Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Dec 2018
Improving the Accuracy of Scores to Predict Gastrostomy after Intracerebral Hemorrhage with Machine Learning.
Gastrostomy placement after intracerebral hemorrhage indicates the need for continued medical care and predicts patient dependence. Our objective was to determine the optimal machine learning technique to predict gastrostomy. ⋯ Machine learning techniques other than logistic regression (eg, random forests, extreme gradient boost, and kth nearest neighbors) were significantly more accurate for predicting gastrostomy using the same independent variables. Machine learning techniques may assist clinicians in identifying patients likely to need interventions.
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J Stroke Cerebrovasc Dis · Dec 2018
Case ReportsSuperficial Temporal Artery to Anterior Cerebral Artery Hemi-bonnet Bypass Using Radial Artery Graft for Prevention of Complications after Surgical Treatment of Partially Thrombosed Large/Giant Anterior Cerebral Artery Aneurysm.
Partially thrombosed large/giant aneurysm of the anterior cerebral artery is still challenging because this complex aneurysm requires arterial revascularization in the deep operation field. Therefore, direct neck clipping is often impossible. We describe our experiences with extracranial-intracranial bypass as an insurance bypass prior to clipping of partially thrombosed anterior cerebral artery aneurysms, and discuss the microsurgical technique and strategy. ⋯ Superficial temporal artery-radial artery graft-anterior cerebral artery hemi-bonnet bypass prior to aneurysm dissection can avoid ischemic complication during temporary occlusion and secures permanent revascularization after complete obliteration of partially thrombosed large/giant anterior cerebral artery aneurysm.
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J Stroke Cerebrovasc Dis · Dec 2018
Case ReportsRectus Sheath Hematoma Following Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator for Cerebral Infarction: A Case Report.
A 76-year-old Japanese man was admitted to our department because of aphasia and right hemiparesis. Brain magnetic resonance imaging showed cerebral infarction caused by occlusion of the left middle cerebral artery, and alteplase therapy was started. Thrombectomy was subsequently performed, resulting in recanalization. ⋯ Rectus sheath hematomas present as acute abdominal pain and are often misdiagnosed. Although several predisposing factors for rectus sheath hematomas have been identified, whether recombinant tissue-type plasminogen activator causes rectus sheath hematomas, remains unclear. This case highlights the need to consider a rectus sheath hematoma as a differential diagnosis of abdominal pain following treatment with recombinant tissue-type plasminogen activator.
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J Stroke Cerebrovasc Dis · Dec 2018
Handling of Missing Outcome Data in Acute Stroke Trials: Advantages of Multiple Imputation Using Baseline and Postbaseline Variables.
In acute stroke randomized trials, missingness of final functional outcome data reduces study power and potentially biases findings of treatment effect. Best methods for handling missing outcome data have not been well delineated for diseases with monophasic onset and subsequent improvement, like acute stroke. ⋯ For acute stroke trials, multiple imputation using baseline and postbaseline observations is an advantageous approach to missing outcome data-handling, yielding high accuracy, reduced directional bias, and greater preservation of study power.
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J Stroke Cerebrovasc Dis · Dec 2018
Randomized Controlled TrialVirtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial.
Virtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients. ⋯ We found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.