Browsing by Author "Beslać-Bumbaširević, Ljiljana (6506489179)"

Background/Aim. Stroke remains one of the leading causes of death and disability worldwide. The aim of the study was to determine the nursing care-associated predictors of in-hospital mortality in the patients with acute ischemic stroke (AIS) who were hospitalized at the Department of Emergency Neurology. Methods. Prospective cohort study included 59 consecutive patients with AIS admitted to the Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade. The patients were followed until discharge or death. For exploring a relationship between the outcome of patients with AIS and different groups of factors, the univariate and multivariate Cox proportionate hazard regression models were used. Results. There were 32 male and 27 female patients with AIS. The mean age was 62.5 ± 15.2 years. The average duration of hospitalization was 11.1 ± 9.6 days (median 8 days; range 1-54 days). Almost 80% of patients (47/59; 79.7%) were admitted to the stroke unit, while 12 (20.3%) patients were admitted to the intensive care unit. In the univariate Cox regression analysis the significant variables (p < 0.05) were the Morse score (p = 0.030) and the type of admission unit (p = 0.029). The multivariate predictive model revealed that the type of admission unit (stroke unit vs conventional unit) [hazard ratio (HR) = 0.16; p = 0.032] was the independent predictor of in-hospital mortality in the patients with AIS. Conclusion. The results of this study showed an important role of nursing staff in the recovery of the AIS patients, as well as that admission to the stroke units versus the conventional units is the independent predictor of decreased in-hospital mortality. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

[No abstract available]

INTRODUCTION: Hemiballism (HB) is a relatively rare hyperkinetic disorder commonly caused by an acute stroke. Such patients usually receive symptomatic therapy with limited effect. We report the case of an acute stroke patient with HB who was successfully treated with intravenous recombinant tissue plasminogen activator (rtPA). CASE REPORT: A 67-year-old man with a history of hypertension and ischemic coronary heart disease presented in the emergency room 85 minutes after sudden onset of involuntary coarse flinging movements of the left arm and leg. Neurological investigation revealed oromandibular dyskinesia; left blepharospasm; dyskinetic movements of the head and neck; dysarthria; and forceful, jerky, irregular, flinging, large-amplitude involuntary movements involving his left arm and left leg. Initial brain computed tomography showed only mild confluent periventricular hypodensities in the vicinity of the frontal horns. The calculated National Institutes of Health Stroke Scale score was 1, for dysarthria. The sudden onset of HB, however, suggested an acute stroke and we decided to treat the patient with intravenous rtPA. Thrombolytic therapy with rtPA began 200 minutes after symptom onset, and after the patient's increased arterial blood pressure was resolved. Follow-up examination performed 12 hours after therapy revealed only mild dysarthria; mild ataxia of the left arm, and ataxic gait. Delayed brain computed tomography did not indicate recent ischemia, although a fluid attenuated inversion recovery magnetic resonance imaging sequence revealed high signal intensity lesions in the vicinity of the right putamen and left cerebellar hemisphere. After 1 month, a follow-up examination revealed only mild dysarthria and mild ataxia of the left arm. CONCLUSIONS: Acute stroke patients with low National Institutes of Health Stroke Scale score, including patients with HB, should be considered as candidates for thrombolytic treatment. Copyright © 2011 by Lippincott Williams &Wilkins.

Introduction: Poststroke infections are the most common medical complications of stroke and can occur in up to 65% of patients. The aim of this study was to assess the rate of infectious complications during hospitalization of stroke patients and to evaluate the impact of infection in general, including each of the urinary tract infection (UTI), pneumonia, and sepsis, on fatal and poor functional outcome at discharge. Methods: This retrospective study enrolled patients who have been diagnosed with acute ischemic stroke treated in a 1-year period. Poor functional outcome at discharge was defined as severe invalidity and included patients with modified Rankin Scale score of 3-5. Univariate and multivariate analyses were performed. Results: We analyzed 133 patients with acute ischemic stroke. Poststroke infection occurred in 63 (47.4%) patients. The most common infection was UTI that was present in 27 (20.3%) patients. Multivariate logistic regression analysis after adjustment for confounders demonstrated that poststroke infection was an independent predictor of poor functional outcome (odds ratio [OR] 12.82, 95% confidence interval [CI] 4.09-40.0, P <.001) and death at discharge (OR 14.92, 95% CI 2.97-76.92, P = .001). When analyzing the impact of each infectious complication, multivariate logistic regression showed that UTIs were an independent predictor of poor functional outcome (OR 14.08, 95% CI 3.06-64.84, P = .001) and death (OR 9.81, 95% CI 1.46-65.68, P = .019) at discharge. Conclusion: Infection is a frequent poststroke complication and represents an independent predictor of poor functional and fatal early stroke outcome. © 2013 by National Stroke Association.