Audebert, H. J. and Singer, O. C. and Gotzler, B. and Vatankhah, B. and Boy, S. and Fiehler, J. and Lansberg, M. G. and Albers, G. W. and Kastrup, A. and Rovira, A. and Gass, A. and Rosso, C. and Derex, L. and Kim, J. S. and Heuschmann, P. (2011) Postthrombolysis hemorrhage risk is affected by stroke assessment bias between hemispheres. NEUROLOGY, 76 (7). pp. 629-636. ISSN 0028-3878,
Full text not available from this repository. (Request a copy)Abstract
Objective: Stroke symptoms in right hemispheric stroke tend to be underestimated in clinical assessment scales, resulting in greater infarct volumes in right as compared to left hemispheric strokes despite similar clinical stroke severity. We hypothesized that patients with right hemispheric nonlacunar stroke are at higher risk for secondary intracerebral hemorrhage after thrombolysis despite similar stroke severity. Methods: We analyzed data of 2 stroke cohorts with CT-based and MRI-based imaging before thrombolysis. Initial stroke severity was measured with the NIH Stroke Scale (NIHSS). Lacunar strokes were excluded through either the presence of cortical symptoms (CT cohort) or restriction to patients with prestroke diffusion-weighted imaging (DWI) lesion size >3.75 mL (MRI cohort). Probabilities of having a parenchymal hematoma were determined using multivariate logistic regression. Results: A total of 392 patients in the CT cohort and 400 patients in the MRI cohort were evaluated. Although NIHSS scores were similar in strokes of both hemispheres (median NIHSS: CT: 15 vs 13, MRI: 14 vs 16), the frequencies of parenchymal hematoma were higher in right hemispheric compared to left hemispheric strokes (CT: 12.4% vs 5.7%, MRI: 10.4% vs 6.8%). After adjustment for potential confounders (but not pretreatment lesion volume), the probability of parenchymal hematoma was higher in right hemispheric nonlacunar strokes (CT: odds ratio [OR] 2.3; 95% confidence interval [CI] 1.08-4.89; p = 0.032) and showed a borderline significant effect in the MRI cohort (OR 2.1; 95% CI 0.98-4.49; p = 0.057). Adjustment for pretreatment DWI lesion size eliminated hemispheric differences in hemorrhage risk. Conclusions: Higher hemorrhage rates in right hemispheric nonlacunar strokes despite similar stroke severity may be caused by clinical underestimation of the proportion of tissue at bleeding risk. Neurology (R) 2011; 76: 629-636
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TISSUE-PLASMINOGEN ACTIVATOR; TELEMEDIC PILOT PROJECT; ACUTE ISCHEMIC-STROKE; CARE TEMPIS; THROMBOLYSIS; SCALE; TRANSFORMATION; ASSOCIATION; RELIABILITY; DIFFERENCE; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 25 Jun 2020 13:27 |
| Last Modified: | 25 Jun 2020 13:27 |
| URI: | https://pred.uni-regensburg.de/id/eprint/21270 |
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