• Publikační typ
• časopisecké články MeSH

Introduction: The e-STROKE study is a prospective, multicenter observational study designed to assess the impact of various CT parameters (including e-ASPECT, CT perfusion (CTP), collateral flow status, and the size and location of the ischemic lesion) on the clinical outcomes of patients with ischemic stroke, as evaluated by the modified Rankins Scale (mRS) three months post-stroke. This study also aims to investigate whether the use of multimodal CT imaging increases the number of patients eligible for recanalization therapy. The analysis will integrate data from the RES-Q registry and radiological data from the e-STROKE system provided by Brainomix Ltd. Aims: The primary aim is to determine the predictive value of CT parameters (e-ASPECTS, CTP, collateral vessel status, and ischemic lesion volume and location) on three-month functional outcomes, as defined by the mRS, in patients with non-lacunar stroke following recanalization treatment (IVT and/or MT). The secondary aim is to evaluate whether multimodal CT examination leads to an increase in the number of patients eligible for recanalization therapy. Additionally, this study seeks to assess the specificity and sensitivity of multimodal CT in distinguishing stroke mimics from actual strokes. Methods: This multicenter observational study involves patients with suspected acute ischemic stroke and a premorbid mRS ≤ 4, who are treated with endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or managed conservatively in stroke centers within the Czech Stroke Research Network (STROCZECH), which is part of the Czech Clinical Research Infrastructure Network (CZECRIN). Data collection includes demographic, clinical, and imaging data variables such as age, sex, ethnicity, risk factors, treatment times (OTT, DNT, and OGT), TICI scores, post-treatment hemorrhage (ECAS II), mRS outcome, stroke etiology, e-ASPECTS, acute ischemic volume (AIV), thrombus length on NCCT, CTA collateral score and collateral vessel density, location of large vessel occlusion, ischemic core, hypoperfusion volume, mismatch ratio and volume, final infarct volume, hemorrhage volume, and MRI in case of negative follow-up NCCT. Conclusions: We anticipate collecting robust clinical and radiological data from approximately 2000 patients across 22 centers over a 12-month period. The results are expected to enhance the precision of diagnostic and prognostic radiological markers in managing acute stroke.

• Publikační typ
• časopisecké články MeSH

Soudní lékař se často setkává s diagnózou otřesu mozku, respektive lehkého mozkového poranění (mTBI). Dřívější koncept mozkové komoce (otřesu mozku) jako funkční a plně reverzibilní klinické jednotky je nutno považovat za překonaný, neboť otřes mozku může vést k prokazatelným strukturálním změnám mozku. Proto se doporučuje od používání pojmu „otřes mozku“ či „komoce“ co nejdříve upustit. Protože jsou ale tyto termíny v klinické praxi mnohde stále používány a neexistuje jednoznačné kritérium, jak odlišit komoci od mTBI, je pragmatické tyto pojmy považovat za synonyma, což platí i pro tento článek. Soudní lékař v souvislosti s mTBI řeší zpravidla tři otázky: diagnóza zranění, závažnost zranění a mechanizmus a způsob vzniku zranění. Měl by vždy zvážit, zda ke klinikem diagnostikovanému mTBI skutečně došlo, k tomu může využít konzultaci s neurologem. Pokud ano, jde vždy o poruchu zdraví, může ale jít i o těžké zranění. Ze statistiky ÚZIS vyplývá, že průměrná doba léčení je u otřesu mozku delší než dosud akceptované 2–3 týdny. Postkomoční syndrom je relativně častou komplikací otřesu mozku. Adresa pro korespondenci: doc. MUDr. František Vorel, CSc., Soudnělékařské oddělení Nemocnice České Budějovice, a.s. B. Němcové 54, 370 01 České Budějovice tel. 602 430 152, e-mail vorel.frantisek@nemcb.cz Delivered: March 1, 2024 Accepted: April 1, 2024

The forensic physician is often faced with the diagnosis of concussion or mild traumatic brain injury (mTBI). The earlier concept of cerebral concussion as a functional and fully reversible clinical entity must be considered obsolete, as concussion can lead to demonstrable structural changes in the brain. It is therefore recommended that the use of the term ‘concussion’ be abandoned as soon as possible. However, as these terms are still used in clinical practice in many places and there is no clear criterion to distinguish concussion from mTBI, it is pragmatic to consider these terms as synonyms. The forensic physician typically addresses three issues in the context of mTBI: the diagnosis of the injury, the severity of the injury, and the mechanism and mode of injury. He or she should always consider whether the clinician-diagnosed mTBI actually occurred, and may use consultation with a neurologist to do so. If so, it is always a medical disorder, but it may also be a severe injury. Statistics from the Institute of Health Information and Statistics (IHIS) show that the average period of incapacity for concussion is 39 days for people aged 20-65, which is longer than the previously accepted 2-3 weeks. The average period of incapacity for work for men and women is not statistically different. However, it increases with age, by almost one day for each year of age between 20 and 65 years. Post-concussion syndrome is a relatively common complication of concussion.

