타과에서 의뢰된 급성뇌경색의 임상과 영상 특징
Clinical and Radiological Characteristics of Acute Ischemic Stroke Consulted from Nonneurology Departments
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Background: An acute ischemic infarction can occur in patients admitted to a nonneurology department, which canresult in a delay in the diagnosis that could produce a poor outcome. The aim of this study was to identify the clinical andradiologic features of ischemic stroke diagnosed during consultations in nonneurology departments. Methods: Acute ischemic stroke patients who were admitted to a neurology department or who were diagnosed after aconsultation to a neurology department between October 2007 and February 2009 were enrolled. Acute ischemic strokewas diagnosed by a stroke neurologist with the aid of diffusion-weighted MRI. Clinical variables [age, sex, risk factors,initial score on the National Institutes of Health Stroke Scale, stroke subtype, and modified Rankin scale (mRS) score at 3months] were obtained. Poor clinical outcome was defined as a mRS score of 3-6. Stroke lesion types based on MRI wereclassified into single vascular territory, multiple vascular territories, and multiple circulations. Results: In total, 340 patients were enrolled, 84 (24.7%) of whom were diagnosed in nonneurology departments. Amongthe 84 consultations, 57 cases were symptomatic ischemic strokes, and 27 cases exhibited irrelevant acute ischemiclesions. With respect to the stroke subtype, other cause (10.7% vs 4.8%) and undetermined cause (42.9% vs 20.7%) weremore common in the nonneurology department patients (p<0.0001). Acute ischemic strokes in multiple circulations werealso more common in those from nonneurology departments (44.0% vs 11.0%, p<0.0001), along with higherhigh-sensitivity C-reactive protein levels. A poor clinical outcome was more common among patients in thenonneurology departments than among those in the neurology department (75.0% vs 27.5%, p<0.0001). Conclusions: Ischemic strokes from nonneurology departments tend to appear as nonlocalizing neurologic symptomsand spread in multiple circulations, and are associated with a worse outcome than those from neurology departments.
Abstract
Background: An acute ischemic infarction can occur in patients admitted to a nonneurology department, which canresult in a delay in the diagnosis that could produce a poor outcome. The aim of this study was to identify the clinical andradiologic features of ischemic stroke diagnosed during consultations in nonneurology departments. Methods: Acute ischemic stroke patients who were admitted to a neurology department or who were diagnosed after aconsultation to a neurology department between October 2007 and February 2009 were enrolled. Acute ischemic strokewas diagnosed by a stroke neurologist with the aid of diffusion-weighted MRI. Clinical variables [age, sex, risk factors,initial score on the National Institutes of Health Stroke Scale, stroke subtype, and modified Rankin scale (mRS) score at 3months] were obtained. Poor clinical outcome was defined as a mRS score of 3-6. Stroke lesion types based on MRI wereclassified into single vascular territory, multiple vascular territories, and multiple circulations. Results: In total, 340 patients were enrolled, 84 (24.7%) of whom were diagnosed in nonneurology departments. Amongthe 84 consultations, 57 cases were symptomatic ischemic strokes, and 27 cases exhibited irrelevant acute ischemiclesions. With respect to the stroke subtype, other cause (10.7% vs 4.8%) and undetermined cause (42.9% vs 20.7%) weremore common in the nonneurology department patients (p<0.0001). Acute ischemic strokes in multiple circulations werealso more common in those from nonneurology departments (44.0% vs 11.0%, p<0.0001), along with higherhigh-sensitivity C-reactive protein levels. A poor clinical outcome was more common among patients in thenonneurology departments than among those in the neurology department (75.0% vs 27.5%, p<0.0001). Conclusions: Ischemic strokes from nonneurology departments tend to appear as nonlocalizing neurologic symptomsand spread in multiple circulations, and are associated with a worse outcome than those from neurology departments.
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