| 2 | Artery of Percheron occlusion:role of diffusion-weighted imaging in the early diagnosis显示文摘Bilateral thalamic infarcts have a low frequency among different subtypes of strokes.Since it does not involve a particular vascular territory,it therefore usually involves the occlusion of the artery of Percheron(AOP).Here we report a 79-year-old right-handed Parkinsonian female patient,who was found unresponsive in bed.On examination,the patient was drowsy with a Glasgow Coma Score(GCS)of 10/15(E2M5V3).She had absent doll’s eye response with anisocoric pupils and intermittent vertical gaze palsy.Although the patient had no apparent motor deficits,she was in a state of persistent somnolence with memory impairment and lack of initiative.Diffusion-weighted magnetic resonance imaging(MRI)of the brain showed focal areas of restricted diffusion in the medial part of the thalami bilaterally and the rostral part of mid-brain(right>left)(bilateral paramedian thalamic with mid-brain pattern),suggestive of a hyper-acute infarct in the territory of AOP.The patient was anticoagulated with 40 mg subcutaneous low molecular weight heparin and was started on double anti-platelets along with supportive measures.The level of consciousness is improved at a slow rate to a GCS of 12/15(E4M5V3).The patient had marked abulia with periods of drowsiness interspersed with periods of restlessness and uttering of abnormal sounds,but she was able to execute simple commands.In conclusion,occlusion of the AOP is a rare cause of coma in elderly patients.Diffusion-weighted MRI is the imaging modality of choice for early diagnosis.Early diagnosis of AOP occlusion may lead to favorable outcomes. | Murali Krishna Menon Suma Mariam Jacob Muhammed Jasim Abdul Jalal | 2016 | Neuroimmunology and Neuroinflammation2016，3，1： | 0 |
| 3 | Predicting short-term adverse outcomes in the geriatric population presenting with syncope:a comparison of existing syncope rules and beyond显示文摘OBJECTIVES Syncope at age 65+is associated with increased mortality,irrespective of cause.Syncope rules were designed to aid in risk-stratification but were only validated in the general adult population.Our objective was to determine if they can be applied to a geriatric population in predicting short-term adverse outcomes.METHODS In this single-center retrospective study,we evaluated 350 patients aged 65+presenting with syncope.Exclusion criteria included confirmed non-syncope,active medical condition,drug or alcohol-related syncope.Patients were stratified into high or low risk based on Canadian Syncope Risk Score(CSRS),Evaluation of Guidelines in Syncope Study(EGSYS),San Francisco Syncope Rule(SFSR),and Risk Stratification of Syncope in the Emergency Department(ROSE).Composite adverse outcomes at 48-hour and 30-day included all-cause mortality,major adverse cardiac and cerebrovascular events(MACCE),return emergency department visit,hospitalization,or medical intervention.We assessed each score's ability to predict the outcomes using logistic-regression and compared performances using receiver-operator curves.Multivariate analyses were performed to study the associations between recorded parameters and outcomes.RESULTS CSRS outperformed with AUC of 0.732(95%CI:0.653-0.812)and 0.749(95%CI:0.688-0.809)for 48-h and 30-day outcomes,respectively.Sensitivities for CSRS,EGSYS,SFSR,and ROSE for 48-hour outcomes were 48%,65%,42% and 19%;and for 30-day outcomes were 72%,65%,30% and 55%,respectively.Atrial fibrillation/flutter on EKG,congestive heart failure,antiarrhythmics,systolic blood-pressure<90 at triage,and associated chest pain highly correlated with 48-h outcomes.An EKG abnormality,heart disease history,severe pulmonary hypertension,BNP>300,vasovagal predisposition,and antidepressants highly correlated with 30-day outcomes.CONCLUSIONS Performance and accuracy of four prominent syncope rules were suboptimal in identifying high-risk geriatric patients with short-term adverse outcomes.We identified some significant clinical and laboratory information that may play a role in predicting short-term adverse events in a geriatric cohort. | Suud A.Kiradoh Timothy E.Craven Maria O.Rangel Lillian M.Nosow Erfan Zarrinkhoo Suma Menon Parag A.Chevli Tareq M.Islam Luqman A.Thazhatuveetil-Kunhahamed | 2023 | Journal of Geriatric Cardiology2023，20，1： | 0 |
您所在的机构暂未开通此部分的功能，请联系管理员