INTRODUCTION: Various analgesics are used to control intense headaches in patients following subarachnoid hemorrhage. In addition to pain control, it has been shown that some analgesics can affect various pathophysiological cascades. Therefore, we devised a study to assess whether the use of metamizole has a significant impact on the development of ischemic complications, hydrocephalus, and the overall outcome in patients following aneurysmal subarachnoid hemorrhage in the context of the other non-opioids and opioids effects. METHODS: In our retrospective, single-center cohort study, we enrolled 192 patients diagnosed with subarachnoid hemorrhage. We recorded their initial clinical status, comorbidities, and the daily dosage of analgesics over 14 days of hospitalization after the onset of subarachnoid hemorrhage. Using univariate and subsequent multivariate logistic regression analysis, we assessed the influence of various factors, including analgesics, on the development of delayed cerebral ischemia and hydrocephalus, as well as on 2-week and 6-month outcomes. RESULTS: Although the administration of non-opioids, in general, had no effect on the development of delayed cerebral ischemia or hydrocephalus, the use of metamizole as the main analgesic was associated with a significantly lower chance of poor outcome at both 2-weeks and 6-months, as well as the development of delayed cerebral ischemia. As opioids were indicated primarily for analgosedation in mechanically ventilated patients with poor clinical status, their usage was associated with a significantly higher chance of poor outcome, delayed cerebral ischemia, and hydrocephalus. CONCLUSION: Our results suggest that the prescription of metamizole may be associated with better outcomes and a lower chance of delayed cerebral ischemia development in patients after subarachnoid hemorrhage. Considering the retrospective nature of our study and the limited worldwide availability of metamizole due to its prohibition in some countries, our results do not demonstrate a clear benefit but rather justify the need for subsequent prospective studies.
- MeSH
- analgetika terapeutické užití aplikace a dávkování MeSH
- antiflogistika nesteroidní * terapeutické užití aplikace a dávkování MeSH
- dospělí MeSH
- hydrocefalus etiologie MeSH
- ischemie mozku farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metamizol * terapeutické užití aplikace a dávkování MeSH
- retrospektivní studie MeSH
- senioři MeSH
- subarachnoidální krvácení * farmakoterapie komplikace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. METHODS: Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes. RESULTS: Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed. CONCLUSION: Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- reperfuze * metody MeSH
- senioři MeSH
- subarachnoidální krvácení terapie diagnostické zobrazování mortalita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain poorly understood, with many underdiagnosed cases. Muhimbili Orthopaedic and Neurosurgery Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim of this study is to describe the current aSAH management with regional outcomes and limitations. METHODS: Patients with aSAH confirmed by computed tomography/magnetic resonance angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiologic characteristics, injury characteristics, and the modified Rankin Scale (mRS) score. RESULTS: In total, 22 patients, with a female/male ratio of 1.4 and a median age of 54 years (interquartile range [IQR], 47.2-63 years) harboring 24 aneurysms were analyzed. Thirteen patients (59.1%) paid out of pocket. The median distance traveled by patients was 537 km (IQR, 34.7-635 km). The median time between admission and treatment was 12 days (IQR, 3.2-39 days). The most common symptoms were headache (n = 20; 90.9%) and high blood pressure (n = 10; 45.4%). Nine patients (40.9%) had Fisher grade 1 and 12 (54.5%) World Federation of Neurosurgical Societies grade I. The most common aneurysms were of the middle cerebral artery (7/29.2%). Fourteen patients (63.6%) underwent clipping; of those, only 4 (28.6%) were operated on within 72 hours. Mortality was 62.5% in the nonsurgical group. Among clipped patients, 78.6% showed favorable outcomes, with no mortality. Endovascular treatment is not available in Tanzania. CONCLUSIONS: To our best knowledge, this is the first study highlighting aSAH management in Tanzania, with its assets and shortcomings. Our data show pertinent differences among international treatment guidelines, with the resultant outcomes, such as high preoperative mortality resulting from delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.
- MeSH
- intrakraniální aneurysma * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurochirurgie * MeSH
- ortopedie * MeSH
- retrospektivní studie MeSH
- subarachnoidální krvácení * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Tanzanie MeSH
Úvod: Cílem naší studie je prezentovat výsledky léčby u pacientů s prodělaným aneuryzmatickým subarachnoidálním krvácením (SAK) po 3 měsících od ataky, kteří byli ošetřeni clippingem (NCH) nebo coilingem (EV). Materiál a metodika: Studie byla provedena na základě retrospektivní analýzy databáze pacientů s mozkovými aneuryzmaty, kteří byli léčeni mezi lety 2009 a 2019 ve FN Brno. Do studie bylo zařazeno 499 pacientů. Z těchto pacientů bylo 345 (69 %) ošetřeno NCH a 154 (31 %) bylo ošetřeno EV. Pacienty jsme rozdělili do 4 skupin: dle věku na skupiny 0–64 let a 65+ let a dále dle modality ošetření výduti NCH nebo EV. Hodnotili jsme vliv vstupního Hunt-Hessova skóre (HH) na výsledek ošetření dle věku a dané modality a také vztah mezi aktuálním věkem pacienta a výsledkem léčby po 3 měsících od ataky SAK, hodnoceným pomocí modifikované Rankinovy škály (modified Rankin scale; mRS), kde úspěšný výsledek léčby byl mRS 0–2 (soběstačný pacient). Výsledky: Z celkového počtu 499 pacientů bylo 345 (69 %) ošetřeno NCH a 154 (31 %) EV, přičemž průměrný věk NCH a EV ošetřených pacientů nebyl statisticky signifikantně rozdílný (p = 0,2216). U chirurgicky i endovaskulárně léčených pacientů ve všech věkových kategoriích jsme nezaznamenali statisticky signifikantní rozdíl ve skóre HH (p = 0,1664) ani v grafické závažnosti SAK dle Fischerova skóre (p = 0,5041). Uspokojivý výsledek léčby (mRS 0–2) po 3 měsících od ataky mělo ve skupině 65+ let po NCH 49 pacientů (52,88 %), u 65+ po EV 23 (60,61 %). Špatný výsledek léčby (mRS 3–6) po 3 měsících mělo 43 pacientů (47,12 %) ošetřených NCH a 15 (39,39 %) ošetřených EV, což je statisticky významné (p = 0,0002). Uspokojivý výsledek léčby (mRS 0–2) po 3 měsících s dobrým klinickým stavem při přijetí (HH 1–2) mělo ve skupině 0–64 let po NCH 136 pacientů (55 %) a u 65+ po NCH 28 (33 %). Špatný výsledek léčby (mRS 3–6) po 3 měsících při špatném počátečním klinickém stavu (HH 3–5) mělo 50 pacientů (20 %) ošetřených NCH ve skupině 0 -64 let a 39 (44 %) ošetřených NCH ve skupině 65+, což je statisticky významné (p = 0,0001). Závěr: Senioři (65+ let) na rozdíl od mladších pacientů po SAK trpí zvýšeným rizikem špatného neurologického stavu po 3 měsících od ataky, obzvláště jsou-li v těžkém klinickém stavu při přijetí. Nezanedbatelná část těchto pacientů však po ošetření výduti zůstává v dobrém klinickém stavu, proto je potřeba metodu ošetření a rozsah léčby posuzovat individuálně. U seniorů ošetřených endovaskulárně jsme pozorovali lepší výsledek léčby po 3 měsících ve srovnání s pacienty ošetřenými otevřenou operací.
Introduction: The aim of our study is to present the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) 3 months after the attack who were treated with clipping (MS) or coiling (EV). Materials and methods: The study was based on a retrospective analysis of a database of patients with cerebral aneurysms who were treated at the University Hospital Brno between 2009 and 2019. A total of 499 patients were included in the study. Of these patients, 345 (69%) were treated with surgical MS and 154 (31%) were treated with EV. Patients were divided into 4 groups: according to the age into 0–64 years and 65+ years group, and according to the modality of treatment of aneurysm by MS or EV. We evaluated the effect of the initial Hunt-Hess (HH) score on the treatment outcome according to age and modality and also the relationship between the current age of the patient and the treatment outcome at 3 months after the SAH attack, as assessed by a modified Rankin scale (mRS), where the successful treatment outcome was mRS 0–2 (self-sufficient patient), and the effect of the initial Hunt-Hess score (HH) on the treatment outcome was based on age and modality. Results: Of the 499 patients, 345 (69%) were treated with MS and 154 (31%) with EV, and the average age of MS and EV treated patients was not statistically significantly different (P = 0.2216). In both surgically and endovascularly treated patients in all age categories; we did not observe a statistically significant difference in HH score (P = 0.1664) or in graphical severity of SAH according to the Fischer score (P = 0.5041). Satisfactory treatment outcome (mRS 0–2) at 3 months after the attack was found in 49 (52.88%) in the 65+ years group after MS and 23 (60.61%) in the 65+ years group after EV. Poor treatment outcome (mRS 3–6) at 3 months was found in 43 (47.12%) in MS treated and 15 (39.39%) in EV treated patients, which was statistically significant (P = 0.0002). Satisfactory treatment outcome (mRS 0–2) at 3 months with good clinical status on admission (HH 1–2) was seen in 136 (55%) patients in the 0–64 years group after MS and 28 (33%) in the 65+ years group after MS. Poor treatment outcome (mRS 3–6) after 3 months with poor initial clinical condition (HH 3–5) had 50 (20%) patients treated with MS in the 0 -64 years group and 39 (44%) treated with MS in the 65+ years group, which is statistically significant (P = 0.0001). Conclusion: Elderly (65+ years) after SAH are at a higher risk of poor neurological status 3 months after the attack compared to younger patients, especially if they are in a severe clinical condition on admission. However, a significant proportion of these patients remain in a good clinical condition after treatment of an aneurysm, so the method of treatment and extent of treatment needs to be assessed individually. In elderly patients treated endovascularly, we observed a better treatment outcome at 3 months compared with patients treated by open surgery.
