Vídeo original do NIH para treinamento da NIHSS. O booklet com as instruções da escala pode ser baixado aqui.
NIH Stroke Scale Training – Basics
Resposta
Arquivo da categoria: Unidade de AVC
Predicting outcome of IV thrombolysis–treated ischemic stroke patients: the DRAGON score
Objective: To develop a functional outcome prediction score, based on immediate pretreatment parameters, in ischemic stroke patients receiving IV alteplase.
Methods: The derivation cohort consists of 1,319 ischemic stroke patients treated with IV alteplase at the Helsinki University Central Hospital, Helsinki, Finland. We evaluated the predictive value of parameters associated with the 3-month outcome and developed the score according to the magnitude of logistic regression coefficients. We assessed accuracy of the model with bootstrapping. External validation was performed in a cohort of 330 patients treated at the University Hospital Basel, Basel, Switzerland. We assessed the score performance with area under the receiver operating characteristic curve (AUC-ROC).
Results: The DRAGON score (0–10 points) consists of (hyper)Dense cerebral artery sign/early infarct signs on admission CT scan (both = 2, either = 1, none = 0), prestroke modified Rankin Scale (mRS) score >1 (yes = 1), Age (≥80 years = 2, 65–79 years = 1, <65 years = 0), Glucose level at baseline (>8 mmol/L [>144 mg/dL] = 1), Onset-to-treatment time (>90 minutes = 1), and baseline National Institutes of Health Stroke Scale score (>15 = 3, 10–15 = 2, 5–9 = 1, 0–4 = 0). AUC-ROC was 0.84 (0.80–0.87) in the derivation cohort and 0.80 (0.74–0.86) in the validation cohort. Proportions of patients with good outcome (mRS score 0–2) were 96%, 88%, 74%, and 0% for 0–1, 2, 3, and 8–10 points, respectively. Proportions of patients with miserable outcome (mRS score 5–6) were 0%, 2%, 5%, 70%, and 100% for 0–1, 2, 3, 8, and 9–10 points, respectively. External validation showed similar results.
Conclusions: The DRAGON score is valid at our site and was reliable externally. It can support clinical decision-making, especially when invasive add-on strategies are considered. The score was not studied in patients with basilar artery occlusion. Further external validation is warranted.
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D. Strbian, MD, PhD, A. Meretoja, MD, PhD, MSc (Stroke Med), F.J. Ahlhelm, MD, PhD, J. Pitkäniemi, PhD (Stat), P. Lyrer, MD, M. Kaste, MD, PhD, S. Engelter, MD and T. Tatlisumak, MD, PhD
From the Department of Neurology (D.S., A.M., M.K., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Departments of Diagnostic and Interventional Neuroradiology (F.J.A.) and Neurology (P.L., S.E.), University Hospital Basel, Basel, Switzerland; and Department of Public Health (J.P.), University of Helsinki, Helsinki, Finland.
TCC na fase aguda do AVC – site para treinamento
Já está disponível o site – www.aspectsinstroke.com – desenvolvido pelo Calgary Stroke Team no Canadá para treinamento de interpretação de Tomografia Computadorizada do Crânio (TCC) no contexto da fase aguda do Acidente Vascular Cerebral Isquêmico (AVCi).
Trata-se de excelente ferramenta baseada no escore ASPECTS aplicável sobretudo nas doenças isquêmicas em território de artéria cerebral média.
O site roda em qualquer browser mas fica bem mais funcional no Internet Explorer. Além de discutir o papel da TCC na fase aguda do AVCi, explica e exemplifica o escore ASPECTS e traz casos para treinamento. Muito bom.
NIH STROKE SCALE (booklet)
Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the exam and work quickly. Except where indicated, the patient should not be coached (i.e., repeated requests to patient to make a special effort). >>> NIHSS Booklet >>>
Manuseio crítico de pacientes com hemorragia subaracnóide
Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management ofSAHto address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data. >>> Leia o artigo
Hemorragia cerebral
Introdução: A hemorragia cerebral intraparenquimatosa é com frequência um dos aspectos mais esquecidos da doença vascular cerebral. Objetivo: Rever a hemorragia intracerebral em diversos aspectos desde a sua epidemiologia e etiologia, assim como a patogenia, clínica, diagnóstico e prognóstico. Métodos. Realizamos uma revisão rigorosa da literatura existente, com especial atenção à publicada nos últimos anos. Foram analisadas as tendências atuais no tratamento médico e cirúrgico da hemorragia intraparenquimatosa e à luz destes dados depreende-se algumas ideias que podem resultar úteis para o seu tratamento. Conclusões: É evidente que existem nestes momentos lacunas importantes no tratamento de vários aspectos da hemorragia cerebral e que deve ser este um campo em que no futuro abundem estudos terapêuticos que venham resolver as grandes incertezas que existe no tratamento desta patologia. [REV NEUROL 2002; 35: 1056-66] >>> Leia o artigo
Classificação TOAST
A etiologia de AVC isquêmico (AVCI) afeta o prognóstico e seu manuseio. Estudos clínicos de terapias para pacientes com AVCI agudo devem incluir avaliações por subtipo de AVC. Um sistema para classificação dos subtipos de AVCI principalmente com base na etiologia foi desenvolvido para o “Trial of Org 10172 in Acute Stroke Treatment” (TOAST). A classificação dos subtipos foi preparada a partir das características clínicas e resultados de estudos complementares. Diagnósticos “possíveis” e “prováveis” foram feitos com base no grau certeza dos médicos. A concordância inter-observador foi testada por dois neurologistas que não participaram na elaboração dos critérios. Os neurologistas, de forma independente, utilizaram o sistema de classificação TOAST na avaliação de 20 pacientes, primeiramente apenas em aspectos clínicos e, em seguida, depois de analisar os resultados dos exames complementares. A classificação TOAST estabelece cinco subtipos de AVCI: 1) aterosclerose de grande artéria, 2) cardioembolismo, 3) oclusão de pequenos vasos, 4) AVCI de outras etiologias determinadas, e 5) AVCI de etiologia indeterminada. Usando esta classificação, a concordância inter-observador foi muito alta. Na verdade, os dois médicos discordaram em apenas um paciente. Ambos foram capazes de chegar a um diagnóstico etiológico específico nos demais 11 pacientes, enquanto a causa de acidente vascular cerebral não foi determinada em nove. Concluem os autores que a Classificação TOAST é fácil de usar e tem boa concordância entre observadores. A partir deste estudo a Classificação TOAST passou a ser utilizada em diversos estudos sobre AVCI. Leia o artigo na íntegra
Unidade de AVC – artigos para leitura
Destacado
Artigos importantes que devem ser lidos durante o estágio na Unidade de AVC:
- Interpretation of Head CT scan – Reviewing a CT
- Interpretation of Head CT scan – Ischaemic Stroke
- Interpretation of Head CT scan – Haemorrhagic Stroke
- Interpretation of Head CT scan – Subarachnoid Haemorrhage
- Interpretation of Head CT scan – Cerebral Venous Sinus Thrombosis
- DISTINGUISHING BETWEEN STROKE AND MIMIC AT BEDSIDE (2006)
- STROKE – RISK FACTORS – THE INTERSTROKE STUDY (2010)
- NEW APPROACH TO STROKE SUBTYPING – THE A-S-C-O (PHENOTYPIC) CLASSIFICATION
- STROKE – CLINICAL INTERPRETATION AND USE OF SCALES (2006)
- ISCHEMIC STROKE – AMERICAN STROKE ASSOCIATION GUIDELINES (2007)
- STROKE – DEFINITION AND EVALUATION OF TRANSIENT ISCHEMIC ATTACK (2009)
- AVC – ESCALAS DE AVALIAÇÃO E SEGUIMENTO
- ANATOMY OF THE CIRCULATION OF THE BRAIN AND SPINAL CORD
- MANUAL DE ROTINAS DE ATENDIMENTO AO AVC DO MINISTÉRIO DA SAÚDE
HGF - Neurologia 