Abstract TP435: Hospital of Origin Does Not Influence Outcome in Patients Treated With Decompressive Hemicraniectomy After Malignant Middle Cerebral Artery Infarction
0
Citation
0
Reference
10
Related Paper
Abstract:
Introduction: Decompressive hemicraniectomy has been shown to reduce mortality in malignant middle cerebral artery (MCA) infarction. This procedure has been done for malignant MCA infarction at our institution, a tertiary referral centre, since 2011. We aimed to review the outcomes of patients receiving this procedure based on hospital of origin. Hypothesis: Patients originating outside of a tertiary centre would have worse outcomes and delays in obtaining decompressive hemicraniectomy for malignant MCA infarction. Methods: We retrospectively reviewed the medical records of all patients who underwent decompressive hemicraniectomy for malignant MCA infarction from March 2011 until March 2014. We compared 30-day mortality as well as time to surgery between patients presenting to the tertiary referral centre and patients presenting to peripheral hospitals. We compared 30-day mortality between those patients receiving surgery within 48 hours and those receiving surgery over 48 hours. We also compared the clinical characteristics of the patients in our cohort to data from published trials. Results: Eighteen patients underwent decompressive hemicraniectomy during this period of time. The 30-day mortality rate was 10/18 (55.6%). There was no difference in mortality between those presenting to the tertiary referral centre and those presenting to peripheral centres (3/6 [50%] vs 7/12 [58.3%], p=0.99). There was no difference in time to surgery between those presenting to the tertiary referral centre and those presenting to peripheral hospitals (median 44.2 vs 30.5 h, p=0.3933). There was weak evidence of reduced mortality for those undergoing the procedure within 48 hours of onset (6/14 [42.9%] vs 4/4 [100%], p=0.092). The patients in our cohort had no statistically significant difference in mortality compared to those in the hemicraniectomy trials but did have a longer time to surgery and a greater percentage of males. Conclusions: Mortality rates and time to surgery were comparable regardless of hospital of origin for decompressive hemicraniectomy after malignant MCA infarction.Keywords:
Tertiary referral hospital
Tertiary referral centre
Decompressive craniectomy
Medical record
bjectives:There is continuing controversy about the benefits of decompressive craniectomy in massive cere- bral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. Patients and Methods:We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction Glasgow Coma Scale volume of low density and midline shift in CT at three different periods(preoperative immediate postoperative and 3-4weeks after operation and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. Results:All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance and remaining two patients with dominant hemispheric infarc- tion and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. Conclusions:Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome especially for nondominant hemispheric infarction.
Decompressive craniectomy
Cerebral edema
Midline shift
Coma (optics)
Cite
Citations (0)
Abstract Malignant middle cerebral artery [MMCA] infarction has a different topographic distribution that might confound the relationship between lesion volume and outcome. Retrospective study to determine the multivariable relationship between computerized tomographic [CT] infarct location, volume and outcomes in decompressive hemicraniectomy [DHC] for MMCA infarction. The MCA infarctions were classified into four subgroups by CT, subtotal, complete MCA [co-MCA], Subtotal MCA with additional infarction [Subtotal MCAAI] and co-MCA with additional infarction [Co-MCAAI]. Maximum infarct volume [MIV] was measured on the pre-operative CT. Functional outcome was measured by the modified Rankin Scale [mRS] dichotomized as favourable 0–3 and unfavourable ≥4, at three months. In 137 patients, from least favourable to favourable outcome were co-MCAAI, subtotal MCAAI, co-MCA and subtotal MCA infarction. Co-MCAAI had the worst outcome, 56/57 patients with additional infarction had mRS ≥ 4. Multiple comparisons Scheffe test showed no significant difference in MIV of subtotal infarction , co-MCA, Subtotal MCAAI but the outcome was significantly different. Multivariate analysis confirmed MCAAI [7.027 (2.56–19.28), p = 0.000] as the most significant predictor of poor outcomes whereas MIV was not significant [OR, 0.99 (0.99–01.00), p = 0.594]. Other significant independent predictors were age ≥ 55 years 12.14 (2.60–56.02), p = 0.001 and uncal herniation 4.98(1.53–16.19), p = 0.007]. Our data shows the contribution of CT infarction location in determining the functional outcome after DHC. Subgroups of patients undergoing DHC had different outcomes despite comparable infarction volumes.
Stroke
Cite
Citations (4)
Objective To explore the effects of right and left middle cerebral artery (MCA) infarction on immune system of these patients.Method A total of 99 acute MCA infarction patients,admitted to our hospital from January 2006 to February 2013,were enrolled in this retrospective study.Based on the artery involved,these patients were divided into left MCA infarction group (n=51) and right MCA infarction group (n=48).Such data,including dynamic changes of leukocytes (white blood cell count and ratio of each kind of white blood cells) on the 1st,3rd and 7th d of onset,pulmonary infection rate within 1 week of onset and NIHSS and improved Rankin scale scores assessed 1 month after onset/at discharge,were comparatively analyzed between these two groups.Results No significant differences on pulmonary infection rate,temperature within one week of onset,and NIHSS and improved Rankin scale scores assessed 1 month after onset were noted between the two groups (P＞0.05).No statistic difference was found when comparing the different type ofleukocytes on the 1st,3rd and 7th d after stroke and the dynamic changes of leukocytes in the 1st week between the two groups (P＞0.05).But the dynamic changes of neutrophils and lymphocytes in patients without pneumonia were different between the two groups.Conclusion MCA infarction patients have different variation tendency of leukocyte between the left and right side,which may indicate that the mechanism of post-stroke immunodepression is different when affect different MCA.
Key words:
Middle cerebral artery infarction; Cerebral infarction; Immunodepression; Leukocyte; Left side; Right side
White blood cell
Stroke
Cite
Citations (1)
Early detection of infarction is important for early management to minimize the effects of infarctions on the patient. Hyperdense middle cerebral artery is an early sign for infarction. To determine the most accurate way and value for early detection of infarction using hyperdense MCA artery sign. 87 patients with suspected infarction underwent non enhanced CT brain, hyperdense MCA was subjectively determined, then maximum density was determined in the suspected affected side and contralateral side and ratio was made then, follow-up CT was done to detect MCA territory infarction. The HU range of the affected MCA ranged from 44 up to 58 HU (mean value 49.62 HU). The mean value of MCA ratio was 1.24–1.55. HU value >47 and MCA ratio >1.5 100% sensitivity is compared to subjective method that gives 56.3% only. The objective measurements of the MCA as regards HU value and MCA ratio had a sensitivity of 100%, and specificity 60%. Hyperdense middle cerebral artery sign is an accurate method for early detection of infarction.
Cite
Citations (8)
Background: Stroke is the leading cause of disability and second leading cause of death globally. Carotid artery stenosis accounts for 10-15% of ischaemic strokes. Carotid endarterectomy (CEA) is a surgical method of stroke risk reduction in patients with high-grade stenosis. Best evidence recommends CEA within 14 days of an acute neurological event in patients with ipsilateral stenosis >70% to confer maximum preventative benefit.
Tertiary referral centre
Tertiary referral hospital
Tertiary care
Endarterectomy
Cite
Citations (0)
Tertiary referral centre
Tertiary referral hospital
Tertiary care
Cite
Citations (0)
Objective The characteristic and prognosis of great area brain infarction was discussed from the different cause.Methods 31 patients were performed decompressive craniectomy with the great area brain infarction from the different cause.Results 15 patients were died.The mortality rate is 48.4%.Among this,trauma brain infarction mortality rate is 37.5%.Spontaneous brain infarction mortality rate is 36.4%;The mortality rate which the ruptured of internal carotidartery was ligated is 80%.Conclusion The role and prognosis of decompressive craniectomyis is different in great area brain infarction from different cause.
Decompressive craniectomy
Brain infarction
Cite
Citations (0)
Decompressive craniectomy
Tertiary referral hospital
Tertiary level
Cranioplasty
Cite
Citations (2)
Tertiary referral centre
Tertiary referral hospital
Tertiary care
Cite
Citations (2)
Background: Haemoptysis is an alarming symptom, and the management depends upon the aetiology.The etiology of hemoptysis in various studies is based on the geographic location, the patient population studied, the diagnostic tests employed and the time of publication.Although exact percentages vary in large general populations, bronchiectasis, tuberculosis, and bronchogenic carcinoma are the leading causes of hemoptysis Methods: We prospectively evaluated 175 patients with haemoptysis admitted to the department of respiratory medicine pariyaram medical college, kannur, kerala., for 1 year.Results: Among them 160 (91.4%) were males and 15(8.6) were female.The mean age of presentation was 57.31+/13.57.Sputum was positive for AFB in 12% cases.Chest x-ray was abnormal in 94.25% cases.Fibrosis was the most common abnormality (22.28%) followed by consolidation (21.14%)%).Fibreoptic bronchoscopy (FOB) was done in 75 (42.85%)patients CT done in 100 cases.Final diagnosis obtained in 165 cases.Most common cause was found to be due to Pulmonary TB and its sequelae,84 cases(50.9%).Conclusion: Even in patients with history of ATT, hemoptysis doesn't always reflect underlying pulmonary TB or its sequelae.Hence proper diagnostic work up should be under taken in those cases also.Careful assessment of aetiology is essential to provide proper treatment.
Tertiary referral hospital
Tertiary referral centre
Cite
Citations (0)