Background And Purpose: Rapid recognition of those at high risk for malignant edema after stroke would facilitate triage for monitoring and potential surgery. Admission data may be insufficient for accurate triage decisions. We developed a risk prediction score using clinical and radiographic variables within 24 hours of ictus to better predict potentially lethal malignant edema.
Methods: Patients admitted with diagnosis codes of cerebral edema and ischemic stroke, NIHSS score (National Institute of Health Stroke Score) of ≥8 and head computed tomographies within 24 hours of stroke onset were included. Primary outcome of potentially lethal malignant edema was defined as death with midline shift ≥5 mm or decompressive hemicraniectomy. We performed multivariate analyses on data available within 24 hours of ictus. Bootstrapping was used to internally validate the model, and a risk score was constructed from the results.
Results: Thirty-three percent of 222 patients developed potentially lethal malignant edema. The final model C statistic was 0.76 (confidence interval, 0.68-0.82) in the derivation cohort and 0.75 (confidence interval, 0.72-0.77) in the bootstrapping validation sample. The EDEMA score (Enhanced Detection of Edema in Malignant Anterior Circulation Stroke) was developed using the following independent predictors: basal cistern effacement (=3); glucose ≥150 (=2); no tPA (tissue-type plasminogen activator) or thrombectomy (=1), midline shift >0 to 3 (=1), 3 to 6 (=2), and 6 to 9 (=4); >9 (=7); and no previous stroke (=1). A score over 7 was associated with 93% positive predictive value.
Conclusions: The EDEMA score identifies patients at high risk for potentially lethal malignant edema. Although it requires external validation, this scale could help expedite triage decisions in this patient population.
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http://dx.doi.org/10.1161/STROKEAHA.117.016733 | DOI Listing |
Int J Stroke
January 2025
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Background: The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear.
Aims: This study aims to investigate whether intensive and conventional BP management affect outcomes differently, depending on IV tPA administration before EVT.
Methods: In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.
J Infect Public Health
December 2024
Department of Pediatric Infectious Diseases, Ministry of National Guard-Health Affairs (MNGHA), King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City (KAMC), MNGHA, Riyadh, Saudi Arabia.
Necrotizing fasciitis is a potentially life-threatening infection that can lead to rapid muscular and fascial necrosis, often resulting in sepsis. In addition to the rapid disease progression, diagnosing this disease in children can be challenging as they cannot accurately communicate their symptoms. Spontaneous necrotizing fasciitis secondary to Clostridial infection has rarely been described in the literature but occurs in neutropenic patients with significant morbidity and mortality from myonecrosis and gas gangrene.
View Article and Find Full Text PDFJ Orthop Case Rep
January 2025
Department of Orthopedic Surgery, Hadassah University Medical Center, Jerusalem, Israel.
Introduction: Gas gangrene, is an aggressive and life-threatening necrotizing infection of soft tissues. We report a case of upper-limb trauma resulting in clostridial gas gangrene.
Case Report: A 36-year-old healthy male presented to our department with a left humeral shaft fracture and an open elbow fracture.
Anal Chim Acta
February 2025
School of Life Sciences, The Second Affiliated Hospital, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, PR China. Electronic address:
Background: Glioma accounts for 80 % of all malignant primary brain tumors with a high mortality rate. Histopathological examination is the current diagnostic methods for glioma, but its invasive surgical interventions can cause cerebral edema or impair neural functioning. Liquid biopsy proves to be an efficient method for glioma detection.
View Article and Find Full Text PDFSci Rep
January 2025
Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
To describe the management and clinical course of 12 cases of pseudophakic aqueous misdirection syndrome (AMS). Twelve eyes of 12 Patients diagnosed with pseudophakic AMS between 2021 and 2022 were included. Best-corrected visual acuity, refraction, intraocular pressure (IOP), anti-glaucomatous medication, spectral domain ocular coherence tomography (SD-OCT) and postoperative complications were evaluated.
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