Abstract:
BACKGROUND AND PURPOSE:It is not known what fraction of patients with symptomatic cerebral aneurysms are misdiagnosed at initial medical presentation. It is also not clear whether misdiagnosed patients more frequently deteriorate before definitive aneurysm diagnosis and therapy or achieve a poorer outcome than correctly diagnosed patients. METHODS:We reviewed records of consecutive patients with symptomatic cerebral aneurysms managed by four tertiary-care neurosurgical services during a recent 19-month period. Clinical course and outcome were analyzed according to misdiagnosis or correct diagnosis at initial medical evaluation. RESULTS:Fifty-four of 217 patients (25%) were misdiagnosed at initial medical evaluation, including 46 of 121 patients (38%) initially in good clinical condition (clinical grade 1 or 2). Forty-six of 54 patients (85%) in the misdiagnosis group were initially grade 1 or 2 compared with 75 of 163 patients (46%) with correct initial diagnosis (P < .01). Twenty-six of 54 misdiagnosed patients (48%) deteriorated or rebled before definitive aneurysm treatment compared with 4 of 165 correctly diagnosed patients (2%) (P < .001). Among patients initially presenting as clinical grade 1 or 2, overall good or excellent outcome was achieved in 91% of those with correct initial diagnosis and 53% of patients with initial misdiagnosis (P < .001). Deterioration before correct diagnosis accounted for 16 of 67 patients (24%) with poor or worse final outcome in this series. CONCLUSIONS:Patients in good clinical condition with symptomatic cerebral aneurysms were commonly misdiagnosed. Misdiagnosed patients were more likely than correctly diagnosed patients to deteriorate clinically and had a worse overall outcome. Misdiagnosed cases accounted for a significant fraction of overall poor outcomes among consecutive cases of symptomatic aneurysms.
journal_name
Strokejournal_title
Strokeauthors
Mayer PL,Awad IA,Todor R,Harbaugh K,Varnavas G,Lansen TA,Dickey P,Harbaugh R,Hopkins LNdoi
10.1161/01.str.27.9.1558subject
Has Abstractpub_date
1996-09-01 00:00:00pages
1558-63issue
9eissn
0039-2499issn
1524-4628journal_volume
27pub_type
杂志文章相关文献
STROKE文献大全abstract:BACKGROUND AND PURPOSE:Although modern multisequence stroke MRI protocols are an emerging imaging routine for the diagnostic assessment of acute ischemic stroke, their sensitivity for intracerebral hemorrhage (ICH), the most important differential diagnosis, is still a matter of debate. We hypothesized that stroke MRI ...
journal_title:Stroke
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1161/01.STR.0000114203.75678.88
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:There is controversy about the optimal patient position for the detection of right-to-left shunt (RLS). The study was performed to investigate which patient position best detects RLS during contrast-enhanced transcranial Doppler. METHODS:We prospectively evaluated consecutive patients with ische...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.110.609875
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The majority of ischemic stroke patients receiving endovascular recanalization therapy (EVT) experience variable changes of neurological severities during the hyperacute period. We hypothesized that the National Institutes of Health Stroke Scale (NIHSS) score after EVT is a better prognostic fact...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.117.020587
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND AND PURPOSE:We sought to investigate the mechanisms for oxidative injury caused by subarachnoid hemolysate, a pro-oxidant. METHODS:Injection of 50 microL of subarachnoid hemolysate or saline was performed in CD1 mice (n=75), mutant mice deficient in Mn-superoxide dismutase (Sod2+/-; n=23), and their wild-ty...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.32.2.506
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Nimodipine, a calcium antagonist, has been reported to have beneficial effects in acute ischemic infarction. Some calcium channel antagonists have antiplatelet effects. We investigated the effect of oral nimodipine on platelet function in healthy volunteers. METHODS:Twelve healthy volunteers (6 ...
journal_title:Stroke
pub_type: 临床试验,杂志文章
doi:10.1161/01.str.24.1.10
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Stroke-related physical disability can diminish quality of daily living, place care burden on families, and increase need for long-term institutionalization. We developed a prognostic index for use in research and with potential for adaptation to clinical practice that establishes the likelihood ...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.28.3.550
更新日期:1997-03-01 00:00:00
abstract::Blood flow velocity of the middle cerebral artery was monitored during cardiopulmonary bypass procedures by means of transcranial Doppler ultrasonography. Our investigation was carried out in a group of 16 patients with severe carotid stenosis or occlusion and in a control group of 42 patients with no or stenosis of l...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.19.6.674
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Hetereothermic mammals tolerate hypoxia during euthermy and torpor, and evidence suggests this tolerance may extend beyond hypoxia to cerebral ischemia. During hibernation, CA1 hippocampal neurons endure extreme fluctuations in cerebral blood flow during transitions into and out of torpor as well...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.STR.0000217409.60731.38
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the...
journal_title:Stroke
pub_type: 杂志文章,多中心研究
doi:10.1161/STROKEAHA.110.578971
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. METHODS:Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using i...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.116.014265
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND AND PURPOSE:When carotid artery tandem lesions are present, the benefits of carotid endarterectomy (CEA) to reduce recurrent stroke remain uncertain. The present retrospective cohort study aimed to determine the clinical outcomes of CEA for carotid artery tandem stenosis that was diagnosed by contrast-enhanc...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.114.007181
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Multiple acute ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI-MRI) are thought to be of embolic origin. However, in several patients with multiple ischemic lesions on DWI-MRI, no embolic source was detected, despite a thorough clinical work-up. Stroke etiology in such case...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.STR.0000231645.22128.ab
更新日期:2006-08-01 00:00:00
abstract::We compared 211 consecutive patients who had acute ischemic hemispheric stroke and atrial fibrillation with 837 consecutive patients who had stroke without atrial fibrillation. The atrial fibrillation group included a higher frequency of women, older subjects, and those with a severe neurologic deficit, abnormal compu...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.22.2.169
更新日期:1991-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:In the early stage of stroke, the occurrence of neurologic and medical complications is associated with clinical deterioration. Previous studies were focused on the first week after stroke onset. The aim of this study was to evaluate the impact of complications on clinical outcome in patients wit...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.STR.0000259659.91505.40
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The consequences of stroke are a major health concern. This study was conducted to compare the health-related quality of life among long-term survivors of stroke with that of the general population. METHODS:Our data are taken from a population-based case-control study of all 6-year survivors of ...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.31.2.440
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Based on thrombus location and nature and anatomic features of aorta and cerebral arteries, we hypothesized that cardiogenic embolisms (CE) and aortogenic embolisms (AE) might have different right-left propensity and lesion patterns. METHODS:We retrospectively reviewed patients with acute ischem...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.111.616573
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Several studies have reported on the correlation of ultrasonic carotid plaque morphology, cerebrovascular symptoms, and intraplaque hemorrhage. This study correlates ultrasonic carotid plaque morphology with the degree of carotid stenosis. METHODS:Carotid arteries (n=2460) were examined by using...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.0000019127.11189.b5
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND AND PURPOSE:To investigate the incidence of retrograde flow from complex plaques (> or =4-mm-thick, ulcerated, or superimposed thrombi) of the descending aorta (DAo) and its potential role in embolic stroke. METHODS:Ninety-four consecutive acute stroke patients with aortic plaques > or =3-mm-thick in transe...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.109.577775
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Cerebral ischemia and stroke are leading causes of morbidity and mortality. An approach to protecting the brain during ischemia is to try to increase the delivery of oxygen via the residual blood flow through and around ischemic tissue. To test this hypothesis, we used a novel oxygen delivery age...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.28.8.1624
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Glutamate receptor antagonists are protective in animal models of focal cerebral ischemia. Lamotrigine (3,5-diamino-6-[2,3-dichlorophenyl]-1,2,4-triazine) is an anticonvulsant drug that blocks voltage-gated sodium channels and inhibits the ischemia-induced release of glutamate. We describe the ce...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.26.1.117
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Peri-infarct depolarizations (PIDs) that occur in ischemic boundary zones of the cerebral cortex of experimental animals have been shown to promote rather than simply to indicate the evolution of the lesion and are especially prominent in the rat. To study the influence of one factor, species, on...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.31.1.214
更新日期:2000-01-01 00:00:00
abstract::Spontaneously hypertensive rats (SHR) have been shown to have an increased capacity for superior cervical sympathetic nerve activity which may protect against stroke (Mueller et al: Stroke 13: 115, 1982). Sympathetic nerve activity has never been examined in the stroke-prone substrain of SHR (SP). In this study we mea...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.16.1.73
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Our aim in this study was to assess the incidence and determining factors of angiographic recurrences after endovascular treatment of aneurysms. METHODS:A retrospective analysis of all patients with selective endosaccular coil occlusion of intracranial aneurysms prospectively collected from 1992...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.STR.0000073841.88563.E9
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Spontaneous echo contrast (SEC) is thought to represent a risk factor for cardioembolic stroke. In vitro studies suggest that SEC results from interaction between red cells and fibrinogen. To better understand the relation between SEC and stroke and to investigate the in vivo genesis of SEC, we e...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.25.8.1564
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The remaining limitations of ultrasonographic imaging in accurately quantifying internal carotid stenosis or diagnosing internal carotid occlusion may be overcome by enhancing the echogenicity of flowing arterial blood with contrast agents. This study assessed the usefulness of the intravenous (t...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.25.2.385
更新日期:1994-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:A transient ischemic attack (TIA) in the brain is classically considered a syndrome lasting <24 hours. Having previously shown that an experimental challenge with the GABAA agonist midazolam in recovered stroke patients can reinduce the acute clinical state, we determined whether TIA patients wou...
journal_title:Stroke
pub_type: 临床试验,杂志文章
doi:10.1161/01.STR.0000056540.04159.F3
更新日期:2003-03-01 00:00:00
abstract::Background and Purpose- We sought to explore the effect of genetic imbalance on functional outcome after ischemic stroke (IS). Methods- Copy number variation was identified in high-density single-nucleotide polymorphism microarray data of IS patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Pati...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.118.021856
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Cerebral emboli can be identified by the presence of typical microembolic signals (MES) in transcranial Doppler (TCD) spectral curves. The usefulness of this technique was studied by evaluating the prevalence and time course of MES in patients with acute stroke. In addition, we examined the influ...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/01.str.28.2.358
更新日期:1997-02-01 00:00:00
abstract::Background and Purpose- Recanalization with tPA (tissue-type plasminogen activator) is the only pharmacological therapy available for patients with ischemic stroke. However, the percentage of patients who may receive this therapy is limited by the risk of hemorrhagic transformation (HT)-the main complication of ischem...
journal_title:Stroke
pub_type: 杂志文章
doi:10.1161/STROKEAHA.118.021540
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The CHA2DS2-VASc score aims to improve risk stratification of ischemic stroke among patients with atrial fibrillation to identify those who can safely forego oral anticoagulation. Oral anticoagulation treatment guidelines remain uncertain for CHA2DS2-VASc score of 1. We conducted a systematic rev...
journal_title:Stroke
pub_type: 杂志文章,meta分析,评审
doi:10.1161/STROKEAHA.115.012609
更新日期:2016-05-01 00:00:00