparisons.
Results: There were 73, admissions for sSAH occurred in women age group of years from , of which 3, 5. Over the 12 years of study period, proportion of sSAH during pregnancy increased from 4. Proportion of sSAH during pregnancy was highest in age group years Conclusion: There is an upward trend in the pregnancy related spontaneous SAH from to Clinical outcomes of spontaneous SAH in pregnant women were better than in non-pregnant women.
Abstract Objective: Extensive research has long been focused on improving morbidity and mortality related to cerebral vasospasm which is well known as a major complication in subarachnoid hemorrhage SAH patients. The aim of this meta-analysis is to assess the effectiveness of cilostazol, a selective inhibitor of phosphodiesterase Type III, on cerebral vasospasm after SAH. Methods: Randomized and non randomized studies that compared effectiveness of cilostazol in SAH were included.
A total of 6 trials met the inclusion criteria and were included in the meta-analysis. Primary end point was symptomatic vasospasm. Secondary end points were angiographic vasospasm, new cerebral infarct, mortality, and functional outcome i. Angiographic vasospasm was also significantly lower among those who received cilostazol as compared to control group RR 0.
Cilostazol was associated with lower likelihood of new cerebral infarct in comparison to best medical therapy RR 0. There was no difference between the risk of mortality between subjects who received airway cilostazol compared with those who were in control group RR 0.
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There was improvement of mRS noted in patients who received cilostazol therapy RR 1. Conclusion: Cilostazol administration may improve the outcome of patients with SAH.
Further studies are needed to confirm this efficacy of cilostazol. Taylor Kimberly Stroke. We investigated whether sST2 predicts delayed cerebral ischemia DCI and day clinical outcome in patients with aneurysmal subarachnoid hemorrhage SAH.
Functional outcome was assessed at 3 months using the modified Rankin Scale mRS with good and poor outcome defined as mRS and , respectively. Using a consensus definition, DCI was defined as a 2-point drop in GCS over a sustained period in patients whose clinical deterioration could not be explained by another cause. Multivariable logistic regression, Kaplan-Meier survival analysis, and receiver operating characteristic curves were used to determine the ability of sST2 to predict outcome and mortality.
These findings were tested for replication in an independent cohort of 51 SAH patients recruited from a separate institution. Elevated sST2 was also independently associated with poor day functional outcome OR 2.
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It is unclear how long cEEG monitoring should be done in hemorrhagic and ischemic stroke patients to exclude subclinical seizures. Results: Among the patients who had EEG monitoring, had seizures. Among the patients included, median time to seizure onset was 3 hours. Patients were divided into ischemic, hemorrhagic and non-vascular etiologies. Hemorrhages were subdivided into subdural, subarachnoid, parenchymal, epidural and mixed types. Thus, a novel therapeutic agent that directly targets brain damages after SAH is strongly required.
For this purpose, we developed aminocaproic acid stabilized ceria nanoparticles Amicar-CeNPs , which have incomparable anti-oxidative activity and biocompatibility. SAH was induced by endovascular perforation of middle cerebral artery of rats. A single dose of Amicar-CeNPs 0. Neuronal death, macrophage infiltration, SAH grade and brain water content were evaluated at 72 hours. Mortality and neurologic function were assessed for 14 days.
SAH grades were comparable between the two groups Conclusions: Amicar-CeNPs, totally synthesized in aqueous phase, demonstrated very promising results against SAH via potent anti-oxidative, neuroprotective and anti-inflammatory activities. Abstract Introduction: Many randomized clinical trials RCTs have been conducted for subarachnoid hemorrhage SAH , yet no treatment definitively improves outcome. Predictive ability of early phase trials is uncertain because outcome is strongly related to baseline severity factors, yet imbalances are common in these trials.
We previously developed a method for ischemic stroke to identify promising treatments at early phase using a pooled model constructed from the control arms of RCTs and comparing trial outcomes at their own baselines. We applied this method to SAH. These surfaces incorporate statistical variability to assess whether a treatment differs from expected outcome of a pooled sample.
Treatment arms from RCTs and single arm trials for SAH are then visually compared against the pooled controlled arm to see if they surpassed the prediction surfaces at their own baseline conditions. To confirm the model can identify futility, 7 tirilazad trials were superimposed and all were on the prediction surface Fig. Top Panel. Mortality models did not find an increase with the most promising treatments. Conclusions: Outcome models based on percentage of high grade WFNS and age were successfully developed.
This approach may be useful to prioritize treatments worthy of further study. Abstract Introduction: Assessment of stroke outcomes specific to speech and language typically depends on lengthy batteries yielding a derived score that has little functional meaning to patients. Our aim was to develop a simple, highly reliable, ordinal outcome scale specific to language and communication disability.
Methods: Modeled after the Rankin Scale, the Communication Disability Scale is a 6-item ordinal scale to assess degree of disability specifically related to communication deficits. Speech therapists independently assessed the patients. The kappa statistic for agreement was 0. The items link language deficits to limitations in activities of daily living ADLs attributable to communication deficits.
This new scale may be valuable in assessing the effects of speech therapies in clinical trials and the need for caregiver assistance in practice. Because of this, rehabilitation assessments are delayed, which causes downstream delays in the patient getting to the next level of care. We sought to evaluate the feasibility, safety, and effect on length of stay in the acute stroke population post tPA. After reviewing the literature, we were able to find one small study that supported very early mobilization. We then gathered historical data and prospectively collected data on our study group.
Vol 49, No Suppl_1 | Stroke
All patients who received tPA were eligible unless otherwise stated by the physician. The data was then used to determine harm, length of stay, and time to rehabilitation assessment. During the study time period, 87 patients were seen after 12 hours at a median of 17 hours post tPA. An additional 60 patients were seen after 24 hours due to being sedated, or staffing. In the pre-study phase there were no falls noted for patients who remained in bed for 24 hours.
The study group similarly had no falls. There were also no incidents of worsening, 1 incidence of hypotension, in the study population. The length of stay in the study group was reduced from 4.
https://learkaimartheofur.tk We now are able to safely monitor these patients and use evidence to drive decisions in care. This small study further supports the idea of early mobilization and treatment as safe, effective, and feasible.