Clinical predictors of abnormal computed tomography findings in patients with altered mental status.
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INTRODUCTION: While non-contrast computed tomography (CT) of the brain can be used to rapidly identify patients with altered mental status (AMS) in the emergency department (ED), with an acute intracranial bleed or infarct, a wide variation in its use exists. The aim of this pilot study was to identify the clinical predictors of an abnormal CT result in ED patients with AMS. METHODS: We conducted a retrospective study of patients aged 15 years and older presenting with undifferentiated AMS in a busy urban ED over one year. Data collected included demographical, clinical, laboratory and radiological features. The primary outcome of interest was the presence of an abnormal CT result defined as an acute infarct or intracranial bleed. Secondary outcomes were clinical predictors of an abnormal CT result. The data was analysed using descriptive statistics. Logistic regression was used to identify clinical predictors of an abnormal CT result. Odds ratios (ORs) were reported with 95 percent confidence intervals (CIs). RESULTS: 578 patients were recruited, of which 284 (49.1 percent) were males. 327 (56.6 percent) patients underwent CT of the brain. 128 scans (39.1 percent) were abnormal. Logistic regression revealed seven clinical features that were associated with an abnormal CT result. They were mean age greater than or equal to 73 years (OR 1.03; 95 percent CI 1.015-1.045), drowsiness or unresponsiveness (OR 1.73; 95 percent CI 0.17-17.72), previous cerebrovascular accident (OR 2.03; 95 percent CI 0.82-5.02), previous epilepsy (OR 1.63; 95 percent CI 0.63-4.19), tachycardia [greater than 120/min] (OR 1.16; 95 percent CI 0.38-3.54), bradycardia [less than 60/min] (OR 1.35; 95 percent CI 0.19-9.59) and exposure to drugs (OR 1.90; 95 percent CI 0.58-6.26). CONCLUSION: We identified seven clinical predictors of an abnormal CT result in AMS patients. Future research in prospective studies is needed to validate these findings. (+info)
Factors influencing pre-hospital delay after ischemic stroke and transient ischemic attack.
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BACKGROUND AND PURPOSE: We investigated which factors influence pre-hospital delay after the onset of stroke and transient ischemic attack (TIA). METHODS: A total of 113 patients with ischemic stroke or TIA who were directly transported to the emergency room within 24 hours of onset were entered into the study. We analyzed factors relating to an early arrival at hospital (< or =2 hours), and factors relating to an early emergency call (< or =1 hour). RESULTS: The interval between symptom onset and arrival at hospital was within 2 hours in 75 (66%) patients. The interval between symptom onset and call to emergency was significantly related to arrival within 2 hours (p<0.001), whereas time (p=0.09) and distance (p=0.32) for transportation were not. The interval between onset and emergency call was within 1 hour in 68 patients (60%). The presence of a bystander (Odds ratio 3.68) and consciousness disturbance (Odds ratio 2.49) were independently related to an early emergency call. CONCLUSION: An early emergency call is essential for the timely admission of stroke patients into a hospital. The presence of a bystander and consciousness disturbance are keys to an early emergency call. (+info)
Recent advances in the understanding of neglect and anosognosia following right hemisphere stroke.
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This article highlights the latest findings regarding the cognitive-behavioral syndromes of neglect and anosognosia for hemiplegia that occur following right hemisphere stroke. We review papers published in the past 2 years pertaining to neurophysiology, assessment, and intervention for these two syndromes. (+info)
Consciousness and epilepsy: why are complex-partial seizures complex?
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Endorsement of the FOUR score for consciousness assessment in neurosurgical patients.
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The Full Outline of UnResponsiveness (FOUR) score was previously developed for neurological assessment, but has not been validated in neurosurgical patients, so was compared to the Glasgow Coma Scale (GCS) in practice. Four groups of raters, expert clinicians, novice clinicians, experienced nurses, and inexperienced nurses, assessed 64 patients in awake, drowsy, stuporous, and comatose conditions to investigate rater reliability. Then, 36 patients were evaluated by 1 expert clinician and 1 from the other groups randomly to test the difference. Spearman's correlation was used to find the correlation between both scores from 68 patients. The estimation of FOUR score cut points was validated by weighted kappa compared with the GCS to establish the risk prognosis. Score feasibility was analyzed by nonparametric test. Intraclass correlation in each group was over 0.9, with no difference between expert and inexperienced raters (p > 0.05). The correlation was 0.78. Low, intermediate, and high risk prognosis were associated with 0-7, 8-14, and 15-16 FOUR scores with kappa of 0.92. The feasibility of the FOUR score was lower than that of the GCS (p < 0.01). The FOUR score is reliable and valid for consciousness evaluation with some consequences for practicability. Extensive implementation would increase familiarity. (+info)
Subarachnoid hemorrhage caused by ruptured dissecting aneurysm arising from the extracranial distal posterior inferior cerebellar artery--case report.
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A 50-year-old man presented with a dissecting aneurysm arising from the extracranial portion of the right posterior inferior cerebellar artery (PICA) causing subarachnoid hemorrhage (SAH) and manifesting as sudden onset of disturbed consciousness. Computed tomography showed SAH with ventricular reflux predominantly in the posterior fossa. Angiography revealed a fusiform aneurysm of the right PICA originating extracranially from the right vertebral artery. The aneurysm was isolated and excised. Histological examination showed dissection of the aneurysm wall. Dissecting aneurysm arising from the extracranial portion of the PICA is extremely rare. (+info)
Vernet's syndrome caused by large mycotic aneurysm of the extracranial internal carotid artery after acute otitis media--case report.
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An 85-year-old man presented with a rare large aneurysm of the extracranial internal carotid artery (ICA) due to acute otitis media manifesting as Vernet's syndrome 2 weeks after the diagnosis of right acute otitis media. Angiography of the right extracranial ICA demonstrated an irregularly shaped large aneurysm with partial thrombosis. The aneurysm was treated by proximal ICA occlusion using endovascular coils. The ICA mycotic aneurysm was triggered by acute otitis media, and induced Vernet's syndrome as a result of direct compression to the jugular foramen. Extracranial ICA aneurysms due to focal infection should be considered in the differential diagnosis of lower cranial nerve palsy, although the incidence is thought to be very low. (+info)
Headache in Cerebral Venous Thrombosis: incidence, pattern and location in 200 consecutive patients.
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