AIM: The aim of this study was to detect the diagnostic accuracy of a novel app (Neurology Dx) vis-à-vis neurology residents. METHODS: A multicenter cross-sectional study involving seven leading ...teaching neurology institutes in India was conducted by recruiting 100 neurology residents. Primary outcome was proportion of correctly identified high likely gold standard differential diagnoses. Secondary outcomes were proportions of correctly identified first high likely, first three high likely, first five high likely, and combined moderate plus high likely gold standard differentials. RESULTS: Four sets comprising 15 movement disorder vignettes each (total 60) were tested on 100 neurology residents (one set for each resident) and also on the app (60 vignettes). Residents correctly identified the gold standard "high likely" differentials with a frequency of 13.6% as against 41.5% by the app (95% confidence interval CI: 21.9-34.1). On combining "high" and "moderate likely" differentials, residents could accurately identify gold standard differentials with a frequency of 10.8% as against 37.9% by the app (95% CI: 22.6-31.9). The residents correctly identified first five high likely gold standard differentials with a frequency of 13.5% versus 23.7% by the app (95% CI: 5.3-15.9). The residents correctly identified first three high likely gold standard differentials with a frequency of 13.0% versus 15.8% by the app (95% CI: -1.2-7.9). Residents correctly identified the first "high likely" gold standard differential in 32.3% as against 35% by the app (95% CI: -8.4-15.6). CONCLUSIONS AND RELEVANCE: This study suggests that an app (Neurology Dx) is capable of generating differential diagnoses to complement clinical reasoning of neurology residents (CTRI/2017/06/008838).
DEMOGRAPHIC , CLNICAL AND IMAGING PROFILE , ETIOLOGIC CLASSIFICATION, MANAGEMENT STRATEGIES AND OUTCOMES OF STROKES IN ELDERLY ( 80 YEARS AND ABOVE) - A FIVE YEAR RETROSPECTIVE STUDYRimpy Joseph, ...Venugopalan Y Vishnu, Rohit Bhatia, Sahil Kohli, Ayush Agarwal, Vasantha PadmaIntroduction : Age is the most important non-modifiable risk factor for all stroke subtypes & patient outcomes are greatly influenced by age. Patients and methods : Retrospective review of data collected from admission, discharge and death registers along with detailed analysis of case summaries obtained from Computerised Patient Record System (CPRS) at AIIMS during the time period 2014-2018. Results : A total of 105 patients with strokes in elderly (>80 yrs) were admitted during the study period. The mean age at presentation was 81.69 years (Ischemic, 82.11 and hemorrhagic 83.32 yrs). Ischemic strokes constituted 61 (75.24% ) while hemorrhagic strokes accounted for 21 (24.76% )of all strokes. The males in ischemic and hemorrhagic stroke were 50.63%% and 50% respectively. Risk factors were hypertension ( 81.01%), diabetes ( 35.44%), coronary artery disease (31.64%) & atrial fibrillation ( 31.64%). Nineteen patients (24%) presented within the window period for thrombolysis of which fourteen underwent thrombolysis . Decompressive craniectomy was done in 2 patients and two patients underwent mechanical thrombectomy. The most frequent TOAST classification subtypes were Large artery atherosclerosis (37.97%), cardioembolic stroke (31.64% )and undetermined etiology ( 2 or more -30.37%). The mortality rate in ischemic and hemorrhagic stroke were 21/79 (26.58%) and 10/26 (38.46%) respectively.More than 90% of hemorrhagic stroke patients were hypertensive. The most frequent location was gangliocapsular(63.63%). Two patients required hematoma evacuation and another two required EVD insertion.Conclusion : Ischemic strokes constituted two-third of stroke in very elderly and 24 % received thrombolysis. In ICH the most common location was gangliocapsular and more than 90% had hypertension.
Hypothesis: Low frequency repetitive trans cranial magnetic stimulation onto the contralesional primary motor cortex along with physical therapy in subacute ischemic stroke patients will enhance ...serum VEGF and BDNF levelsMethods: Participants with first ever ischemic stroke (n=96) in the previous 15 days were randomized after a run-in period of 75+/- 7 days with standard physical therapy to receive 10 sessions of real low frequency (1 Hz, 750 pulses, inter train stimulus interval~45 seconds, 110% resting motor threshold) rTMS (n=47) on contralesional primary motor cortex or to sham stimulation (n=49) over a duration of 2 weeks. Non fasting venous blood samples were collected at baseline, pre-rTMS and post-rTMS for serum VEGF and BDNF estimation.Results: There was significant increase in the mean VEGF(673.04 u00b1193.28 pg/ml vs 797.24 u00b1 224.27 pg/ml ; p<0.001and BDNF(25.12 u00b110.11 ng/ml vs 30.64 u00b1 9.64 ng/ml; p<0.001) at post rTMS was seen in the Real rTMS group compared to the Sham rTMS groupConclusion: Both VEGF and BDNF levels were significantly elevated in patients receiving low frequency rTMS in combination with physical therapy compared to those receiving only conventional physical therapy. Both these growth factors may have significant role in the pathophysiology of stroke recovery mediated by rTMS.
IntroductionThe current standard of care in acute ischemic stroke (AIS) within window period is thrombolysis with or without endovascular therapy. The role of neuroprotective therapies especially ...within window period, to salvage the ischemic penumbra is unclear. Our study is targeting the effect of Citicoline immediately after the revascularization therapy. Most of the neuroprotective drug trials have included patients after the critical window period. Those patients undergoing revascularization therapy are expected to have a good ischemic penumbra. Moreover, Citicoline has never been used concurrently in any clinical trial involving endovascular therapy. MethodsAll consecutive AIS patients aged above 18 years, satisfying criteria for reperfusion therapy (thrombolysis or thrombectomy) will be randomized to intervention and placebo arm immediately after therapy with concealed allocation. Patients in the Citicoline arm will receive 1gm intravenous therapy for 3 days followed by oral treatment (1 gm twice daily) for 39 days. Primary outcome is change in stroke volume from baseline to week 6. Secondary outcomes are mRS 0-2, NIHSS 0-2 and mortality at 90 days.ResultsWe have randomized 39 patients till date and expect to enroll 114 patients in our study period (two years).ConclusionThe benefit of Citicoline in the immediate post reperfusion therapy has never been studied. The neuroprotectant may play a significant role in salvaging the ischemic penumbra during the early stages of stroke evolution.
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