- MeSH
- lidé MeSH
- senioři MeSH
- statistika jako téma MeSH
- subarachnoidální krvácení * chirurgie MeSH
- výsledek terapie * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem 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
- dospělí MeSH
- hospitalizace MeSH
- lidé MeSH
- nemocnice MeSH
- odds ratio MeSH
- prospektivní studie MeSH
- subarachnoidální krvácení * diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Cerebrospinal fluid analysis is an important part of the diagnosis of many diseases and is used across many medical disciplines. The changes that take place in the central nervous system are reflected in the composition of the cerebrospinal fluid. A wide range of laboratory methods is used for cerebrospinal fluid analysis, one of which is cytological analysis. Cerebrospinal fluid cytology makes it possible to obtain valuable information about the processes taking place in the central nervous system of the examined patient in a relatively short period of time and with common means. Quantitative and qualitative cytology is a simple and technically undemanding method, but an experienced cytologist is needed.
Analýza mozkomíšního moku představuje důležitou součást diagnostiky řady chorob a je využívána napříč mnoha lékařskými obory. Změny, které probíhají v centrální nervové soustavě, se odráží ve složení mozkomíšního moku. Za účelem analýzy likvoru je využíváno široké spektrum laboratorních metod, jednou z nich je i analýza cytologická. Cytologie likvoru umožňuje v poměrně krátkém časovém úseku a s běžnými prostředky získat cenné informace o procesech odehrávajících se v centrální nervové soustavě vyšetřovaného pacienta. Kvantitativní i kvalitativní cytologie je jednoduchá a technicky nenáročná metoda, je však zapotřebí zkušeného cytologa.
- MeSH
- dějiny lékařství MeSH
- lidé MeSH
- meningitida etiologie mortalita mozkomíšní mok patologie MeSH
- mozkomíšní mok * cytologie MeSH
- nádory nervového systému diagnóza mozkomíšní mok MeSH
- nemoci nervového systému * diagnóza etiologie klasifikace mozkomíšní mok MeSH
- neurozánětlivé nemoci etiologie klasifikace mozkomíšní mok MeSH
- roztroušená skleróza diagnóza mozkomíšní mok MeSH
- subarachnoidální krvácení diagnóza mozkomíšní mok MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- cerebrovaskulární poruchy diagnostické zobrazování etiologie klasifikace patologie MeSH
- cévní mozková příhoda * diagnostické zobrazování etiologie klasifikace patologie MeSH
- duševní poruchy diagnóza etiologie patologie MeSH
- ischemická cévní mozková příhoda etiologie patologie MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- subarachnoidální krvácení etiologie patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
This multicentre prospective cohort study aimed to compare the accuracy of the PAASH, WFNS, and Hunt and Hess (H&H) scales in predicting the outcomes of adult patients with aneurysmal SAH presented to three central hospitals in Hanoi, Vietnam, from August 2019 to June 2021. Of 415 eligible patients, 32.0% had a 90-day poor outcome, defined as an mRS score of 4 (moderately severe disability) to 6 (death). The PAASH, WFNS and H&H scales all have good discriminatory abilities for predicting the 90-day poor outcome. There were significant differences in the 90-day mean mRS scores between grades I and II (p = 0.001) and grades II and III (p = 0.001) of the PAASH scale, between grades IV and V (p = 0.026) of the WFNS scale, and between grades IV and V (p < 0.001) of the H&H scale. In contrast to a WFNS grade of IV-V and an H&H grade of IV-V, a PAASH grade of III-V was an independent predictor of the 90-day poor outcome. Because of the more clearly significant difference between the outcomes of the adjacent grades and the more strong effect size for predicting poor outcomes, the PAASH scale was preferable to the WFNS and H&H scales.
- MeSH
- dospělí MeSH
- lidé MeSH
- pacienti MeSH
- prognóza MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- subarachnoidální krvácení * diagnóza MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVES: To investigate the impact of intracerebral haematoma (ICH) on the outcomes and the factors related to an ICH in patients with aneurysmal subarachnoid haemorrhage (aSAH) in a low- and middle-income country. DESIGN: A multicentre prospective cohort study. SETTING: Three central hospitals in Hanoi, Vietnam. PARTICIPANTS: This study included all patients (≥18 years) presenting with aSAH to the three central hospitals within 4 days of ictus, from August 2019 to June 2021, and excluded patients for whom the admission Glasgow Coma Scale was unable to be scored or patients who became lost at 90 days of follow-up during the study. OUTCOME MEASURES: The primary outcome was ICH after aneurysm rupture, defined as ICH detected on an admission head CT scan. The secondary outcomes were 90-day poor outcomes and 90-day death. RESULTS: Of 415 patients, 217 (52.3%) were females, and the median age was 57.0 years (IQR: 48.0-67.0). ICH was present in 20.5% (85/415) of patients with aSAH. There was a significant difference in the 90-day poor outcomes (43.5% (37/85) and 29.1% (96/330); p=0.011) and 90-day mortality (36.5% (31/85) and 20.0% (66/330); p=0.001) between patients who had ICH and patients who did not have ICH. The multivariable regression analysis showed that systolic blood pressure (SBP) ≥140 mm Hg (adjusted odds ratio (AOR): 2.674; 95% CI: 1.372 to 5.214; p=0.004), World Federation of Neurosurgical Societies (WFNS) grades II (AOR: 3.683; 95% CI: 1.250 to 10.858; p=0.018) to V (AOR: 6.912; 95% CI: 2.553 to 18.709; p<0.001) and a ruptured middle cerebral artery (MCA) aneurysm (AOR: 3.717; 95% CI: 1.848 to 7.477; p<0.001) were independently associated with ICH on admission. CONCLUSIONS: In this study, ICH was present in a substantial proportion of patients with aSAH and contributed significantly to a high rate of poor outcomes and death. Higher SBP, worse WFNS grades and ruptured MCA aneurysms were independently associated with ICH on admission.
- MeSH
- cerebrální krvácení komplikace MeSH
- cévní mozková příhoda * komplikace MeSH
- hematom diagnostické zobrazování epidemiologie etiologie MeSH
- intrakraniální aneurysma * komplikace diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- subarachnoidální krvácení * komplikace diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Vietnam MeSH
Although cerebral venous thrombosis is rare, it is a serious and often overlooked diagnosis. Due to the wide range of non-specific clinical symptoms, diagnosis is often difficult. In the last decade, patient mortality has been significantly reduced by improvements in treatment and diagnosis techniques and higher awareness of this diagnosis. In our case, we present a 70-year-old patient in whom cerebral venous thrombosis first manifested as a symptomatic epileptic seizure and was diagnosed thanks to anamnestic data, clinical symptoms and neuroimaging methods. The patient's conditions improved after anticoagulant therapy and treatment of the epileptic seizure. The goal of the article is to describe the diversity of the clinical picture of cerebral venous thrombosis and highlight the good prognosis of the patient if treatment is started early.
I když je trombóza žilních splavů vzácná, jedná se o závažnou a často opomíjenou diagnózu. Diagnóza je častokrát těžká kvůli širokému spektru nespecifických klinických příznaků. V poslední dekádě mortalita pacientů klesá v důsledku zvýšeného povědomí o této diagnóze a pokroku v zobrazovacích metodách. V našem případu prezentujeme 70letého pacienta, u kterého se trombóza mozkových žilních splavů projevila nejdříve symptomatickým epileptickým záchvatem a byla diagnostikována na základě anamnestických dat, klinických příznaků a zobrazovacích metod. Po nasazení antikoagulační terapie a zaléčení epileptického záchvatu došlo ke stabilizaci klinického stavu a regresi bolesti hlavy. Kazuistika poukazuje na různorodost klinického obrazu trombózy mozkových splavů a dobrou prognózu pacienta, když se včasně zahájí terapie.
- MeSH
- bolesti hlavy etiologie MeSH
- diferenciální diagnóza MeSH
- heparin nízkomolekulární aplikace a dávkování MeSH
- ischemická cévní mozková příhoda * diagnostické zobrazování etiologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek diagnostické zobrazování patologie MeSH
- počítačová rentgenová tomografie MeSH
- senioři MeSH
- subarachnoidální krvácení diagnostické zobrazování etiologie MeSH
- trombóza nitrolebních žilních splavů * diagnostické zobrazování farmakoterapie patologie MeSH
- výsledek terapie MeSH
- záchvaty etiologie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH