Prognostic significance of initial computer tomography and neurological deficit in patients after cerebral stroke – an introductory report
Keywords:
brain ischemic stroke, rehabilitation, CT scan, Scandinavian Stroke Scale (SSS)Abstract
We surveyed 50 patients (27 male, and 23 female patients), between 19 and 85 years of age, all of whom were diagnosed with brain ischemic stroke in the distribution area of middle cerebral artery (MCA). All patients underwent rehabilitation in rehabilitation ward. The time from incidence of stroke reached from I up to 10 years, and the length of ward stay was 3 up to 5 weeks. In this work we used results of examinations performed in the acute period of stroke in patients with symptoms of focal brain injury, ie. initial brain CT scan without contrast administration performed up to 12 hours after clinical symptoms onset and the initial clinical state evaluated after admission to neurology ward with SSS — data collected from medical documentation of 22 patients. To evaluate the clinical state and rehabilitation effects in rehabilitation ward we used: the Barthel Index, Rivermead Mobility Index and the Rankin Scale. Depending on the absence or presence of ischemic changes and their extent on brain CT scan, we divided patients into 3 groups: Group I — with the correct brain image, Group 2 — with early ischemic changes (EIC) < 1/3 of MCA territory, and Group 3 — with EIC > 1/3 of MCA territory. In all patients we observed clinical state improvement after rehabilitation. The efficiency of rehabilitation showed no relationship with the result of initial brain CT scan, but it correlated with the initial neurological deficit assessed with the SSS. The clinical state of patients at discharge from rehabilitation ward showed relationship with results of brain CT scans and the SSS result.
1. The result of neuroimaging examination stays in connection with clinical state in patients after an episode of ischemic stroke, but it shows no importance in differentiating rehabilitation results in this ‘group of patients at the early stage.
2. The prognosis of final clinical state and rehabilitation effects in patients at the early stage of ischemic stroke must include the SSS results performed at the early stage
Downloads
References
Dobkin B.: Strategies for stroke rehabilitation, Lancet Neurology 2004, 3: 528–536.
Patel A., Duncan P., Lai S., Studenski S.: The relation between impairments and functional outcomes poststroke, Arch. Phys. Med. Rehabil. 2000, 81: 1357–1363.
Jorgensen H., Nakayama H., Raaschou H.: Outcome and time course of recovery in stroke, part I; time course. Arch. Phys. Med. Rehabil. 1995, 76: 406–412.
Aboderin I, Venables G.: For the Pan European Consensus Meeting on Stroke Management, Stroke management in Europe, J. Intern. Med. 1996, 24: 173–180.
Brola W, Czernicki J.: Porównanie skal uszkodzenia stosowanych w ocenie pacjentów po udarze mózgu, Postępy Rehabilitacji 1999,13: 37–43.
Symons S., Cullen S., Buonanno F., Gonzalez G., Lev M.: Noncontrast Conventional Computed Tomography in the Evaluation of Acute Stroke, Seminars in Roentgenology 2002, 37(3): 185–191.
Sobczyńska D., Maciejek Z., Czyszkowski P.: Dynamika zmian obrazu tomografii komputerowej głowy w udarze niedokrwiennym mózgu z uwzględnieniem czynników ryzyka i rokowania, Udar Mózgu 2003, 5 (1): 1–5.
Podemski R., Gurański K., Ejma M., Sąsiadek M., Turek T., Kowalewski K.: Kliniczno-prognostyczne znaczenie wczesnych zmian w tomografii komputerowej głowy u chorych z niedokrwiennym udarem mózgu, Udar Mózgu 2001, 3 (1):13–19.
Seniów J., Członkowska A.: Poznawcze i emocjonalne konsekwencje udaru mózgu w aspekcie procesu rehabilitacji, Rehab. Med. 2003, 7, 1:9–14.
Opara J.: Skale udarów, Oficyna Wydaw. Politechnika Opolska, Opole 1999.
Kowalska J., Wolińska A., Moskal J., Kaźmierski R.: Ocena stanu klinicznego pacjentów po przebytym udarze mózgu według skal NIHHS i Skandynawskiej z wykorzystaniem technik video, Nowiny Lekarskie 2001, 70, I: 160–167.
Harvey R., Dostosowanie leczenia po udarze mózgu do możliwości chorego, Medycyna po Dyplomie 1999, 8, (6):11–16.
Duncan P., Horner R., Reker D., Samsa G., Hoenig H., Hamilton B., LaClair B., Dudley T.: Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke, Stroke 2002, 33, 167–178.
Raport zespołu ekspertów NPPLUM: Postępowanie w ostrym udarze niedokrwiennym mózgu, Neur. Neurochir. Pol., 1999; 4: 13–14.
Hacke W., Kaste M., Skyhoj O., Orgogozo J., Bogousslavsky J.: Postępowanie w udarze mózgu – aktualne (2002) zalecenia European Stroke Initiative, Medycyna Praktyczna 2002, 7: 125–155.
Kwolek A.: Postępy w leczeniu i rehabilitacji osób po udarze niedokrwiennym mózgu, Rehabilitacja Medyczna 2002, 6 (1): 9–19.
Kwolek A.: Zasady rehabilitacji po udarze mózgu [w:] Kwolek A. (red.), Rehabilitacja w udarze mózgu, Wydawnictwo UR, Rzeszów, 2009, 132–141.
Prusiński A., Domżał M., Kozubski W., Szczudlik A.: Rokowanie w udarach niedokrwiennych mozgu [w:] Niedokrwienne udary mózgu,- medica press, Bielsko-Biała 1999, 186–190.
Kaste M., Bogousslavsky J., Busse O., Deisenhammer E., Kwieciński H., Olsen T., Orgogozo J-M., Hacke W.: Rekomendacje dla postępowania po udarze mózgu, Cerebrovascular Diseases 2000; 10 (3):1–11.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2009 Medical Journal of the Rzeszow University
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
