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      Diagnostic and prognostic values of cerebral oxygen saturations measured by INVOS™ in patients with ischemic and hemorrhagic cerebrovascular disease

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          Abstract

          Objectives

          In this study it was aimed to investigate whether measurement of potential changes of cerebral oxygenation saturations due to ischemic or hemorrhagic cerebrovascular diseases have an early diagnostic and prognostic value.

          Methods

          Adult patients (≥18 years old) having acute ischemic or hemorrhagic stroke were included in the study. Patients under 18-year-old, those with incomplete data or suspicious diagnosis were excluded.

          The cerebral oxygen saturations of the patients were compared with the healthy subjects. Patients were also grouped according to their clinical outcomes; good clinical status (group 1) and poor clinical status (group 2). These groups were compared according to the patients’ cerebral oxygen saturations.

          Results

          The mean oxygen saturation of the patients and healthy people were similar (59.48% ± 10.6 versus 58.44% ± 9.6). There was no difference between patients and healthy population according to cerebral oxygen saturations. Furthermore, mean oxygen levels were also similar between the hemisphere without lesion and with lesion in the patients group (59.8% ± 11.8 versus 59.2% ± 10.4).

          When the patients were grouped according to their clinical status, there were 30 patients in group 1 and 15 in group 2. The cerebral oxygen saturations of the hemisphere with lesion were similar between these groups and no statistical difference was observed (59.2% ± 9.3 versus 59.1% ± 12.6, p = 0.9). There was also no statistical difference between the groups when delta oxygen levels of the affected and unaffected hemispheres of the groups were calculated (0.9% ± 6.1 versus 0.13% ± 8.4, p = 0.7).

          Conclusion

          Results of this study revealed that there was no difference in cerebral oxygen saturations measured by near-infrared cerebral oximetry system between the patients with cerebrovascular disease and healthy population. Furthermore, our results did not support that the cerebral oxygen saturations may be used for determining the prognosis of the patients with cerebrovascular disease.

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          Most cited references21

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          Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.

          Controversy exists about the optimal imaging technique in acute stroke. It was hypothesised that CT is comparable with DWI, when both are read systematically using quantitative scoring. Ischaemic stroke patients who had CT within six hours and DWI within seven hours of onset were included. Five readers used a quantitative scoring system (ASPECTS) to read the baseline (b) and follow up CT and DWI. Use of MRI in acute stroke was also assessed in patients treated with tissue plasminogen activator (tPA) by prospectively recording reasons for exclusion. Patients were followed clinically at three months. bDWI and bCT were available for 100 consecutive patients (admission median NIHSS = 9). The mean bDWI and bCT ASPECTS were positively related (p<0.001). The level of interrater agreement ranged from good to excellent across all modalities and time periods. Bland-Altman plots showed more variability between bCT and bDWI than at 24 hours. The difference between bCT and bDWI was < or =2 ASPECTS points. Of bCT scans with ASPECTS 8-10, 81% had DWI ASPECTS 8-10. Patients with bCT ASPECTS of 8-10 were 1.9 times more likely to have a favourable outcome at 90 days than those with a score of 0-7 (95% CI 1.1 to 3.1, p = 0.002). The relative likelihood of favourable outcome with a bDWI ASPECTS 8-10 was 1.4 (95% CI 1.0 to 1.9, p = 0.10). Of patients receiving tPA 45% had contraindications to urgent MRI. The differences between CT and DWI in visualising early infarction are small when using ASPECTS. CT is faster and more accessible than MRI, and therefore is the better neuroimaging modality for the treatment of acute stroke.
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            Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome.

            To determine the value of regional cerebral oxygen saturation (rSo2), fractional cerebral tissue oxygen extraction (FTOE) measured by near-infrared spectroscopy (NIRS), and amplitude integrated electroencephalogram (aEEG) after birth asphyxia in relation to neurodevelopmental outcome. NIRS measured rSo2, FTOE, and aEEG were monitored simultaneously, together with arterial oxygen saturation (Sao2) and blood pressure during the first 48 hours after severe birth asphyxia in 18 term infants. FTOE was calculated as [Sao2-rSo2]/Sao2. Neurodevelopmental outcome was assessed at 3, 9, and 18 months and 3 and 5 years of age. At the time points 6, 12, 18, 24, 30, 36, 42, and 48 hours after birth, the mean values of Sao2, rSo2, FTOE, and mean arterial blood pressure were calculated over a 1-hour period. A stepwise-regression model was used to investigate the relative contribution of rSo2, FTOE, or aEEG to developmental outcome. Nine Infants died during the neonatal period as a result of neurologic deterioration, and 8 infants had a normal outcome at 5 years of age. One child developed learning disabilities and a mild diplegia. The rSo2 and FTOE remained stable in infants with a normal outcome. The rSo2 increased and the FTOE decreased after 24 hours in the infants with an adverse outcome. (rSo2: 65% vs 84% at 12 and 48 hours, respectively; FTOE: 0.32 vs 0.12 at 12 and 48 hours, respectively). aEEG showed the closest relationship with outcome, but also rSo2 showed a significant correlation 24 hours after birth. rSo2 and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.
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              Early life risk factors for cerebrovascular disease: A systematic review and meta-analysis.

              Cerebrovascular disease (CVD) causes subclinical brain vascular lesions detected using neuroimaging and childhood factors may increase later CVD risk.
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                Author and article information

                Contributors
                Journal
                Turk J Emerg Med
                Turk J Emerg Med
                Turkish Journal of Emergency Medicine
                Elsevier
                2452-2473
                17 January 2019
                April 2019
                17 January 2019
                : 19
                : 2
                : 64-67
                Affiliations
                [1]University of Health Sciences, Umraniye Training and Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey
                Author notes
                []Corresponding author. Umraniye Training and Research Hospital, Emergency Medicine Clinic, Elmalikent Mahallesi Adem Yavuz Cad. No:1, Umraniye, Istanbul, Turkey. aksel@ 123456gokhanaksel.com @ 123456drgokhanaksel
                Article
                S2452-2473(18)30308-X
                10.1016/j.tjem.2019.01.001
                6497985
                72c8a810-3ee1-43fd-bd35-55f37cb83089
                2019 Emergency Medicine Association of Turkey. Production and hosting by Elsevier B. V. on behalf of the Owner.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 30 November 2018
                : 9 January 2019
                : 9 January 2019
                Categories
                Original Research Article

                stroke,cerebrovascular disorders,diagnosis,diagnosis emergency department

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