Úvod: Hodnocení kvality života u pacientů po prodělané ischemické CMP (iCMP) je nezbytné pro objektivní posouzení následků v běžném životě a umožňuje lépe identifikovat všechny aspekty postižení a omezení. V ČR však validovaný specifický nástroj pro hodnocení kvality života u pacientů po iCMP chybí. Cíl: Validace české verze nejčastěji používaného nástroje na světě – Stroke Impact Scale verze 3.0 (SIS 3.0), která umožní její standardizované použití v české populaci. Soubor a metodika: Do validační studie byli zařazeni konsekutivní pacienti s iCMP bez kognitivního deficitu ve věku 18–80 let. Vnitřní konzistence byla zjišťována pomocí Cronbachova koeficientu alfa. Na hodnocení konstrukční a kriteriální validity SIS byly použity škály SIS 3.0, WHOQOL-BREF, National Institutes of Health Stroke Scale, modifikovaná Rankinova škála, index Barthelové a škála hodnocení úzkosti a deprese při hospitalizaci (Hospital Anxiety and Beck Depression Inventory). Výsledky: Do studie bylo zařazeno celkem 150 pacientů (58,4 % mužů, průměrný věk 57,6 ± 13,7 let) průměrně 3,8 ± 0,4 měsíce po vzniku iktu, přičemž 96,7 % z nich dosáhlo dobrého klinického výsledku (mRS 0–2). Cronbachův koeficient alfa jednotlivých domén se pohyboval v rozmezí domén od 0,750 do 0,934. Signifikantní korelace byly zjištěny mezi doménami SIS 3.0, WHOQOL-BREF a ostatními testy námi použité neuropsychologické baterie. Závěr: V prezentované studii byly ověřeny psychometrické vlastnosti a potvrzena dostatečná kriteriální a konstrukční validita české verze SIS 3.0.

Introduction: Assessment of the quality of life in patients after ischemic stroke (IS) is essential to objectively assess the consequences in everyday life and to better identify all aspects of disability and limitations. However, there is no validated specific tool for quality-of-life assessment in patients after IS in the Czech Republic. Aim: To validate the Czech version of the Stroke Impact Scale (SIS) 3.0 – the most used tool worldwide in stroke survivors, which will allow its standardized use in the Czech population. Patients and methods: Consecutive patients with IS without cognitive deficit aged 18–80 years were included in the validation study. Internal consistency was examined using the Cronbach’s alpha coefficient. The following scales were used to determine the construct and criterion validity of the Czech version of SIS 3.0: WHOQOL-BREF, the National Institutes of Health Stroke Scale, modified Rankin Scale, Barthel Index, and Hospital Anxiety and Beck Depression Inventory. Results: A total of 150 patients (58.4% men, mean age 57.6 ± 13.7 years) were enrolled in the study at a mean follow-up of 3.8 ± 0.4 months after the onset of stroke, with 96.7% achieving good functional independence (mRS 0–2). Cronbach’s alpha coefficient of particular domains ranged from 0.750 to 0.934. Significant correlations were found between SIS 3.0 domains, WHOQOL-BREF and other used tools of the neuropsychological battery. Conclusion: In the presented study, the psychometric properties were verified and adequate criteria and construct validity of the Czech version of SIS 3.0 were confirmed.

• MeSH
• Ischemic Stroke * MeSH
• Clinical Studies as Topic MeSH
• Quality of Life * MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Psychiatric Status Rating Scales MeSH
• Reproducibility of Results MeSH
• Test Anxiety Scale MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Wheat consumption is increasing worldwide and also increasing is the frequency of celiac disease (CeD), a pathological response to wheat protein (gluten) in genetically susceptible individuals. Non-celiac gluten sensitivity (NCGS) is another, less studied wheat-induced pathology. The treatment for both is a gluten-free diet (GFD). More individuals choose the diet than predicted by the epidemiological 1-2% prevalence. A preliminary survey by questionnaire asked members and attendees of the local gluten information group (GIG) meetings and functions about their diagnostic experiences and symptom levels in order understand the increased demand for gluten-free foods. Same-aged and -sex friends participated as a comparative “control”. Mixed methods were used including content analyses of prose narratives and independent and paired t tests of symptom levels measured with Likert scales. This convenience sample, surveyed in 2011-2012, is mostly female (54 F, 5 M) with an average age of 54.6 ± 2.0 years. Most participants consulted medical professionals with mean time to diagnosis of 7 years determined mostly from “classic” presenting symptoms. Negative biopsies or blood tests and atypical symptoms that overlap other conditions delayed diagnosis. There were 43 and 16 participants with CeD and NCGS, respectively differing little in symptom levels. Self-diagnosis and use of naturopaths account for some of the “excess” individuals. General practitioners should be encouraged to get additional nutrition training and to discuss with patients dietary choices that support wellness and minimize the risk for pathological immune responses. Patients with CeD particularly need support and follow-up in the transition to a GFD.

• Keywords
• neceliakální glutenová senzitivita, atypické symptomy,
• MeSH
• Wheat Hypersensitivity MeSH
• Thyroiditis, Autoimmune MeSH
• Diet, Gluten-Free MeSH
• Celiac Disease diagnosis   diet therapy   prevention & control   MeSH
• Chronic Disease MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Immune System physiopathology   MeSH
• Menu Planning methods   standards   MeSH
• Middle Aged MeSH
• Humans MeSH
• Delayed Diagnosis MeSH
• Pilot Projects MeSH
• Signs and Symptoms MeSH
• Surveys and Questionnaires classification   utilization   MeSH
• Fatigue MeSH
• Treatment Outcome MeSH
• Patient Education as Topic MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH

BACKGROUND: Data are limited on optimal threshold for baseline National Institutes of Health Stroke Scale in predicting outcome after stroke thrombolysis (intravenous thrombolysis). AIMS: Finding thresholds for baseline National Institutes of Health Stroke Scale scores that predict functional outcome and baseline vessel occlusion. METHODS: We analyzed 44 331 patients with available modified Rankin Scale score at three-months and 11 632 patients with computed tomography/magnetic resonance angiography documented vessel occlusion at baseline in the SITS-International Stroke Thrombolysis Register. Main outcomes were functional independency (modified Rankin Scale 0-2) at three-months and baseline vessel occlusion. We obtained area under the curves by receiver operating characteristic analysis and calculated multivariately adjusted odds ratio for the outcomes of interest based on baseline National Institutes of Health Stroke Scale scores. RESULTS: For functional independency, National Institutes of Health Stroke Scale scores of 12 (area under the curve 0·775) and for baseline vessel occlusion, scores of 11 (area under the curve 0·678) were optimal threshold values. For functional independency, adjusted odds ratio decreased to 0·07 (95% CI 0·05-0·11), and for presence of baseline occlusion, aOR increased to 3·28 (95% CI 3·04-3·58) for National Institutes of Health Stroke Scale scores 12 and 11, respectively, compared with National Institutes of Health Stroke Scale score 0. National Institutes of Health Stroke Scale thresholds decreased with time from stroke onset to imaging, with 2-3 points, respectively, if time to imaging exceeded three-hours. CONCLUSIONS: Ideally, all acute stroke patients should have immediate access to multimodal imaging. In reality these services are limited. Baseline National Institutes of Health Stroke Scale scores of 11 and 12 were identified as markers of baseline vessel occlusion and functional independency after intravenous thrombolysis, respectively. These values are time dependent; therefore, a threshold of National Institutes of Health Stroke Scale 9 or 10 points may be considered in the prehospital selection of patients for immediate transfer to centers with multimodal imaging and availability of highly specialized treatments.

• MeSH
• Stroke diagnosis   drug therapy   pathology   MeSH
• Fibrinolytic Agents administration & dosage   MeSH
• Administration, Intravenous MeSH
• Brain Ischemia diagnosis   drug therapy   pathology   MeSH
• Humans MeSH
• Magnetic Resonance Angiography MeSH
• Brain drug effects   pathology   MeSH
• Cerebral Angiography MeSH
• Multimodal Imaging MeSH
• National Institutes of Health (U.S.) MeSH
• Tomography, X-Ray Computed MeSH
• Prospective Studies MeSH
• Registries MeSH
• Aged MeSH
• Severity of Illness Index * MeSH
• Tissue Plasminogen Activator administration & dosage   MeSH
• Thrombolytic Therapy * methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• United States MeSH

BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) underestimates clinical severity in posterior circulation stroke and patients presenting with low NIHSS may be considered ineligible for reperfusion therapies. This study aimed to develop a modified version of the NIHSS, the Posterior NIHSS (POST-NIHSS), to improve NIHSS prognostic accuracy for posterior circulation stroke patients with mild-moderate symptoms. METHODS: Clinical data of consecutive posterior circulation stroke patients with mild-moderate symptoms (NIHSS <10), who were conservatively managed, were retrospectively analyzed from the Basilar Artery Treatment and Management registry. Clinical features were assessed within 24 hours of symptom onset; dysphagia was assessed by a speech therapist within 48 hours of symptom onset. Random forest classification algorithm and constrained optimization were used to develop the POST-NIHSS in the derivation cohort. The POST-NIHSS was then validated in a prospective cohort. Poor outcome was defined as modified Rankin Scale score ≥3 at 3 months. RESULTS: We included 202 patients (mean [SD] age 63 [14] years, median NIHSS 3 [interquartile range, 1-5]) in the derivation cohort and 65 patients (mean [SD] age 63 [16] years, median NIHSS 2 [interquartile range, 1-4]) in the validation cohort. In the derivation cohort, age, NIHSS, abnormal cough, dysphagia and gait/truncal ataxia were ranked as the most important predictors of functional outcome. POST-NIHSS was calculated by adding 5 points for abnormal cough, 4 points for dysphagia, and 3 points for gait/truncal ataxia to the baseline NIHSS. In receiver operating characteristic analysis adjusted for age, POST-NIHSS area under receiver operating characteristic curve was 0.80 (95% CI, 0.73-0.87) versus NIHSS area under receiver operating characteristic curve, 0.73 (95% CI, 0.64-0.83), P=0.03. In the validation cohort, POST-NIHSS area under receiver operating characteristic curve was 0.82 (95% CI, 0.69-0.94) versus NIHSS area under receiver operating characteristic curve 0.73 (95% CI, 0.58-0.87), P=0.04. CONCLUSIONS: POST-NIHSS showed higher prognostic accuracy than NIHSS and may be useful to identify posterior circulation stroke patients with NIHSS <10 at higher risk of poor outcome.

• MeSH
• Ataxia MeSH
• Stroke * diagnosis   therapy   MeSH
• Cough MeSH
• Middle Aged MeSH
• Humans MeSH
• National Institutes of Health (U.S.) MeSH
• Deglutition Disorders * diagnosis   etiology   MeSH
• Prognosis MeSH
• Prospective Studies MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• United States MeSH

BACKGROUND AND OBJECTIVES: Function is an important outcome after stroke; traditional assessments may not capture functional deficits important to patients. We examined the validity of the Standard Assessment of Global Everyday Activities (SAGEA), a patient-reported outcome that assesses activities important to patients and for use in international clinical trials. METHODS: The NAVIGATE-ESUS trial evaluated rivaroxaban compared to aspirin in preventing recurrent stroke in 7213 participants. The Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the SAGEA were collected at entry. Chi square tests were used to compare proportions and Spearman rank correlations were used to compare between measures. SAGEA was compared to the Modified Frailty Index (MFI) and the occurrence of infarct to examine criterion validity RESULTS: Participants were 67 years, 2/3 were male, and at baseline 30% had no disability and 58% had slight disability according to mRS scores. SAGEA was weakly correlated with the mRS (r=0.37), the NIHSS (r=0.29) and the MFI (r=0.30). Of the 2154 with an mRS score of 0, 61% reported difficulty on the SAGEA. The largest discrepancies between SAGEA and other measures were because of cognitive functional deficits detected by the SAGEA that were not identified on other assessments. A larger number of MRI identified infarcts (acute and covert) were associated with a higher SAGEA score (p=0.007). CONCLUSIONS: The SAGEA is a simple, globally applicable measure of cognitive and functional abilities that identifies issues that other commonly used assessments of disability and function do not capture.

• MeSH
• Aspirin therapeutic use   MeSH
• Stroke * drug therapy   therapy   MeSH
• Activities of Daily Living MeSH
• Humans MeSH
• Rivaroxaban therapeutic use   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH

BACKGROUND: Evaluating the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) who may be at risk of poor outcomes using grading systems is one way to make a better decision on treatment for these patients. This study aimed to compare the accuracy of the modified World Federation of Neurosurgical Societies (WFNS), WFNS, and Hunt and Hess (H&H) Grading Scales in predicting the outcomes of patients with aSAH. METHODS: From August 2019 to June 2021, we conducted a multicenter prospective cohort study on adult patients with aSAH in three central hospitals in Hanoi, Vietnam. The primary outcome was the 90-day poor outcome, measured by a score of 4 (moderately severe disability) to 6 (death) on the modified Rankin Scale (mRS). We calculated the areas under the receiver operator characteristic (ROC) curve (AUROCs) to determine how well the grading scales could predict patient prognosis upon admission. We also used ROC curve analysis to find the best cut-off value for each scale. We compared AUROCs using Z-statistics and compared 90-day mean mRS scores among intergrades using the pairwise multiple-comparison test. Finally, we used logistic regression to identify factors associated with the 90-day poor outcome. RESULTS: Of 415 patients, 32% had a 90-day poor outcome. The modified WFNS (AUROC: 0.839 [95% confidence interval, CI: 0.795-0.883]; cut-off value≥2.50; PAUROC<0.001), WFNS (AUROC: 0.837 [95% CI: 0.793-0.881]; cut-off value≥3.5; PAUROC<0.001), and H&H scales (AUROC: 0.836 [95% CI: 0.791-0.881]; cut-off value≥3.5; PAUROC<0.001) were all good at predicting patient prognosis on day 90th after ictus. However, there were no significant differences between the AUROCs of these scales. Only grades IV and V of the modified WFNS (3.75 [standard deviation, SD: 2.46] vs 5.24 [SD: 1.68], p = 0.026, respectively), WFNS (3.75 [SD: 2.46] vs 5.24 [SD: 1.68], p = 0.026, respectively), and H&H scales (2.96 [SD: 2.60] vs 4.97 [SD: 1.87], p<0.001, respectively) showed a significant difference in the 90-day mean mRS scores. In multivariable models, with the same set of confounding variables, the modified WFNS grade of III to V (adjusted odds ratio, AOR: 9.090; 95% CI: 3.494-23.648; P<0.001) was more strongly associated with the increased risk of the 90-day poor outcome compared to the WFNS grade of IV to V (AOR: 6.383; 95% CI: 2.661-15.310; P<0.001) or the H&H grade of IV to V (AOR: 6.146; 95% CI: 2.584-14.620; P<0.001). CONCLUSIONS: In this study, the modified WFNS, WFNS, and H&H scales all had good discriminatory abilities for the prognosis of patients with aSAH. Because of the better effect size in predicting poor outcomes, the modified WFNS scale seems preferable to the WFNS and H&H scales.

• MeSH
• Adult MeSH
• Hospitalization MeSH
• Humans MeSH
• Hospitals MeSH
• Odds Ratio MeSH
• Prospective Studies MeSH
• Subarachnoid Hemorrhage * diagnosis   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

OBJECTIVES: A geometric annuloplasty ring could improve efficacy and stability of aortic valve repair. Toward this goal, a 1-piece 3-dimensional titanium annuloplasty ring with Dacron covering was developed and tested successfully in animals. The purpose of this study was to define hemodynamic outcomes with this device used as the annuloplasty component of human aortic valve repair. METHODS: In a 4-center pilot trial with informed consent, 16 patients underwent aortic valve repair for aortic insufficiency, with the annuloplasty device sutured into the annulus beneath the leaflets. Preoperative annular diameter averaged 26.5 ± 2.0 (mean ± standard deviation) mm, and average ring size was 22.3 ± 1.2 mm. After annuloplasty, leaflet defects were easy to identify, and 14 of 16 patients (88%) required leaflet plication and/or autologous pericardial reconstruction for leaflet defects. Three patients had ascending aortic replacement, and 2 had remodeling root replacement. One had ultrasonic leaflet decalcification and another tricuspid valve annuloplasty. Follow-up data were from site-specific studies at the 6-month postoperative time point. RESULTS: There were no in-hospital mortalities or major complications. Preoperative aortic insufficiency grade (0-4 scale) was 3.6 ± 1.0 and fell to 1.0 ± 0.8 at 6 months (P < .0001). New York Heart Association class fell from 2.5 ± 0.5 to 1.1 ± 0.3 (P < .0001). Postrepair valve area was 2.7 ± 0.2 cm(2), and 6-month mean systolic gradient was 11.3 ± 3.3 mm Hg. Left ventricular end-diastolic diameter and ejection fraction both normalized (both P < .0001). CONCLUSIONS: Geometric ring annuloplasty facilitated aortic valve repair, allowing more precise reconstruction of leaflet defects. Aortic insufficiency reduction and systolic gradients were excellent, and expansion of valve reconstruction into broader categories of aortic valve disease seems indicated.

• MeSH
• Cardiac Valve Annuloplasty instrumentation   MeSH
• Aortic Valve physiopathology   surgery   ultrasonography   MeSH
• Aortic Valve Insufficiency diagnosis   physiopathology   surgery   MeSH
• Echocardiography, Doppler, Color MeSH
• Time Factors MeSH
• Heart Valve Prosthesis Implantation instrumentation   MeSH
• Echocardiography, Transesophageal MeSH
• Hemodynamics * MeSH
• Middle Aged MeSH
• Humans MeSH
• Recovery of Function MeSH
• Pilot Projects MeSH
• Polyethylene Terephthalates MeSH
• Prosthesis Design MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis * MeSH
• Severity of Illness Index MeSH
• Titanium MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Článek seznamuje s problematikou posuzování invalidity u osob po CMP. V ČR dochází k postupnému poklesu počtu posouzení invalidity po CMP, přestože incidence CMP neklesá – počty nemocných léčených ročně v iktových centrech jsou obdobné. Tuto skutečnost lze považovat za nepřímý důkaz zvyšující se kvality zdravotnické péče o nemocné s CMP a úspěchu organizace akutní iktové péče v ČR. Po analýze 14 let starých posudkových kritérií invalidity pro nervová onemocnění autoři doporučují využití hodnoticích škál používaných u pacientů s CMP, např. modifikované Rankinovy škály (modified Rankin scale; mRS) a indexu Barthelové (Barthel index; BI) za účelem zpřesnění a objektivizace posuzování invalidity po CMP.

The article introduces the issue of the post-stroke disability assessment. In the Czech Republic, there is a gradual decrease in the number of disability assessments of stroke patients, despite non-decreasing incidence of stroke. Specifically, the number of stroke patients treated in stroke centers per year remains consistent. This fact can be considered as the indirect evidence of good organization and improvement of complex medical care for stroke patients in the Czech Republic. Based on the fourteen-years old analysis of disability assessment criteria for nervous system dysfunctions, authors recommend using scoring scales such as the modified Rankin scale (mRS) and Barthel index (BI) for this purpose to ensure more accurate objectification in the post-stroke invalidity assessment.

• Keywords
• lékařská posudková služba, invalidita po iktu, invalidní důchody, iktová centra,
• MeSH
• Tertiary Care Centers MeSH
• Stroke * MeSH
• Quality of Health Care MeSH
• Humans MeSH
• Patient Acuity MeSH
• Peer Review MeSH
• Disability Evaluation * MeSH
• Social Security MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Posttraumatický hydrocefalus představuje aktivní a progresivní proces nadměrné akumulace mozkomíšního moku způsobený narušenou likvorodynamikou po kraniocerebrálním poranění. Incidence posttraumatického hydrocefalu je v literatuře udávána ve velmi širokém rozmezí 0,7-86 %, což je důsledkem rozdílů v diagnostických kritériích a klasifikaci. 32letý pacient byl přijat po pádu na inline bruslích na oblast zátylku. Vstupně byl jeho stav zhodnocen jako Glasgow Coma Scale 4 s pravostrannou mydriázou. Dle výpočetní tomografie mozku byl zjištěn akutní subdurální hematom frontotemporoparietálně vpravo s přetlakem středočárových struktur doleva a difuzní edém mozku. Byla provedena evakuace hematomu z dekompresivní kraniektomie. S měsíčním odstupem došlo u pacienta k rozvoji těžké levostranné hemiparézy, somnolence a zpomalení psychomotorického tempa. Na výpočetní tomografii mozku byl nalezen čtyřkomorový komunikující posttraumatický hydrocefalus. Pacientovi byl zaveden ventrikuloperitoneální shunt a byla provedena kranioplastika defektu kalvy po dekompresivní kraniektomii pro propadávající se kožní lalok. I přes primárně neuspokojivě se vyvíjející klinický stav s nutností několikrát upravit otevírací tlak ventilu ventrikuloperitoneálního shuntu a jedenkrát provést výměnu celého zkratového systému je pacient pět let po kraniotraumatu ve velmi dobrém stavu - lucidní, orientovaný všemi směry, komunikující, bez zásadní poruchy hybnosti, modified Rankin Scale 2.

Posttraumatic hydrocephalus is an active and progressive process of excessive accumulation of cerebrospinal fluid due to impaired dynamics of cerebrospinal fluid caused by traumatic brain injury. The incidence of posttraumatic hydrocephalus is given in the literature in a very wide range of 0.7-86 %, which is the result of differences in the diagnostic criteria and classification. A 32-year-old patient was admitted after a fall on inline skates at the nape area. His entering condition was assessed as Glasgow Coma Scale 4 with right-sided mydriasis. Brain computed tomography revealed acute subdural hematoma frontotemporoparietally above right hemisphere with midline structures being shifted to the left side and diffuse cerebral edema. The hematoma was evacuated from decompressive craniectomy. One month later the patient developed severe left-sided hemiparesis, somnolence and slowing down of psychomotor speed. Brain computed tomography revealed four-ventricles communicating posttraumatic hydrocephalus. The patient was introduced ventriculoperitoneal shunt and he was treated with cranioplasty of the skull defect after decompressive craniectomy because of sinking skin flap. Despite primarily disappointingly evolving clinical condition with the need to repeatedly adjust the opening pressure in the valve of ventriculoperitoneal shunt and once to replace the entire shunt system, five years after craniotrauma the patient was in very good condition - lucid, oriented across all aspects, communicating and without movement disorders, modified Rankin Scale 2.

• MeSH
• Surgical Flaps MeSH
• Decompressive Craniectomy MeSH
• Adult MeSH
• Hydrocephalus * surgery   MeSH
• Humans MeSH
• Men MeSH
• Paraparesis surgery   MeSH
• Tomography, X-Ray Computed MeSH
• Hematoma, Subdural surgery   MeSH
• Accidental Falls MeSH
• Ventriculoperitoneal Shunt MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Case Reports MeSH

Popisujeme případ úspěšné rekanalizace a příznivý klinický výsledek u pacienta s akutním uzávěrem bazilární tepny (basilar artery occlusion, BAO) a intervenční léčby (interventional treatment, IT). Sedmašedesátiletý muž byl přijat v komatózním stavu, s kvadruplegií a decerebrační rigiditou. Při příjmu byly zjištěny hodnoty skóre 11 na stupnici GLCS (Glasgow-Liege Coma Scale), 24 na stupnici National Institutes of Health Stroke Scale (NIHSS) a 5 na modifi kované Rankinově škále (modifi ed Rankin Scale, mRS). Před IT byl pořízen nekontrastní CT sken. Pro podezření na BAO bylo okamžitě provedeno angiografi cké vyšetření mozku, které prokázalo BAO mediálního a distálního segmentu. Léčba se prováděla intraarteriální katetrizací včetně balonkové angioplastiky a trombolýzy s aplikací 20 mg přípravku Actilyse (do 4 hodin od nástupu symptomů). Následné angiografi cké vyšetření potvrdilo optimální výsledek výkonu, po němž bylo na JIP pacientovi infuzně podáno během dalších tří hodin 10 mg přípravku Actilyse. Vzhledem ke zlepšení neurologického stavu byla o 12 hodin později provedena extubace. První den došlo k obnově vědomí a dokázal mluvit; další neurologický defi cit nebyl zjištěn. Kontrolní CT neprokázalo nové známky ischemické cévní mozkové příhody. CT angiografi e prokázala úplnou rekanalizaci distálního segmentu bazilární tepny a středně významnou reziduální stenózu v mediálním segmentu. Sedmý den po výkonu byl pacient propuštěn z nemocnice s hodnotami skóre NIHSS 7, GLCS 20 a mRS 3. Podle našeho názoru byla v našem případě léčba úspěšná díky rychle stanovené klinické diagnóze, rychlé dostupnosti katetrizačního sálu a časně provedené mechanicko-farmakologické rekanalizaci.

We describe a case of successful recanalisation and favorite clinical outcome of a patient with acute basilar artery occlusion (BAO) and interventional treatment (IT). A 67-year old patient presented in a comatose state, with quadriplegia, and decerebrate posturing. His initial Glasgow-Liege Coma Scale (GLCS) score was 11, Institutes of Health Stroke Scale (NIHSS) 24, and modifi ed Rankin Scale (mRS) 5. Non-contrast CT was performed before IT. Due to suspicion of BAO, an immediate cerebral angiography was performed. It demonstrated BAO in the middle and distal segment. Intra-arterial catheter based treatment was performed including balloon angioplasty and thrombolysis with 20 mg Actilyse (within four hours of symptoms onset). An optimal angiographic result was achieved. After the procedure the patient was treated in ICU with another 10 mg Actilyse infused over the next 3 hours. Because of neurological condition improving, the patient was extubated 12 hours later. On the fi rst day, he regained consciousness, being able to speak, without new neurologic defi cit. Control CT did not demonstrate new signs of ischemic stroke. CT angiography showed complete basilar artery recanalization in the distal part and a moderate residual stenosis in the middle segment. On the 7th day the patient was discharged with NIHSS 7, GLCS 20, mRS 3. We believe that the success in our case was a result of the prompt clinical diagnosis, fast access to the cathlab and early mechanical-pharmacological recanalization.

• MeSH
• Basilar Artery surgery   pathology   radiography   MeSH
• Time-to-Treatment MeSH
• Middle Aged MeSH
• Humans MeSH
• Mechanical Thrombolysis methods   MeSH
• Cerebral Angiography methods   MeSH
• Thrombolytic Therapy methods   MeSH
• Vertebrobasilar Insufficiency * etiology   drug therapy   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH