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Category: Volume 09 Issue 05 May 2021
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Title: Prevalence of Disturbed Level of Consciousness in Ischemic Cerebrovascular Stroke Patients Presented to the Emergency Department of Alexandria University Hospital

Authors: Mohamed Elsayed Mohamed, Abdel-Fattah Ali El-Qersh, Mohamed Mohamed Hamdy, Nadia Foad Farghaly

 DOI: https://dx.doi.org/10.18535/jmscr/v9i5.19

Abstract

A study performed on 122 patients diagnosed with ischemic cerebrovascular stroke presented to the Emergency department of Alexandria University hospital during the period from 1/7/2014 to 31/12/2014 in order to study the prevalence of disturbed level of consciousness in this group of patients. Those patients were subjected to history taking, clinical examination, and assessment of the LOC, laboratory investigations and radiological examination using CT-brain and MRI in selected cases.

The most common risk factors were hypertension then Diabetes Mellitus. Males were more affected than female and the mean age of the patients was 59 years and the mean systolic blood pressures of patients were 144 mm.Hg.

Based on the GCS it was found that 27% of the patients had DLC. The patients were classified according to the severity of the impairment of the LOC into mild (GCS 14-13), Moderate (GCS 12-9) and Severe (GCS 3-8).Mild cases comprised 36.3% , moderate 33.3% and severe 30.3% of DLC patients.33.3% of the DLC patients were intubated.

The most important CT-brain finding in the DLC patients was MCA infarction that was found in 45.5% of DLC patients. Those patients are more labile to develop brain swelling and haemorrhagic transformation. It was found that 40% of MCA stroke patients were in deep coma.

Infratentorial infarctions also are an important causes for the occurrence of disturbed level of consciousness.

Hypertension is an important risk factor for stroke yet, it was found no significant correlation between hypertension and DLC.

It was found that there was a significant correlation between DLC and the admission hyperglycaemia and hyponatremia. While there was no correlation between raised admission Creatinine level and altered mental status.

Keywords: Disturbed level of consciousness , Cerebrovascular stroke , GCS.

References

  1. Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
  2. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview. Stroke. 2001;32(10):2426-32.
  3. Carrera E, Maeder-Ingvar M, Rossetti AO, Devuyst G, Bogousslavsky J. Trends in Risk Factors, Patterns and Causes in Hospitalized Strokes over 25 Years: The Lausanne Stroke Registry. Cerebrovascular Diseases. 2007;24(1):97-103.
  4. Giacomini MK. Gender and ethnic differences in hospital-based procedure utilization in California. Archives of Internal Medicine. 1996;156(11):1217-24.
  5. Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk Factors, Outcome, and Treatment in Subtypes of Ischemic Stroke: The German Stroke Data Bank. Stroke. 2001;32(11): 2559-66.
  6. Hashem S, Fathy H, Elsayed M, Hassan R, Samir H, Kamal M. Outcome and prognosis after ischemic stroke. Egypt J Neurol PsychiatNeurosurg. 2004;41:195-212.
  7. Heinsius T, Bogousslavsky J, Van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology. 1998;50(2):341-50.
  8. Heuschmann PU, Kolominsky-Rabas PL, Misselwitz B, et al. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: The german stroke registers study group. Archives of Internal Medicine. 2004;164(16):1761-8.
  9. Hornig CR, Rust DS, Busse O, Jauss M, Laun A. Space-occupying cerebellar infarction. Clinical course and prognosis. Stroke. 1994;25(2):372-4.
  10. Koren-Morag N, Goldbourt U, Tanne D. Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease. Neurology. 2006;67(2):224-8.
  11. Oxbury JM, Greenhall RC, Grainger KM. Predicting the outcome of stroke: acute stage after cerebral infarction. BMJ. 1975;3(5976):125-7.
  12. Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the Prognosis of Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases.23(5):850-4.
  13. Takagi S, Shinohara Y. Internal carotid occlusion: volume of cerebral infarction, clinical findings, and prognosis. Stroke. 1981;12(6):835-9.
  14. White H, Boden-Albala B, Wang C, Elkind MSV, Rundek T, Wright CB, et al. Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics: The Northern Manhattan Study. Circulation. 2005;111(10):1327-31.
  15. Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59(1):67-71.

Corresponding Author

Mohamed Elsayed Mohamed

Emergency Department, Faculty of Medicine University of Alexandria, Egypt