exudates and Cerebral-Hemorrhage

Intravenous (IV) thrombolysis with alteplase (rt-PA) is effective in ischaemic stroke. The primary objective was to evaluate predictors of functional outcome in acute ischaemic stroke (AIS) patients treated with IV rt-PA. The secondary objective was to assess the outcome with the modified Rankin scale (mRS). We also examined the predictive value of the Totaled Health Risks in Vascular Events (THRIVE) score.. AIS patients treated with IV rt-PA from February 2012 to August 2016 were recruited. Demographic data, National Institutes of Health Stroke Scale (NIHSS) scores, timing and neuroradiological findings were recorded. Patients received a dose of 0.9 mg/kg IV rt-PA within 4.5 hours of symptom onset. mRS score was evaluated at discharge and three months, and good and poor clinical outcomes were defined as scores of 0-2 and 3-6, respectively. Baseline THRIVE scores were assessed.. 36 patients received IV rt-PA. 20 (55.6%) patients had an mRS score of 0-2 at three months. Based on THRIVE score, 86.1% had a good or moderately good prognosis. On univariate analysis, poor outcome was associated with NIHSS score before rt-PA (p = 0.03), THRIVE score (p = 0.02), stroke subtype (p = 0.049) and diabetes mellitus (DM; p = 0.06). Multiple logistic regression showed that outcome was significantly associated with NIHSS score before rt-PA (p = 0.032) and DM (p = 0.010).. Our newly developed Malaysian IV rt-PA service is safe, with similar outcomes to the published literature. Functional outcome after thrombolysis was associated with baseline NIHSS score and DM.

Topics: Aged; Brain Ischemia; Cerebral Hemorrhage; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Intracranial Thrombosis; Malaysia; Male; Middle Aged; Neurologic Examination; Outcome and Process Assessment, Health Care; Stroke; Tertiary Care Centers; Thrombolytic Therapy; Tissue Plasminogen Activator

Primary intracerebral haemorrhage (ICH) results in significant morbidity and mortality among patients. There is a paucity of epidemiological data on this condition in Malaysia. The purpose of this hospital based study was to define the clinical profile in patients with primary spontaneous intracerebral haemorrhage at University of Malaya Medical Centre (UMMC) and to determine the mortality rate of intracerebral haemorrhage at the time of discharge, the prognostic factors and one year outcome of this cohort of patients. Sixty-six patients were admitted at the Neurosurgical unit of University of Malaya Medical Centre for a period of 13 months from March 2002 to March 2003. Fifty percent of the subjects were female. The mean age was 61.6 +/- 16.7 years. Among our patients with intracerebral haemorrhage, the common risk factors were: hypertension (80.3%), diabetes mellitus (25.7%) and smoking (27.2%). Common presenting features for our series were: weakness (61.8%), LOC (58.5%), headache (56.3%) and speech disturbances (45.3%). On neuroimaging, the lesions were seen in basal ganglia/thalamus (45.1%), lobar (32.9%), brainstem (13.4%) and cerebelli (8.5%). The overall 30 days mortality rate for intracerebral haemorrhage (ICH) was 43.9%. The important predictors of for mortality were the GCS score on admission (p < 0.0001), haematoma volume > 30 mls (p < 0.0001), evidence of intraventricular extension (p = 0.011) and ICH score (p < 0.0001). At one year follow up, 48.5% (n = 32) were dead, 33.3% (n = 11) obtained good recovery, 36.4% (n = 12) moderate disability, 18.2% (n = 6) severe disability and 3% remain vegetative state. The overall mortality rate for our series of patients with primary intracerebral haemorrhage is quite similar to previously published epidemiological studies. ICH scoring is useful in the prognostication.

Topics: Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage; Epidemiologic Studies; Female; Glasgow Coma Scale; Health Status; Health Status Indicators; Health Surveys; Humans; Malaysia; Male; Middle Aged; Prognosis; Prospective Studies; Registries; Risk Factors; Surveys and Questionnaires; Treatment Outcome

To determine the survival rates and risk factors associated with mortality in premature very low birth weight or VLBW (< or = 1500 grams) infants.. This is a part-retrospective and part-prospective study of VLBW infants admitted into the Special Care Nursery, University Hospital Kuala Lumpur, between August 1994 and July 1996.. Of the 184 infants without lethal congenital malformations, 144 (78%) infants survived till discharge. The causes of death included respiratory diseases (63%), infections (30%), gastrointestinal abnormalities (5%) and intracerebral haemorrhage (2%). On multivariate logistic regression analysis, birth weight of 1 kg or less [odds ratio (OR) 3.88, 95% Confidence Interval (CI) 2.22, 6.67, p < 0.001], gestational age of 28 weeks or less [OR 1.78, 95% CI 1.03, 3.03, p = 0.038], ventilatory support [OR 2.68, 95% CI 1.46, 4.92, p = 0.002] and male gender [OR 1.83, 95% CI 1.10, 3.06, p = 0.021] were significant predictive factors for increased mortality. In a subgroup of 87 infants who were ventilated for severe respiratory distress syndrome, their survival was predicted by birth weight above 1 kg, gestational age greater than 28 weeks, appropriate for gestational age and surfactant replacement therapy.. Mortality remains high for the very low birth weight and very premature infants. Prolonging the duration of pregnancy and administrating exogenous surfactant to ventilated infants with RDS are two important measures to improve survival amongst VLBW infants.

Topics: Birth Weight; Cause of Death; Cerebral Hemorrhage; Confidence Intervals; Female; Forecasting; Gastroschisis; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Logistic Models; Malaysia; Male; Odds Ratio; Patient Discharge; Pregnancy; Prospective Studies; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Sex Factors; Survival Rate

Intracranial haemorrhage is a major cause of severe morbidity and mortality in child abuse cases in developed countries. However, similar data are not available in most developing countries. This study therefore aimed to determine the incidence of intracranial haemorrhage amongst all cases of child physical abuse, the nature of the injuries incurred, and the morbidity and mortality resulting therefrom. Among 369 cases of physical abuse seen over a 4-year period, 41 (11.4%) had intracranial haemorrhage, of whom 37 (90%) were 2 years old or less. A history of trauma was present in only eight (20%), of which only two were compatible with the injuries incurred. Subdural haemorrhages accounted for 80% of the cases, with skull fractures present in only nine cases. Fifty-four per cent of the 37 children aged 2 years of age or less had no external signs of trauma, but 11 of them had retinal haemorrhages. This is in contrast to the children older than 2 years of age who all had external signs of trauma. The overall prognosis was dismal with an early mortality of almost 30% (13 cases) and at least seven cases with severe neurological sequelae. These findings are comparable with studies from developed countries which have established that non-accidental injury must be considered as a cause of intracranial haemorrhage in any young child, despite the absence of external signs of trauma.

Topics: Cerebral Hemorrhage; Child Abuse; Child, Preschool; Developing Countries; Female; Humans; Incidence; Infant; Infant, Newborn; Malaysia; Male; Population Surveillance; Retrospective Studies

Topics: Brain Injuries; Cerebral Hemorrhage; Craniocerebral Trauma; Craniotomy; General Surgery; Humans; Malaysia; Neurosurgery; Referral and Consultation; Telemedicine; Treatment Outcome

Sixty-nine severely head-injured patients treated by general surgeons over a 28 month period with admission Glasgow Coma Scale motor scores of 3 to 8 were reviewed retrospectively. Fifty-one patients were comatose on admission with periods from injury to admission exceeding 4 h in 34 patients who were referred from peripheral hospitals. Forty patients with acute intracranial bleeding underwent emergency decompressive surgery with 13 good recoveries and 18 deaths; good recoveries were observed in 11 of 20 patients with extradural haemorrhages, one out of eight patients with subdural haemorrhages, and one of 12 patients with intracerebral and/or combined haemorrhages. Twenty-nine patients with no evidence of acute mass lesions were treated medically with sedation, mechanical ventilation and mannitol infusion for cerebral decompression with seven good recoveries and 16 deaths. There were 15 good outcomes in 40 patients with admission motor scores of 6, 7 or 8 and five good outcomes in 29 patients with scores of 3, 4 or 5. A good outcome of 29% in the study may be improved by (i) better neurosurgical training of surgical and nursing staff; (ii) provision of technologically advanced diagnostic and treatment modalities; (iii) an efficient referral system; and (iv) provision of effective long-term rehabilitation.

Topics: Activities of Daily Living; Adolescent; Adult; Brain Edema; Brain Injuries; Cerebral Hemorrhage; Coma; Craniocerebral Trauma; Female; Glasgow Coma Scale; Humans; Malaysia; Male; Neurologic Examination; Retrospective Studies; Surgery Department, Hospital; Survival Rate; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

The outcome of 109 patients with severe head injury was studied in relation to clinical and computed tomographic (CT) criteria on admission, after resuscitation. Age, Glasgow Coma Score (GCS) and state of pupils strongly correlated with outcome. The presence of hypothalamic disturbances, hypoxia and hypotension were associated with an adverse outcome. The CT indicators associated with poor outcome were perimesencephalic cistern (PMC) obliteration, subarachnoid haemorrhage, diffuse axonal injury and acute subdural haematoma. The prognostic value of midline shift and mass effect were influenced by concomitant presence of diffuse brain injury. For the subset of patients aged < 20 years, with GCS 6-8 and patent PMC (n = 21), 71.4% correct predictions were made for a good outcome. For the subset of patients aged > 20 years, with GCS 3-5 and partial or complete obliteration of PMC (n = 28), 89.3% correct predictions were made for a poor outcome.

Topics: Adolescent; Adult; Age Factors; Aged; Brain Edema; Cerebral Hemorrhage; Child; Child, Preschool; Craniocerebral Trauma; Glasgow Coma Scale; Humans; Infant; Malaysia; Middle Aged; Predictive Value of Tests; Prognosis; Subarachnoid Hemorrhage; Tomography, X-Ray Computed