Journal ArticleDOI
Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study.
Götz Thomalla,Frank Hartmann,Eric Juettler,Eric Juettler,Oliver C. Singer,Fritz-Georg Lehnhardt,Martin Köhrmann,Jan F. Kersten,Anna Krützelmann,Marek Humpich,Jan Sobesky,Christian Gerloff,Arno Villringer,Arno Villringer,Jens Fiehler,Tobias Neumann-Haefelin,Peter D. Schellinger,Joachim Röther +17 more
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TLDR
This work tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset and found it to be true.Abstract:
Objective
Early identification of patients at risk of space-occupying “malignant” middle cerebral artery (MCA) infarction (MMI) is needed to enable timely decision for potentially life-saving treatment such as decompressive hemicraniectomy. We tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset.
Methods
In a prospective, multicenter, observational cohort study patients with acute ischemic stroke and MCA main stem occlusion were studied by MRI including diffusion-weighted imaging (DWI), perfusion imaging (PI), and MR-angiography within 6 hours of symptom onset. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.
Results
Of 140 patients included, 27 (19.3%) developed MMI. The following parameters were identified as independent predictors of MMI: larger acute DWI lesion volume (per 1 ml odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06; p 82 ml predicted MMI with high specificity (0.98, 95% CI 0.94–1.00), negative predictive value (0.90, 0.83–0.94), and positive predictive value (0.88, 0.62–0.98), but sensitivity was low (0.52, 0.32–0.71).
Interpretation
Stroke MRI on admission predicts malignant course in severe MCA stroke with high positive and negative predictive value and may help in guiding treatment decisions, such as decompressive surgery. In a subset of patients with small initial DWI lesion volumes, repeated diagnostic tests are required. ANN NEUROL 2010read more
Citations
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Journal ArticleDOI
Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Eelco F. M. Wijdicks,Kevin N. Sheth,Bob S. Carter,David M. Greer,Scott E. Kasner,W. Taylor Kimberly,Stefan Schwab,Eric E. Smith,Rafael J. Tamargo,Max Wintermark +9 more
TL;DR: This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere and classifies the level of certainty and the class and level of evidence.
Journal ArticleDOI
Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke.
L. C.S. Souza,Albert J Yoo,Zeshan M Chaudhry,Seyedmehdi Payabvash,André Kemmling,Pamela W. Schaefer,Joshua A Hirsch,Karen L. Furie,R. G. Gonzalez,Raul G. Nogueira,Michael H. Lev +10 more
TL;DR: In patients with AIS with PAOs, CTA collaterals correlate with admissionDWI infarct size and a malignant collateral profile is highly specific for large admission DWI lesion size and poor functional outcome.
Journal ArticleDOI
Safety and efficacy of intravenous glyburide on brain swelling after large hemispheric infarction (GAMES-RP): a randomised, double-blind, placebo-controlled phase 2 trial
Kevin N. Sheth,Jordan J. Elm,Bradley J. Molyneaux,Holly E. Hinson,Lauren A. Beslow,Gordon Sze,Ann Christin Ostwaldt,Gregory J. del Zoppo,J. Marc Simard,Sven Jacobson,W. Taylor Kimberly +10 more
TL;DR: Intravenous glyburide was well tolerated in patients with large hemispheric stroke at risk for cerebral oedema and was no difference in the composite primary outcome.
Journal ArticleDOI
Sulfonylurea receptor 1 in central nervous system injury: a focused review.
TL;DR: Clinical trials of an intravenous formulation of glibenclamide in TBI and stroke underscore the importance of recent advances in understanding the role of the Sur1-regulated NCCa-ATP channel in acute ischemic, traumatic, and inflammatory injury to the CNS.
Journal ArticleDOI
Evidence-Based Guidelines for the Management of Large Hemispheric Infarction: A Statement for Health Care Professionals from the Neurocritical Care Society and the German Society for Neuro-Intensive Care and Emergency Medicine
Michel T. Torbey,Julian Bösel,Denise H. Rhoney,Fred Rincon,Dimitre Staykov,Arun P. Amar,Panayiotis N. Varelas,Eric Jüttler,DaiWai W. Olson,Hagen B. Huttner,Klaus Zweckberger,Kevin N. Sheth,Christian Dohmen,Ansgar M. Brambrink,Stephan A. Mayer,Osama O. Zaidat,Werner Hacke,Stefan Schwab +17 more
TL;DR: Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited and recommendations were developed based on the quality of evidence and the balance of benefits and harms.
References
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TL;DR: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement and should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke.
Journal ArticleDOI
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Erik von Elm,Douglas G. Altman,Matthias Egger,Matthias Egger,Stuart J. Pocock,Peter C Gøtzsche,Jan P. Vandenbroucke +6 more
TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.
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Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond
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