• MeSH
• komoce mozku * diagnóza   etiologie   MeSH
• lidé MeSH
• postkomoční syndrom diagnóza   patologie   MeSH
• pracovní neschopnost statistika a číselné údaje   MeSH
• stupeň závažnosti nemoci MeSH
• traumatické poranění mozku * diagnóza   etiologie   MeSH
• výzkum MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: Non-contrast computed tomography (CT) and CT angiography are the gold standard in neuroimaging diagnostics in the case of suspected stroke. CT perfusion (CTP) may play an important role in the diagnosis of stroke mimics (SM), but currently, it is not a standard part of the stroke diagnostic procedure. The project is a multicentre prospective observational clinical research focused on refining the diagnostics of stroke and stroke mimics (SM) in hospital care. AIM: This study aimed to evaluate the degree of specificity and sensitivity of multimodal CT (NCCT, CTA, and CTP) in the diagnosis of SM versus stroke. METHODOLOGY: In this study, we will include 3,000 patients consecutively admitted to the comprehensive stroke centres with a diagnosis of suspected stroke. On the basis of clinical parameters and the results of multimodal CT and magnetic resonance imaging (MRI), the diagnosis of stroke and SM will be established. To clarify the significance of the use of the multimodal CT scan, the analysis will include a comparison of the blinded results for each imaging scan performed by radiologists and AI technology and a comparison of the initial and final diagnosis of the enrolled patients. Based on our results, we will compare the economic indicators and costs that would be saved by not providing inadequate treatment to patients with SM. CONCLUSION: The expected outcome is to present an optimised diagnostic procedure that results in a faster and more accurate diagnosis, thereby eliminating the risk of inadequate treatment in patients with SM. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, NCT06045455.

• Publikační typ
• časopisecké články MeSH

BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.

• MeSH
• cerebrální krvácení komplikace   MeSH
• cévní mozková příhoda * epidemiologie   terapie   diagnóza   MeSH
• COVID-19 * komplikace   MeSH
• endovaskulární výkony * škodlivé účinky   MeSH
• fibrinolytika terapeutické užití   MeSH
• intrakraniální krvácení etiologie   MeSH
• ischemická cévní mozková příhoda * epidemiologie   chirurgie   MeSH
• ischemie mozku * komplikace   epidemiologie   chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• registrace MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

• MeSH
• anamnéza MeSH
• antiflogistika nesteroidní aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• bolesti zad * diagnóza   etiologie   terapie   MeSH
• fyzikální vyšetření MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• antikoagulancia terapeutické užití   MeSH
• cévní mozková příhoda * diagnóza   epidemiologie   terapie   MeSH
• hypolipidemika terapeutické užití   MeSH
• lidé MeSH
• mechanická trombolýza metody   MeSH
• mozkový krevní oběh fyziologie   MeSH
• péče o pacienty v kritickém stavu MeSH
• rizikové faktory MeSH
• sekundární prevence MeSH
• trombektomie metody   MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé MeSH

Headache is a very common symptom that a patient presents with in the acute outpatient clinic. Repeated migraine-like headache can be misleading and lead to partial downplaying of the difficulty, but it is of course appropriate to perform an imaging examination if this has not already been done. We present here an example of a young patient who visited our outpatient clinic in similar circumstances with very surprising findings on neuroimaging, her diagnosis, treatment, and evolution over time. We demonstrate here the importance of assessing the sensitivity of individual tests and, even if the diagnostic criteria were not met, the high suspicion of a disease that is very rare in our country.

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• MeSH
• albendazol aplikace a dávkování   MeSH
• bolesti hlavy * diagnostické zobrazování   etiologie   farmakoterapie   mozkomíšní mok   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mozek diagnostické zobrazování   patologie   MeSH
• neurocysticercosis diagnostické zobrazování   farmakoterapie   mozkomíšní mok   patologie   terapie   MeSH
• neúspěšná terapie MeSH
• počítačová rentgenová tomografie MeSH
• poruchy senzitivity etiologie   MeSH
• spinální punkce MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH