Дисертації: "Diagnosis of strokes «Strokeml»"

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Іваненко, В. Ю. "Software system for early diagnosis of strokes «Strokeml»." Thesis, ХНУРЕ, 2021. https://openarchive.nure.ua/handle/document/16155.

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Scientific supervisor of work – Iryna Leshchynska Candidate of Technical Sciences, Associate Professor of the Department of Software Engineering
The aim of the work is to develop a software system that allows the user to be tested, analyzes its results and provides the user with information about his susceptibility to stroke disease. The software system also aims to preserve the results of tests and provide recommendations for nutrition and healthy living.

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2

Walsh, Kyle B. "Plasma Biomarkers for Ischemic and Hemorrhagic Stroke Diagnosis." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1511859455574062.

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3

Brazzelli, Miriam. "Studies to inform the methods for Cochrane systematic reviews of diagnostic accuracy in stroke medicine." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5566.

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Background A variety of tests are used in clinical practice to help the diagnostic process and so improve patient care. Many aspects of stroke management depend on accurate and rapid diagnosis. Brain imaging, including CT or MRI, is necessary to identify the location and extent of the cerebral lesion, and to determine the pathological type of stroke and its likely cause. Current treatments - such as thrombolysis - for ischaemic stroke have increased the need for clear evidence on which imaging test is optimal for diagnosis in the acute phase of stroke. Systematic reviews of diagnostic test accuracy may provide evidence on the best use of a diagnostic test in clinical practice and help clinicians to decide among alternative tests. The Cochrane Collaboration has recently included systematic reviews of diagnostic test accuracy within its remit. However, to prepare Cochrane systematic reviews of diagnostic test accuracy is challenging because the methods for such reviews are still in a state of flux. Materials and methods The research work undertaken for this thesis addresses four relevant methodological aspects of such reviews and, I hope, will contribute to informing the development of the methods for Cochrane systematic reviews of test accuracy: i) I assessed the quality of reporting of imaging studies in stroke medicine published between 1995 and 2008 with the current STAndards for the Reporting of Diagnostic accuracy studies (STARD) criteria; ii) I assessed the magnitude of publication bias in diagnostic accuracy studies in stroke medicine, by reviewing all diagnostic abstracts presented at two international stroke meetings between 1995 and 2004 and so evaluating the characteristics and findings of the identified abstracts; iii) I have evaluated the methods for preparing reviews of test accuracy by undertaking a pilot review according to the draft recommendations of the Cochrane Diagnostic Test Accuracy Working Group; iv) I conducted a survey to assess a) how well clinicians and health professionals interpret findings of Cochrane systematic reviews of diagnostic accuracy presented in summary documents; and b) what is the best format for summarising findings of Cochrane reviews of diagnostic accuracy. Conclusions In conclusion, methodological issues concerning the validity and reliability of findings of studies included in systematic reviews of diagnostic accuracy remain of fundamental importance. More empirical evidence is needed to address potential biases such as reporting bias and publication bias. To allow dissemination of diagnostic reviews findings in clinical practice better ways of communicating main characteristics and key results of systematic reviews of diagnostic accuracy should be considered. In the current literature, the quality of reporting and methodological quality of imaging studies for the diagnosis of stroke is less than satisfactory and leaves room for improvement. This is worrying, especially if current health imaging policies are in fact based on poor quality evidence and hence scarce health resources may not being deployed as effectively as they could be.

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4

Whiteley, William Nichol. "Blood markers for the diagnosis and prognosis of stroke." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5609.

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Many blood markers have been associated with stroke. I set out to determine whether blood markers can be applied to: (i) improve the accuracy of the clinical diagnosis of stroke or TIA, and/or (ii) improve the prediction of poor outcome in patients who are still symptomatic at the time of admission with stroke or TIA. I systematically reviewed the existing literature on the diagnostic performance of a range of blood markers measured soon after stroke onset, to inform the choice of markers for my subsequent prospective studies in this thesis. Many studies had deficiencies in their design, which may have explained the apparently – and perhaps spuriously - impressive diagnostic performance of several markers. In the light of these data I was able to improve the design of my own studies and suggest how future studies of diagnostic markers could be improved. In order to define an appropriate comparator test for assessing the diagnostic accuracy of blood markers, I first examined the performance of emergency room nurses and doctors. I assessed the accuracy of their diagnosis of TIA or stroke (‘acute cerebrovascular disease’) in patients presenting with symptoms of suspected stroke, and compared them with a number of stroke diagnostic scales. In the 405 patients recruited to the study, the sensitivity of emergency department staff was 77% and specificity 58%. Each stroke diagnostic scale had a slightly better sensitivity, though worse specificity, than an emergency department clinician. I decided to use the diagnosis by an emergency department clinician of ‘probable or definite acute cerebrovascular disease’ as the best clinical performance reference standard. In blood taken from the same cohort of 405 patients, accredited research laboratories measured markers of inflammation, thrombosis, thrombolysis, cardiac strain and cerebral damage. Tissue plasminogen activator and loge N-terminal pro brain natriuretic peptide were associated positively with a diagnosis of acute cerebrovascular disease, though each marker did not add diagnostic value to the diagnosis of an emergency department doctor or nurse. I systematically reviewed the literature examining the association between the levels of blood markers with poor outcome (i.e. death or dependency) after stroke. I found that although almost all markers studied had a positive association with poor outcome, there were methodological problems with many studies, chiefly small sample size, publication bias or within study reporting biases, and lack of adjustment for important confounders such as age or stroke severity. With data from the Edinburgh Stroke Study, I examined the association between circulating markers of the inflammatory response (white cell count, interleukin-6, Creactive protein and fibrinogen) and poor outcome after stroke. After adjustment for age, whether the patient lived alone, was independent of activities of daily living, was orientated, able to lift both arms and able to walk, I found that higher levels of interleukin-6, white cell count and glucose were associated with poor outcome. The relevant test of a biological marker is not its predictive ability alone, but whether, when added to a validated predictive model based on clinical variables, it improves the prediction of outcome. No individual marker improved the prediction of poor outcome when added to a validated prognostic model based on clinical variables alone. From my cohort of 405 patients with suspected stroke 285 patients had a confirmed diagnosis. Follow up of these 285 patients with confirmed acute cerebrovascular disease showed that, after adjustment for neurological impairment and age, only interleukin-6 and N-terminal pro brain natriuretic peptide were significantly associated with death or disability at 3 months. Neither marker improved the predictions of a model to predict poor outcome based on clinical variables alone. To examine the relationship between circulating markers of the inflammatory response and recurrent stroke, myocardial infarction, and vascular death (‘recurrent vascular events’), again I used data from the Edinburgh Stroke Study. After adjustment for clinical predictors (age, prior MI, stroke, or TIA and AF) I found that higher levels of interleukin-6, C-reactive protein and fibrinogen remained significantly associated with an increased risk of recurrent vascular events. However, the relationship with deaths from all causes was somewhat stronger for each marker, perhaps suggesting that higher marker levels were associated with debility rather than vascular events per se. In conclusion, I found no marker measured could improve on the diagnostic accuracy of an emergency department clinician for acute cerebrovascular disease, nor improve the prediction of poor outcome by a prognostic model based upon clinical variables. The work of this thesis does not support the routine use of blood markers as an aid to the diagnosis of, or the prediction of outcome of, acute stroke.

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Fattori, Alves Allan Felipe. "Image Processing for Enhancement of Ischemic Stroke in Computed Tomography Examinations." Thesis, Orléans, 2019. http://www.theses.fr/2019ORLE2003.

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L’Accident Vasculaire Cérébral (AVC) est l'une des principales causes de décès dans le monde. Le scanner et l'Imagerie par Résonance Magnétique (IRM) sont les deux principales techniques d'imagerie utilisées pour détecter les AVC. L’examen par scanner reste donc la principale méthode de diagnostic. Dans la plupart des cas, l'évaluation de la région cérébrale compromise est effectuée de manière subjective et peut entraîner des difficultés pour déterminer la région atteinte. Ce travail de thèse propose une approche basée sur un algorithme permettant de mettre en évidence les régions atteintes d’AVC ischémique dans les examens de scanner rétrospectifs. Différentes méthodes de traitement des images ont été utilisées pour réhausser les régions des tissus ischémiques. Afin de permettre aux médecins moins expérimentés de détecter de manière fiable les signes précoces AVC, une nouvelle approche est proposée pour améliorer la perception visuelle de l’accident ischémique cérébral. Une série de 41 images scanner rétrospectifs ont été utilisées, réparties en 25 cas d’AVC ischémiques et 16 patients normaux. Les cas d'AVC ont été obtenus dans les 4,5 heures suivant l'apparition des symptômes. Après la sélection des coupes importantes, une moyenne d'image est effectuée pour réduire le bruit. Ensuite, un modèle de décomposition variationnelle est appliqué afin de conserver la composante pertinente de l'image. Enfin, un algorithme d’espérance-maximisation est appliqué. Un test est proposé afin d’évaluer la performance des observateurs dans un environnement clinique avec et sans l'aide d'images rehaussées. La sensibilité globale de l'analyse de l'observateur a été améliorée de 64,5% à 89,6% et la spécificité de 83,3% à 91,7%. Ces résultats montrent l'importance d'un outil informatique d'aide à la décision en neuroradiologie, notamment dans les situations critiques telles que le diagnostic d'accident ischémique cérébral
Stroke is one of the highest causes of death worldwide. Non-enhanced computed tomography (CT) and nuclear magnetic resonance imaging (MRI) are the two main imaging techniques used to detect stroke. CT has a lower cost and greater accessibility of the population, so it is still the main method used. In most cases, the assessment of the compromised brain area is performed subjectively and may lead to difficulties in diagnosis. This research proposes an approach based on a computational algorithm, highlighting regions of ischemic stroke. Different image processing methods were used to enhance ischemic tissues. A set of 41 retrospective CT scans from Botucatu Medical School (Brazil) was used, divided into 25 cases of acute ischemic stroke and 16 normal patients. Stroke cases were obtained within 4.5 h of symptom onset. After selection of CT slices, image averaging was performed to reduce the noise. This was followed by a variational decomposition model and the expectation maximization method was applied to generate enhanced images. We determined a test to evaluate the performance of observers in a clinical environment with and without the aid of enhanced images. The overall sensitivity of the observer’s analysis was 64.5 % and increased to 89.6 % and specificity was 83.3 % and increased to 91.7 %. These results show the importance of a computational tool to assist neuroradiology decisions, especially in critical situations such as the diagnosis of ischemic stroke

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Sit, Bik-yan Sonia, and 薛碧茵. "Cognitive function in Chinese stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45010390.

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7

Moreira, Rafaella Pessoa. "Stroke â the nursing diagnoses analysis show in the activity/exercise branch." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2511.

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Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico
To determine nursing diagnoses is a very necessary task, for it contributes to the better planning of the interventions in clients who survived after the stroke and who, in most of the cases, presented incapabilities. Due to this, the study aimed to analyze the nursing diagnoses shown in the Activity/Exercise branch in clients with stroke during the period of rehabilitation. A transversal study was done amongst 121 clients who attended one of the eight units of Cearense Beneficent Association of Rehabilitation (ABCR) in Fortaleza City- CearÃ, whose data collection occurred within the period of November, 2007 and March, 2008. The including criteria were: a) to be registered in the ABCR; b) to have suffered from stroke at least once, and presented the diagnosis confirmation by the doctor; c) to be over 18 years old. A form was used for the data collection, which had undergone content validation by two nurses expertise in the care of clients with stroke. The information was collected through interview and physical tests. To name the nursing diagnoses, the Taxonomy II proposed by the North American Nursing Diagnosis Association (NANDA), published in 2008, was followed as reference. With the data compiled in the Excel program, the statistic analysis was done within the EpiInfo and SPSS program. The level of significance adopted in the study was of 5%. All ethical recommendations were followed during the stages of the research. Taking the social and demographic data into account, it was verified that the majority of these participants was from masculine gender, elderly, without a partner, retired or pensioners and had low education and income per capita. Amongst the various risk indicators, the most frequent one was the arterial hypertension, followed by the sedentarism, dislipidemy, cardiopathies and diabetes mellitus. Half of the clients studied had at once suffered from stroke 12 months before, beginning rehabilitation in one of the units of the ABCR for at maximum seven months. The participants showed an average of 6.7 nursing diagnoses; 25.1 defining characteristics; 4.6 related factors and 10.1 risky factors. All the diagnoses of the branch studied were identified, but seven: Falling risk, Impaired physical mobility, Impaired deambulation, Sedentary lifestyle, Risk for disuse syndrome, Risk for intolerance to the activity and Impaired transference capability had the frequency of over 50% and were used for the statistic analysis. According to the tests, there was a statistically significant relation among the diagnoses, with the exception of the followings: Falling risk, Impaired physical mobility, Impaired deambulation and Impaired transference capability with the diagnosis Risk for intolerance to the activity. The defining characteristics, related factors and risky factors were statistically associated with the major part of the nursing diagnoses analyzed. Such fact can be justified by the fact that all of them are part of the same branch within the NANDA (2008). One may conclude that the majority of the nursing diagnoses showed statistically association amongst them. It is verified that the Impaired muscular force and Neuromuscular damage were the most frequent related factors found, causing thus, the main consequences for the stroke. The study permitted a deep knowledge upon the Activity/Exercise branch in clients with stroke
Determinar diagnÃsticos de enfermagem Ã uma atividade de assistÃncia muito necessÃria, pois contribui para o melhor planejamento de intervenÃÃes em clientes que sobreviveram ao acidente vascular encefÃlico (AVE) e que na maioria dos casos apresentam incapacidades. Diante disso, o estudo teve por objetivo analisar os diagnÃsticos de enfermagem pertencentes Ã classe Atividade/ExercÃcio em clientes com acidente vascular encefÃlico no perÃodo de reabilitaÃÃo. Um estudo transversal foi desenvolvido com 121 clientes que freqÃentavam uma das oito unidades da AssociaÃÃo Beneficente Cearense de ReabilitaÃÃo (ABCR) na cidade de Fortaleza-CearÃ, cuja coleta de dados ocorreu no perÃodo de novembro de 2007 a marÃo de 2008. Os critÃrios de inclusÃo foram: a) ser cadastrado na ABCR; b) ter apresentado pelo menos um episÃdio de acidente vascular encefÃlico, com diagnÃstico confirmado por mÃdico; c) ter idade acima de 18 anos. Para a coleta de dados utilizou-se um formulÃrio submetido Ã validaÃÃo de conteÃdo de duas enfermeiras especialistas no cuidado a clientes com acidente vascular encefÃlico. As informaÃÃes foram coletadas por meio de entrevista e exame fÃsico. Para nomeaÃÃo dos diagnÃsticos de enfermagem seguiu-se como referÃncia a Taxonomia II da North American Nursing Diagnosis Association (NANDA), publicada em 2008. Com os dados compilados no Excel fez-se a anÃlise estatÃstica no programa EpiInfo versÃo 3.2 e no SPSS versÃo 16.0. O nÃvel de significÃncia adotado no estudo foi 5%. Todas as recomendaÃÃes Ãticas foram seguidas durante as etapas da pesquisa. Quanto aos dados sociodemogrÃficos, a maioria dos participantes era do sexo masculino, idosos, sem companheiros, aposentados ou pensionistas com baixa escolaridade e baixa renda per capita. Dos diversos indicadores de risco, o mais freqÃente foi a hipertensÃo arterial, seguida do sedentarismo, dislipidemias, cardiopatias e diabetes mellitus. Metade dos clientes estudados teve um episÃdio de AVE hÃ doze meses, com inÃcio de reabilitaÃÃo em uma das unidades da ABCR de no mÃximo sete meses. Em mÃdia, os participantes apresentaram 6,7 diagnÃsticos de enfermagem; 25,1 caracterÃsticas definidoras; 4,6 fatores relacionados e 10,1 fatores de risco. Todos os diagnÃsticos da classe em estudo foram identificados, mas sete: Risco de queda, Mobilidade fÃsica prejudicada, DeambulaÃÃo prejudicada, Estilo de vida sedentÃrio, Risco de sÃndrome do desuso, Risco de intolerÃncia Ã atividade e Capacidade de transferÃncia prejudicada tiveram freqÃÃncia acima de 50% e foram utilizados para anÃlise estatÃstica. De acordo com os testes, identificou-se associaÃÃo estatisticamente significante entre os diagnÃsticos, com exceÃÃo dos seguintes: Risco de queda, Mobilidade fÃsica prejudicada, DeambulaÃÃo prejudicada e Capacidade de transferÃncia prejudicada com o diagnÃstico Risco de intolerÃncia Ã atividade. As caracterÃsticas definidoras, fatores relacionados e os fatores de risco estiveram associados estatisticamente com a maior parte dos diagnÃsticos de enfermagem analisados. Tal fato pode ser justificado por todos fazerem parte da mesma classe da NANDA (2008). Conclui-se que a maioria dos diagnÃsticos de enfermagem mostrou associaÃÃo estatÃstica entre eles. Destaca-se que a ForÃa muscular diminuÃda e PrejuÃzos neuromusculares foram os fatores relacionados mais freqÃentes, sendo as principais conseqÃÃncias do AVE. O estudo permitiu o conhecimento aprofundado da classe Atividade/ExercÃcio da NANDA em portadores de AVE

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Guest, Richard M. "The diagnosis of visuo-spatial neglect through the computer-based analysis of hand-executed drawing tasks." Thesis, University of Kent, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310163.

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9

Moreira, Miguel Alexandre Rodrigues. "Diagnosis support in the stroke: Suporte ao diagnóstico em acidentes cardiovasculares." Master's thesis, Universidade de Aveiro, 2010. http://hdl.handle.net/10773/6624.

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Mestrado em Engenharia de Computadores e Telemática
O acidente vascular cerebral é uma das causas de morte mais frequente em todo o mundo e a decisão de tratamento e o resultado final é altamente dependente da qualidade do diagnóstico. Recentemente, a tomografia de perfusão tem sido utilizada com resultados promissores na avaliação de Acidentes Cardio Vasculares (AVCs), principalmente porque esta técnica dá mais informação sobre as alterações hemodinâmicas dentro da área de enfarte. No entanto, muitos parâmetros diferentes são actualmente usados para analisar os resultados da tomografia de perfusão, tentando integrar a informação temporal que contém. Alguns desses parâmetros são o volume sanguíneo, o fluxo sanguíneo ou o tempo de trânsito por exemplo. Neste trabalho foi desenvolvido um conjunto de ferramentas que permitem aplicar os diversos métodos encontrados na literatura assim como uma aplicação que nos permite seleccionar os métodos e a forma de os aplicar. Desta forma foi possível investigar e trabalhando com os médicos descobrir os métodos mais promissores, assim como implementar ferramentas para a detecção das ares passíveis de recuperação.
Stroke is among the most frequent cause of death around the world and the decision to treat and final outcome is highly dependent on the quality of diagnosis. Recently, cerebral perfusion tomography have been used with promising results in the stroke evaluation mainly because this technique gives further information about the hemodynamic changes within the stroke area. However many different parameters are actually used to analyze the CT perfusion results, trying to integrate the temporal information it contains. Some of these parameters are Blood Volume, Blood Flow or Transit Time for example. We developed a framework that applies several methods present in literature as well as an application that allows us to select the methods and how to apply them. This made it possible to investigate and working with clinical experts to discover the most promising methods and implement tools for detecting potentially recoverable areas.

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TAKAYASU, MASAKAZU, KOJI OSUKA, YOSHIHISA KITAMURA, AKIRA TAMASE, KATSUYOSHI MIYASHITA, KENTARO MORI, MOTOHIRO NOMURA, MUNEYOSHI YASUDA, and HIROSHI SHIMA. "A SPINAL EPIDURAL HEMATOMA WITH SYMPTOMS MIMICKING CEREBRAL STROKE." Nagoya University School of Medicine, 2012. http://hdl.handle.net/2237/16040.

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11

Bayoumy, Hassan, and L. O. Averyanova. "Actual problems of stroke disease cure in Egypt." Thesis, Харків, ХНУРЕ, 2019. http://openarchive.nure.ua/handle/document/8375.

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The causes of stroke disease in Egypt are considered. The diagnosis of stroke is explained, and the used diagnostic instruments are studied. The prevention liver cancer is explained. The treatment of each of the causes of liver cancer is analyzed.

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12

Jackson, Daniel Lee. "Diagnostic technologies for stroke related events : an economic evaluation." Thesis, University of Surrey, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.576120.

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Abstract Stroke is a very serious medical condition, taking place when there is an interruption in the blood supply to the brain. A related condition, the transient ischaemic attack {TIA}, occurs when the brain's blood supply is temporarily interrupted, and a short episode of neurological dysfunction is experienced by the patient. Understanding the impact of Stroke and TIA on healthcare provision is important. One publication presented here reports a prospective telephone survey undertaken on healthcare providers in Europe and the United States of America, examining the current diagnosis and management of TIA patients. We identified similarities in practice patterns for TIA across countries, although there were variations, such as the patient's point of entry to care and their subsequent follow up. I also review the literature published {since 2000} to determine any trends seen in the incidence, prevalence and mortality associated with Stroke in Europe and the United States. This publication found that Stroke is still a very large public health burden, although there is a continued trend of decreasing Stroke mortality. Economic modelling was undertaken to assess the relative cost effectiveness of diagnostic techniques in rapidly identifying the appropriate patients for post-TIA care in the United Kingdom. This paper presents a deterministic 1 year economic model, and suggests that an alternative pathway of care incorporating rapid access to diagnostic technologies for TIA patient assessment realised cost savings when compared to a modelled current standard of care. Three papers presented here examine the relative cost effectiveness of employing additional diagnostic techniques to facilitate the rapid diagnosis, and subsequent appropriate treatment of acute Ischaemic Stroke patients, through the use of decision analytic techniques. I examine the relative cost effectiveness of the use of an additional MRI technique to identify ischemic stroke patients suitable for treatment in the United States, the cost-effectiveness of employing an additional CT perfusion imaging step to assess these patients, and finally I assess the relative cost-effectiveness of using either an additional MRI or an additional CT based selection technique within the context of the NHS in the UK. The findings from these papers suggest that if diagnostic equipment and facilities exist, then when employed within an appropriate clinical care pathway, their application in Stroke and TIA diagnosis and treatment can be considered to be one of their potentially cost effective uses. 2

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Resare, Chatarina. "Närståendes upplevelser av att leva med en person som fått diagnosen stroke. : En litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-27977.

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Sammanfattning Bakgrund: Stroke är den tredje mest förekommande orsaken till dödsfall i Sverige. Risken att få stroke, är högre vid diabetes, högt blodtryck och rökning. Syfte: beskriva närståendes upplevelser av att leva med person som fått diagnosen stroke. Metod: Beskrivande litteraturstudie med granskning av 16 vetenskapliga artiklar. Huvudresultat: Närstående till person med diagnosen stroke upplevde en förändring av sin och sin partners livssituation. Från att just levt i ett partnerskap har relationen nu ändrats till att vara vårdare åt närstående person med diagnosen stroke. De närstående upplevde även att de har fått stor arbetsbelastning, var frustrerade över den situation som uppstått och kände även en stor oro för framtiden. Närstående upplevde även sin relation som mer omtänksam mot sin partner och såg att familjebanden stärktes efter att närstående fått diagnosen stroke. Deltagarna i de granskade studierna hade haft sin diagnos från 3 veckor till 3 år och i 15 av studierna intervjuades deltagarna och i en av studierna samlades informationen in via online inlägg. Slutsats: Stor oro och lite information från vården upplevdes hos de flesta närstående till person med stroke. Denna studie skulle kunna öka förståelsen för närstående och även för den person som fått diagnosen stroke, då de har sin vårdkontakt. Sjuksköterskan behöver öka omvårdnaden för närstående och den person som fått diagnosen stroke. Det skulle underlätta i vardagen hos många familjer, då man får en ökad insikt i sjukdomen stroke och dess komplikationer. Nyckelord: Dagligt liv, närstående, omvårdnad, person med diagnosen stroke.
Background: Stroke is the third most common cause of death in Sweden. The risk of stroke is higher in diabetes, high blood pressure and smoking. Purpose: Describe the perpetrators' experiences of living with a person who has been diagnosed with stroke. Method: Literature study based on evaluation of 16 scientific articles. Result: Proximity to a person diagnosed with stroke is experiencing a change in his / her partner's life situation. From just living in a partnership, the relationship has now changed to being a care provider of a related person diagnosed with stroke. The relatives also felt that they had a great workload, were frustrated by the situation that occurred and also felt a great deal of concern for the future. Relatives also experienced their relationship as more caring for their partner and saw that family ties were strengthened after relatives were diagnosed with stroke. The participants in the studies studied had been diagnosed from 3 weeks to 3 years and in 15 of the studies, participants were interviewed and in one of the studies the information was collected via online postings. Conclusion: Major concerns and some information from the health care system were experienced in most related persons to stroke. This study could enhance understanding for close relatives and also for the person diagnosed with stroke, as they have their care contact. The nurse needs to increase the nursing care for close relatives and the person who has been diagnosed with stroke. This would facilitate the everyday life of many families, as you get an increased insight into the disease stroke and its complications. Keywords: Daily life, diagnosed stroke, nursing, related person.

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14

Zolgharni, Massoud. "Magnetic induction tomography for imaging cerebral stroke." Thesis, Swansea University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678669.

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15

Axelsson, Karin. "Eating problems and nutritional status after stroke." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 1988. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99332.

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Eating problems and nutritional status were studied in a consecutive series of 104 stroke patients admitted to emergency hospital care. During their stay in hospital eating problems were observed in 46 patients. Certain common types of eating problems were identified: aberrant eating behaviour as regards chewing,lokalization or swallowing, eating small amounts, hoarding of food in the mouth, leakage of food from the mouth and unawareness of eating problems. Poor nutritional status occurred in 16 % of the patients on admission and in 22 % on discharge from the stroke unit. A subgroup of 32 patients hospitalized for 21 days or longer was studied for three weeks. On at least one occasion during these three weeks a poor nutritional status was observed in 18 patients, of whom 17 had eating problems. All subjects who had eating problems during their hospital stay, plus those patients without eating problems but with neurological deficits and those living in a nursing home one year after the stroke (n=36) were selected for a longitudinal study 18 months after the onset of stroke. Eating problems were identified in 23 of these patients during their hospital stay while 21 had such problems when they were followed up. Two patients who could not eat due to severe dysphagia (after a stroke) for three years and 18 months respectively, were successfully trained to eat normally. One patient exhibited impaired oral and hypopharyngeal function and the other impaired hypo- pharyngeal function and a spastic crico-pharyngeal muscle. In both patients training in swallowing was the main remedical measure and one of them also had a myotomy of the spastic muscle.

[2] s., s. 1-45: sammanfattning, s. 49-130: Härtill 6 uppsatser

digitalisering@umu

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16

Cavalcante, Tahissa Frota. "DiagnÃsticos de enfermagem em pacientes internados por acidente vascular encefÃlico." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=2484.

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Анотація:

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A identificaÃÃo dos diagnÃsticos de enfermagem contribui para o planejamento das intervenÃÃes de enfermagem necessÃrias no intuito de prevenir e reduzir as incapacidades e recuperar a saÃde. Objetivou-se analisar o perfil de diagnÃsticos de enfermagem em pacientes com acidente vascular encefÃlico durante a hospitalizaÃÃo. Estudo transversal, realizado no perÃodo de outubro de 2007 a abril de 2008, com 91 pacientes com acidente vascular encefÃlico, internados na emergÃncia de um hospital geral localizado na cidade de Fortaleza-CearÃ. Estabeleceram-se como critÃrios de inclusÃo: a) estarem internados pelo diagnÃstico mÃdico de acidente vascular encefÃlico independente do tipo; b) terem idade igual ou superior a 18 anos; c) nÃo terem histÃria prÃvia de acidente vascular encefÃlico. Como critÃrio de exclusÃo estabeleceu-se apenas um: pacientes que durante a coleta de dados apresentarem situaÃÃes de emergÃncia com risco de morte. Para a coleta de dados utilizou-se um formulÃrio submetido Ã validaÃÃo de conteÃdo com quatro enfermeiras especialistas em diagnÃsticos de enfermagem ou no cuidado aos pacientes com acidente vascular encefÃlico. As informaÃÃes foram coletadas por meio de entrevista, exame fÃsico e consulta ao prontuÃrio. Para nomeaÃÃo dos diagnÃsticos de enfermagem seguiu-se como referÃncia a Taxonomia II da North American Nursing Diagnosis Association publicada em 2008. Compilaram-se os dados no Excel e fez-se a anÃlise estatÃstica no programa SPSS. O nÃvel de significÃncia adotado no estudo foi 5%. Quanto aos dados sociodemogrÃficos, conforme verificou-se, estes pacientes eram predominantemente do sexo feminino, aposentados, catÃlicos, viviam com companheiro e com baixa escolaridade e baixa renda. O acidente vascular tipo isquÃmico predominou no grupo (45,9%), seguido pelo tipo hemorrÃgico (38,5%). Segundo constatou-se, esses pacientes apresentaram uma mediana de dez diagnÃsticos de enfermagem e uma mÃdia de onze caracterÃsticas definidoras, seis fatores relacionados e cinco fatores de risco. Os diagnÃsticos de enfermagem mais freqÃentes foram: Risco de infecÃÃo (96,7%), DÃficit no autocuidado para banho/higiene (76,9%), DÃficit no autocuidado para higiene Ãntima (74,7%), DÃficit no autocuidado para vestir-se/arrumar-se (71,4%), ComunicaÃÃo verbal prejudicada (62,6%), PerfusÃo tissular ineficaz â tipo cerebral (59,3%), Risco de integridade da pele prejudicada e Mobilidade no leito prejudicada (52,7%) e Risco de aspiraÃÃo (50,5%). De modo geral, o perfil encontrado neste estudo Ã semelhante aos descritos em outros estudos com pacientes internados em unidades de terapia intensiva. Com exceÃÃo do diagnÃstico de enfermagem Risco de infecÃÃo, os demais mostraram associaÃÃo estatisticamente significante entre si. A totalidade das caracterÃsticas definidoras e dos fatores relacionados revelou associaÃÃo estatÃstica significativa com todos os diagnÃsticos de enfermagem, exceto com Risco de infecÃÃo. Como observado, o estudo permitiu conhecer de forma aprofundada os diagnÃsticos de enfermagem, as caracterÃsticas definidoras, os fatores relacionados e os fatores de risco manifestados pelos pacientes na fase de hospitalizaÃÃo. Destaca-se a presenÃa daqueles de carÃter biolÃgico e de risco. Os achados reforÃam a necessidade da equipe de enfermagem atuar nÃo somente no aspecto curativo, mas tambÃm na prevenÃÃo e na promoÃÃo da saÃde, tanto nos nÃveis secundÃrios de saÃde como nos terciÃrios.
The idetinfication of the diagnoses in nursing contribute to the planning of the nursing interventions in order to prevent and reduce the incapabilities. It was aimed to analize the nursing diagnosis profile in patients with stroke during hospitalization. This is a descriptive study which was done within the period of October 2007 to April 2008, involving 91 patients with stroke, who were hospitalized in an emergency department of a general hospital set in Fortaleza City - CearÃ. Some including criteria were established: a) being hospitalized due to the stroke diagnosed by the doctor, independently on the type; b) being 18 years old or over; c) not having previous history of stroke. The excluding criteria were: a) patients who, during the collection of data, presented emergencial situations as well as dead risk. A form was used for the data collection and it also undergone content validation with four nurses who are expertise in nursing diagnoses or in the care of patients with stroke. The information was collected through enterview, physical test and prontuary consultation. To name the nursing diagnoses, the Taxonomy II proposed by the North American Nursing Diagnosis Association published in 2008 was followed as reference. The data was compiled in the Excel program and the statistic analysis was done within the SPSS program. The level of significance adopted in the study was of 5%. Taking the social and demographic data into account, it was verified that the majority of these patients were from feminine gender, retired, catholics, lived with a partner and had low education and income. The ischemic type of stroke was predominant in the group (45.9%), followed by the hemorrhagic type (38.5%). According to the findings, these patients showed an avarage of nine nursing diagnoses, eleven defining characteristics, six related factors and five risky factors. The most frequent nursing diagnoses were: Risk of infection (96.7%), Self-care deficit_bathing and higiene (76.9%), Self-care deficit_intimate higiene (74.7%), Self-care deficit_self dressing (71.4%), Verbally damaged communication (62.6%), Ineffective tissular perfusion_cerebral type (59.3%), Risk of the integrity of the damaged skin (52.7%) and Risk of aspiration (50.5%). Generally, the profile found in this study is similar to the ones described in other studies with patients hospitalized in intensive therapy units. Apart from the nursing diagnosis Risk of infection, the remaining ones showed statistically significant association among themselves. The total defining characteristics and the related factors revealed significative statistic association with all nursing diagnoses, except from the Risk of infection one. As observed, the study allowed us to know in a deep way the nursing diagnoses, the defining characteristics, the related factors and the risk factors manifested in the patients during hospitalization. The presence of those with biological and risky character stands out. The findings reinforce the need that the nursing team has to act not only upon the curative aspect, but also on the prevention and the health promotion, in the secondary levels of health and the tertiary as well.

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Schmid, Jochen [Verfasser], and O. [Akademischer Betreuer] Dössel. "Microwave Imaging for Stroke Diagnostics / Jochen Schmid ; Betreuer: O. Dössel." Karlsruhe : KIT-Bibliothek, 2016. http://d-nb.info/1121683525/34.

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Johansson, Anette. "Hemrehabilitering av personer med diagnosen stroke : -konsensus genom Delhpi-teknik." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för rehabilitering, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-23496.

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Bakgrund/syfte: Det finns en alltmer ökad fokusering på hemrehabilitering för personer diagnostiserade med stroke. Dock kan utförandet på hemrehabiliteringen variera och det är ännu inte klarlagt hur ett fungerande åtgärdsprogram ska utformas. Syftet var att identifiera vad en hemrehabilitering för personer med stroke bör innehålla utifrån personalens perspektiv i multidisciplinära hemrehabiliteringsteam. Metod: Studien är en deskriptiv studie i enlighet med Delphi-tekniken. Frågeformulär skickades ut via e-mail i 3 rundor till 12 experter bestående av arbetsterapeuter, sjuksköterskor och sjukgymnaster. I Runda 1 fick experterna svara på öppna frågor för att få deras personliga åsikter i ämnet. Frågeformulären i Runda 2 och 3 utformades utifrån svaren från föregående runda där experterna fick markera grad av instämmande på en Likert skala efter varje påstående. Resultat: Sextifyra av 74 påståenden uppnådde en nivå av konsensus på 75 % eller mer. Hemrehabilitering bör innehålla patientens självbestämmande och delaktighet i utformandet. Detta säkerställs av ett klientcentrerat arbetssätt genom samarbete, samverkan och samordning på olika sätt med den sociala omgivningen under rehabiliteringsprocessen. Slutsats: Övergripande komponenter i en hemrehabilitering för personer med stroke är egenmakt, delaktighet och självständighet som uppnås genom det ”det goda teamet” och strategier för samordning. Studiens betydelse: Resultatet i studien kan bidra med värdefull information vid utformandet av hemrehabiliteringsprogram i klinisk verksamhet inom strokerehabilitering.
Background/aim: There is an increasingly focus on home-based rehabilitation for persons diagnosed with stroke. However, rehabilitation in the home environment can be delivered in many different ways and the best way to deliver home-based rehabilitation and its content is not yet clarified in the literature. The aim was to identify what home-based rehabilitation should contain from the perspective of members working in multidisciplinary teams in homes of persons diagnosed with stroke. Methods: The study design was a consensus-building, three-round Delphi survey. Questionnaires were sent by e-mail to a panel of 12 experts including occupational therapists, nurses and physiotherapists. In round 1 the experts were asked to answer open-ended questions to obtain their personal views on the subject. The questionnaire in Round 2 and 3 were built on the results of the previous ones and the experts were asked to mark on a Likert scale the importance of each statement. Results: Sixty-four of 74 statements reached a consensus level of 75% or more. Home-based rehabilitation should contain patient’s autonomy and participation in the rehabilitation program. This is ensured by a client-centred approach characterized by cooperation and interaction with the social environment throughout the rehabilitation process. Conclusions: Overall components in home-based rehabilitation for persons diagnosed with stroke is empowerment, participation and autonomy achieved by ”The good team” and coordination strategies. Significance of the study: The result of the study could be an important source of information when designing home rehabilitation programs for persons with stroke.

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El, Hajj Maya. "Elaboration d'un Score Prédictif des Accidents Vasculaires Cérébraux au Liban." Thesis, Paris Est, 2017. http://www.theses.fr/2017PESC0078/document.

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Background : L’accident Vasculaire Cérébral (AVC) est la deuxième cause de décès au Liban et dans le monde. Il existe une pénurie d'informations fiables concernant l'épidémiologie de l'AVC au Liban. L’objectif de cette étude est d’identifier les facteurs de risque et les symptômes d'AVC dans la population libanaise et de développer un score pour la future prédiction de l'AVC et un score pour le diagnostic de l'AVC en situation d'urgence.Méthodes : Une étude cas-témoin a été menée pour la génération des scores. Les données ont été collectées à l’aide d’une fiche de collecte de données conçue dans deux hôpitaux tertiaires au Liban entre le 1er janvier 2012 et le 31 décembre 2014. Une régression logistique a permis de déterminer les facteurs de risque et les symptômes d'AVC. Les coefficients arrondis ont engendré un score pour le risque d’AVC (ROSS) et un score de diagnostic de l'AVC (DS-Stroke). Une autre étude cas-témoin a été menée pour la validation des scores, où les données ont été collectées à l'aide d'un questionnaire normalisé dans cinq différents hôpitaux tertiaires entre le 1er janvier 2015 et le 31 décembre 2016. Le ROSS et le DS-Stroke ont été validés en les comparant au diagnostic final des hôpitaux.Résultats : En total, 732 participants ont été inclus dans l'étude de génération du score (202 cas d'AVC et 530 contrôles sans AVC) et 650 participants ont été inclus dans l'étude de validation du score (205 cas et 445 contrôles sans AVC). Plusieurs facteurs de risque et symptômes ont été associés à l'AVC au Liban. Le ROSS et le DS-Stroke ont été construits et évalués avec des hautes zones sous la courbe et des valeurs négatives et positives prédictives élevées.Conclusion : Le ROSS est un bon outil d'évaluation des risques pour améliorer la prévision de l'AVC dans la population libanaise et serait particulièrement intéressant dans le cadre des soins primaires afin de réduire l'incidence de l'AVC. Le DS-Stroke est un autre outil précieux à utiliser pour le diagnostic de l'AVC à l'urgence et serait intéressant pour l'utilisateur afin d'avoir un diagnostic précis de l'AVC, appeler à d'autres tests d'urgence si nécessaire et d’accélérer le traitement pour les patients AVC
Background: Stroke is the second leading cause of death in Lebanon and worldwide. There is a scarcity of reliable information about the epidemiology of stroke in Lebanon. We aim to identify stroke risk factors and symptoms in the Lebanese population and develop a score for future stroke prediction and another for stroke diagnosis at emergency.Methods: A case-control study was conducted for the scores generation. Data were collected through a designed data collection sheet at two tertiary hospitals in Lebanon between January 1st, 2012 and December 31st, 2014. A logistic regression determined stroke risk factors and symptoms and the rounded coefficients generated a Risk of Stroke Score (ROSS) and a Diagnosis Score for Stroke (DS-Stroke). Another case-control study was conducted for the scores validation where data were collected through a standardized questionnaire at five different tertiary hospitals between January 1st, 2015 and December 31st, 2016. ROSS and DS-Stroke were validated by comparing them to the hospitals final diagnosis.Results: In total, 732 participants were included in the score generation study (202 stroke cases and 530 stroke-free controls) and 650 participants were included in the score validation study (205 cases and 445 stroke-free controls). Many risk factors and symptoms were found to be associated with stroke in Lebanon. ROSS and DS-Stroke were constructed and validated with high areas under the curve and high negative and positive prediction values.Conclusion: ROSS is a good risk assessment tool for use to improve the prediction of stroke in the Lebanese population and would be of particular interest in the primary care setting to reduce stroke incidence. DS-Stroke is another valuable tool to use for stroke diagnosis at emergency and would be interesting to user in order to have an accurate diagnosis of stroke, call for further emergency testing if necessary and speed up the treatment for stroke patients

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Wong, Oi-chi, and 王藹慈. "Evidence-based bedside swallowing assessment by nurses for the patients with stroke." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48339301.

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Background and Purpose Stroke is the loss of brain’s function caused by hypoxia of brain cells depending on the severity and the location of the stroke. In Hong Kong, strokes are the 4th leading cause of death and morbidity in the year of 2010. Dysphagia is a common morbidity related to stroke. Approximately, 50% of stroke patients with dysphagia are suffered with aspiration and aspiration pneumonia which may lead to increased length of stay in hospitals, mortality rate and medical costs. An early nursing dysphagic screening and assessment protocol can help in early detect of dysphagia and therefore help to reduce incidence of aspiration and pneumonia. In order to understand the effectiveness of the nursing dysphagic screening and assessment protocol for the acute stroke patients, a number of studies have been reviewed to gather evidences for the translational research. A bedside nursing swallowing screening and assessment for patients with stroke is developed by incorporating findings from the literature review. Review Question In comparison to the routine care, is the nursing dysphagia assessment intended for the acute stroke patients more effective in reducing (1) the waiting time for having swallow assessment and the (2) the incidence of aspiration and pneumonia? Methods A systematic review of literatures from Ovid Medline (from 1946 to 2012), Pubmed (all dates), CINAHL Plus (from 1971 to 2012) and China Journal Net (from 1912 to 2012) was conducted. Five studies of bedside swallow screening and assessment that can be performed by nurses were selected and critically appraised using the recognized assessment criteria. Results The key components identified from the reviewed studies including swallowing assessment should be performed by trained nurses and acute stroke patients should be alert and able and can keep the sit up position during the swallowing assessment. Moreover, water swallowing test must be included as a part of the swallow assessment and assessment should best be performed in daily basic. Patients should be keeping nil of mouth when they failed the screening and referred for further assessment and management. Implementation potential in terms of transferability, feasibility and the cost benefit ratio of the proposed innovation were assessed. A communication plan was developed for the integration of the proposed innovation into the clinical setting. Outcome measures such as positive predictive value of detecting dysphagia, mean waiting time of waiting the initial swallow screening, occurrence of pneumonia, staff knowledge and compliance were identified to evaluate the effectiveness of the proposed innovation and guideline. Conclusion The findings of this systematic review showed that the nursing dysphagic swallow screening and assessment is effective in detecting the dysphagia of the acute stroke patients. Further development of the proposed innovation will be conducted in the clinical setting in order to satisfy the needs of the acute stroke patients.
published_or_final_version
Nursing Studies
Master
Master of Nursing

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Edgar, Deborah Rankine. "A multiple sensor dual chamber waveform recording diagnostic pacemaker." Thesis, University of Exeter, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363426.

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Lovelock, Caroline. "The clinical epidemiology of haemorrhagic stroke : time trends and diagnostic tissues." Thesis, University of Oxford, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497042.

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Backström, Eva, and Martin Petersson. "Kommunikationens betydelse i mötet mellan sjuksköterska och en patient med diagnosen stroke." Thesis, Blekinge Tekniska Högskola, Sektionen för hälsa, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-1796.

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Varje år insjuknar ca 25-30 000 människor i stroke i Sverige. Sjuksköterskan måste ha i beaktande att dessa patienter kan ha kommunikationssvårigheter av olika grad. Syftet med studien var att undersöka och beskriva hur sjuksköterskan ska gå till väga när hon ska kommunicera med en patient som har fått diagnosen stroke. Resultatet visar att sjuk-sköterskorna ofta saknar kunskap i hur hon ska agera och bete sig när hon kommunicerar med en patient som fått diagnosen stroke. Brist på tid är också ett vanligt förekommande problem som gör att sjuksköterskan helt enkelt inte hinner lägga den tid som krävs för att kommunicera med den individ som insjuknat i stroke. Till följd av det känner sjuksköterskan att hon inte kan sköta sitt jobb på ett korrekt och tillfredsställande sätt. Slutsatsen av vår studie visar att det bl.a. behöver läggas mer tid på att utveckla sjuksköterskornas kommunikativa kunskaper så att en god och trygg relation kan skapas med den som insjuknat i stroke. Studien är en litteraturstudie med kvalitativ utgångspunkt och Joyce Travelbee´s omvårdnadsteori har använts som teoretisk referensram. Travelbee påtalar vikten av kommunikationen mellan sjuksköterska och patient. Polit & Hunglers modell för litteratursökning har använts och vi har blivit inspirerade av Graneheim & Lundmans sammanställning av analysmetod när vi har analyserat vetenskapliga artiklar.

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Cavalcante, Tahissa Frota. "ValidaÃÃo do diagnÃstico de enfermagem risco de aspiraÃÃo em pacientes com acidente vascular cerebral." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=6354.

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nÃo hÃ
O estudo tem por objeto a validaÃÃo do diagnÃstico de enfermagem Risco de aspiraÃÃo em pacientes com acidente vascular cerebral. Estudo metodolÃgico, desenvolvido em trÃs etapas de validaÃÃo de diagnÃsticos de enfermagem, conforme preconizado por Hoskins (1989): anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica. Para a realizaÃÃo da anÃlise de conceito, utilizou-se como referÃncias o modelo de anÃlise de conceito proposto por Walker e Avant (2005) e a revisÃo integrativa da literatura proposta por Whittemore e Knafl (2005). Procedeu-se Ã busca pela literatura em cinco bases de dados: LILACS, CINAHL, PUBMED, SCOPUS e COCHRANE, com os descritores aspiraÃÃo respiratÃria e acidente cerebral vascular e as suas sinonÃmias nas lÃnguas inglesa e espanhola. ApÃs a aplicaÃÃo de critÃrios de inclusÃo e exclusÃo, restaram 94 estudos (total de 659) que subsidiaram a anÃlise do conceito. Em relaÃÃo ao conceito de aspiraÃÃo respiratÃria, foram encontrados trÃs atributos crÃticos essenciais para a compreensÃo deste conceito: movimento (entrada, penetraÃÃo), objeto (sÃlidos, fluidos, secreÃÃes orofarÃngeas, conteÃdos gÃstricos) e localizaÃÃo exata (abaixo das cordas vocais e trato respiratÃrio inferior). Foram levantados onze fatores de risco para aspiraÃÃo respiratÃria em pacientes com acidente vascular cerebral com os seus respectivos conceitos e referÃncias empÃricas: disfagia, depressÃo do nÃvel de consciÃncia, reflexo de tosse prejudicado ou ausente, desordens neurolÃgicas (trauma cerebral, acidente vascular cerebral e doenÃa de Alzheimer), presbifagia, uso de tubos gastrintestinais, presenÃa de refluxo gastroesofÃgico, imobilizaÃÃo, reflexo de vÃmito ausente, procedimentos invasivos como videofluoroscopia e endoscopia digestiva alta e sedaÃÃo. ApÃs a etapa de anÃlise de conceito, foi construÃdo um instrumento com os conceitos e as referÃncias empÃricas dos fatores de risco identificados. Este foi submetido ao crivo de 26 enfermeiros especialistas na Ãrea do diagnÃstico de enfermagem em estudo. Alguns fatores de risco foram apontados como inapropriados pelos especialistas (proporÃÃo de concordÃncia abaixo de 85%) para a prediÃÃo do risco de aspiraÃÃo respiratÃria: presbifagia, imobilizaÃÃo, reflexo de vÃmito ausente e procedimentos invasivos como endoscopia digestiva alta e videofluoroscopia. Entretanto, ao analisar as sugestÃes dos especialistas, encontrou-se que estes nÃo concordavam com o conceito ou com a referÃncia empÃrica proposta para estes fatores de risco, o que motivou a modificaÃÃo. Grande parte dos especialistas sugeriu o acrÃscimo dos fatores de risco uso de tubos endotraqueais/traqueostomia e cabeceira do leito baixa. Estes fatores de risco analisados e validados por especialistas foram testados na prÃtica clÃnica, por meio de um estudo longitudinal realizado com 24 pacientes internados em um hospital geral por acidente vascular cerebral. Os achados mostraram que disfagia e mobilidade corporal diminuÃda constituem preditores eficazes da presenÃa do diagnÃstico de enfermagem risco de aspiraÃÃo. Os fatores de risco presbifagia, presenÃa de refluxo gastroesofÃgico e procedimentos invasivos como endoscopia digestiva alta e videofluoroscopia nÃo foram indicadores satisfatÃrios do diagnÃstico em estudo. Portanto, sete fatores de risco demonstraram-se, conforme examinado pela anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica, apropriados para avaliar o diagnÃstico de enfermagem risco de aspiraÃÃo em pacientes com acidente vascular cerebral.

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Sundström, Markus, and Emelie Backman. "Vårdpersonals upplevelse av att vårda patientermed diagnosen afasi efter stroke : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99917.

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Background: Stroke is one of the leading causes for longlasting sequelae, among them loss in cognitive function, like aphasia. Aphasia effects the patients ability to understand and express themselves in speaking and writing. To be able to reach a good level of care, the careproviders and patients ought to have the same goals and values. This requires a good communication between the careproviders and patients. Which can be problematic for the caregivers when they don't feel secure in their way of getting close to these patients. Aim: The purpose of this study was to illuminate caregivers experience of caring for patients with the diagnosis aphasia following stroke. Method: This is a literature study where nine studies, with qualitative design, has been analyzed and compiled. Inclusion- and exclusioncritera were used to limit the result. All the studies have been qualitychecked. Result: There are varied experiences for the caregivers when it comes to care for patients with the diagnosis aphasia after stroke. The result is presented with three categories; “Caregivers experience of time and resources for god care”, “Caregivers methods and aids in the care” and “Relationships and feelings connected to the care of patients who suffered aphasia after stroke”. Conclusion: Based on the caregivers experiences in the result, more research is needed in this area, partly to be able to develop strategies that will help the caregivers and save time, and also to be able to map how caregivers feel in the care of these patients.
Bakgrund: Stroke är en av de ledande orsakerna till långvariga följdsjukdomar, däribland kognitiva nedsättningar som afasi. Afasi kan påverka patientens förmåga att förstå och uttrycka sig i tal och skrift. För att uppnå god omvårdnad bör vårdpersonal och patient ha samma mål och värderingar, vilket ställer krav på kommunikationen mellan patient och vårdare. Det kan vara problematiskt för vårdpersonal då de inte alltid känner sig säkra på hur de ska närma sig dessa patienter. Syfte: Syftet med litteraturstudien var att belysa vårdpersonals upplevelser av att vårda patienter med diagnosen afasi efter stroke. Metod: Det här är en litteraturstudie där nio studier, med kvalitativ ansats, har analyserats och sammanställts. Inklusions- och exklusionskriterier har använts för att avgränsa resultatet. Alla studier har kvalitetsgranskats. Resultat: Det finns varierande upplevelser hos vårdpersonal när det kommer till att vårda patienter som diagnostiserats med afasi efter stroke. Resultatet presenteras i tre huvudkategorier; “Vårdpersonals upplevelse av tid och resurser för att ge god omvårdnad”, “Vårdpersonals metoder och hjälpmedel i omvårdnaden” och “Relationer och känslor kopplade till omvårdnaden av patienter med diagnosen afasi efter stroke”. Konklusion: Baserat på vårdpersonals upplevelser behövs mer forskning inom detta område dels för att utveckla strategier som kan hjälpa i kommunikationen och spara tid, men också för att kunna kartlägga hur vårdpersonal känner inför omvårdnaden av dessa patienter.

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Alves, Allan Felipe Fattori. "Image processing for enhancement of ischemic stroke in computed tomography examinations." Botucatu, 2019. http://hdl.handle.net/11449/181997.

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Orientador: Diana Rodrigues Pina
Resumo: O acidente vascular cerebral (AVC) é uma das maiores causas de morte em todo o mundo. No Brasil, o AVC é a principal, sendo que em 2009, foi responsável por 10,2% das mortes registradas. A tomografia computadorizada (TC) e a ressonância magnética nuclear (RMN) são as duas principais técnicas de imagem usadas para detectar o AVC. A TC tem um custo menor e maior acessibilidade da população, por isso ainda é o principal método de avaliação do acidente vascular cerebral. A avaliação do cérebro comprometido é realizada de forma subjetiva e pode levar à dificuldades no diagnóstico. Esta pesquisa propõe a implementação de um algoritmo computacional, destacando regiões de AVC isquêmico. Diferentes métodos de processamento de imagem foram utilizados para melhorar a visualização do tecido isquêmico. Um conjunto de 41 tomografias retrospectivas obtidas na Faculdade Medicina de Botucatu foram utilizadas, divididas em 25 casos de AVC isquêmico e 16 pacientes controle. Os casos de AVC foram obtidos dentro de 4,5 horas após os primeiros sintomas. Após a seleção dos slices com a possível presença de AVC, tais slices foram somados resultando em um único slice com valores médios de forma a reduzir o ruído. Isto foi seguido por um modelo de decomposição variacional onde se mantiveram componentes de interesse da imagem. O método de maximização de expectativas foi aplicado para gerar imagens melhoradas. Determinamos um teste de desempenho de observadores em um ambiente clínico. A sensibilidade ge... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Stroke is one of the highest causes of death worldwide. In Brazil, stroke is the leading cause of death, and in 2009, it was responsible for 10.2% of deaths recorded. Non-enhanced computed tomography (CT) and nuclear magnetic resonance imaging (MRI) are the two main imaging techniques used to detect stroke. CT has a lower cost and greater accessibility of the population, so it is still the main method used. In most cases, the assessment of the compromised brain area is performed subjectively and may lead to difficulties in diagnosis. This research work proposes an approach based on a computational algorithm, highlighting regions of ischemic stroke. Different image processing methods were used to enhance ischemic tissues. A set of 41 retrospective CT scans from Botucatu Medical School (Brazil) was used, divided into 25 cases of acute ischemic stroke and 16 normal patients. Stroke cases were obtained within 4.5 h of symptom onset. After selection of CT slices, image averaging was performed to reduce the noise. This was followed by a variational decomposition model and the expectation maximization method was applied to generate enhanced images. We determined a test to evaluate the performance of observers in a clinical environment with and without the aid of enhanced images. The overall sensitivity of the observer’s analysis was 64.5 % and increased to 89.6 % and specificity was 83.3 % and increased to 91.7 %. These results show the importance of a computational tool to assist n... (Complete abstract click electronic access below)
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27

Cuingnet, Rémi. "Contributions à l’apprentissage automatique pour l’analyse d’images cérébrales anatomiques." Thesis, Paris 11, 2011. http://www.theses.fr/2011PA112033/document.

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L'analyse automatique de différences anatomiques en neuroimagerie a de nombreuses applications pour la compréhension et l'aide au diagnostic de pathologies neurologiques. Récemment, il y a eu un intérêt croissant pour les méthodes de classification telles que les machines à vecteurs supports pour dépasser les limites des méthodes univariées traditionnelles. Cette thèse a pour thème l'apprentissage automatique pour l'analyse de populations et la classification de patients en neuroimagerie. Nous avons tout d'abord comparé les performances de différentes stratégies de classification, dans le cadre de la maladie d'Alzheimer à partir d'images IRM anatomiques de 509 sujets de la base de données ADNI. Ces différentes stratégies prennent insuffisamment en compte la distribution spatiale des \textit{features}. C'est pourquoi nous proposons un cadre original de régularisation spatiale et anatomique des machines à vecteurs supports pour des données de neuroimagerie volumiques ou surfaciques, dans le formalisme de la régularisation laplacienne. Cette méthode a été appliquée à deux problématiques cliniques: la maladie d'Alzheimer et les accidents vasculaires cérébraux. L'évaluation montre que la méthode permet d'obtenir des résultats cohérents anatomiquement et donc plus facilement interprétables, tout en maintenant des taux de classification élevés
Brain image analyses have widely relied on univariate voxel-wise methods. In such analyses, brain images are first spatially registered to a common stereotaxic space, and then mass univariate statistical tests are performed in each voxel to detect significant group differences. However, the sensitivity of theses approaches is limited when the differences involve a combination of different brain structures. Recently, there has been a growing interest in support vector machines methods to overcome the limits of these analyses.This thesis focuses on machine learning methods for population analysis and patient classification in neuroimaging. We first evaluated the performances of different classification strategies for the identification of patients with Alzheimer's disease based on T1-weighted MRI of 509 subjects from the ADNI database. However, these methods do not take full advantage of the spatial distribution of the features. As a consequence, the optimal margin hyperplane is often scattered and lacks spatial coherence, making its anatomical interpretation difficult. Therefore, we introduced a framework to spatially regularize support vector machines for brain image analysis based on Laplacian regularization operators. The proposed framework was then applied to the analysis of stroke and of Alzheimer's disease. The results demonstrated that the proposed classifier generates less-noisy and consequently more interpretable feature maps with no loss of classification performance

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28

Ivanova, N. M. "Correlation of anxiety-depressive disorders and cognitive impairment due to stroke. Features of early diagnosis and treatment." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18976.

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29

Alemany, Ripoll Montserrat. "MRI Diagnosis of Intracranial Hemorrhage : Experimental and Clinical Studies." Doctoral thesis, Uppsala University, Department of Oncology, Radiology and Clinical Immunology, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3333.

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The purpose of this work was to improve the diagnosis of intracranial hemorrhage with MRI, using, among others, T2*-w GE sequences. Various sequences were tested in rabbits at two magnetic field strengths. Then, the most effective technique was applied to stroke patients.

Experimental studies: The MR detectability of small experimental haematomas in the brain and of blood in the cerebrospinal fluid (CSF) spaces of 30 rabbits was evaluated. MRI examinations were performed at determined intervals. The last MR images were compared to formalin fixed brain sections and, in 16 rabbits, also to the histological findings. T2*-weighted GE sequences revealed all the intraparenchymal haematomas at 1.5 T, appearing strongly hypointense. Their signal patterns remained unchanged during the follow-up. Blood in the CSF spaces was best detected at 1.5T with T2*-weighted GE sequences during the first 2 days. FLAIR and SE sequences were rather insensitive.

Clinical studies: MR examinations were performed at 1.5T, including T1- and T2-w SE, FLAIR and T2*-w GE sequences. In the first clinical study, 66 intraparenchymal hematomas (IPH) of different sizes and ages were examined. T2*-w GE sequence was the most sensitive. On all the sequences, we found a big variety of signal patterns, without a clear relationship to the age of the hematomas.

In a second clinical study, MR examinations were performed to 83 patients with acute stroke: 43 presented acute IPH and 40 were used as controls. Old microhemorrhages (OMHs) were found in 60% of the patients with IPH, and in 15% of the controls.

Conclusion: T2*-weighted GE sequences are capable of revealing very small intraparenchymal hemorrhages at any stage, and blood in CSF spaces during at least the first 2 days. The age of IPHs cannot reliably be estimated with MRI. We have found a correlation between the presence of OMHs and acute intraparenchymal hematomas.

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30

Hamilton-Bruce, Monica Anne. "Conventional and topographic electroencephalography and somatosensory evoked potential studies in ischaemic stroke." Adelaide, 1998. http://web4.library.adelaide.edu.au/theses/09PH/09phh222.pdf.

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Copies of author's previously published articles inserted. Bibliography: leaves I-LXIV. Assesses the diagnostic and prognostic value of early electroencephalography (EEG) and somatosensory evoked potential studies in cortical and non-cortical ischaemic stroke. Both conventional and topographic/quantitative studies were performed. A parallel study was carried out on healthy volunteers to provide an effective control. Equipment and quantitative EEG (qEEG) variability was also assessed.

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31

Warburton, Elizabeth. "Mechanisms for the recovery of aphasia following stroke : a positron emission tomography study." Thesis, University of Oxford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299261.

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32

Miller, Lakisha Chitique. "Medical Resident Turnover and Its Association with Inpatient Mortality in Patient Discharges with a Primary Diagnosis in the Heart Disease, Cancer, or Stroke Diagnostic Groups at U.S. Teaching Hospitals, 2002." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1239044238.

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33

Lasserson, Daniel Sascha. "Delay in accessing healthcare after transient ischaemic attack and minor stroke : the role of primary care in the problem and the solution." Thesis, University of Cambridge, 2012. https://www.repository.cam.ac.uk/handle/1810/243938.

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Transient ischaemic attack (TIA) and minor stroke are associated with a high risk of recurrent stroke which can be predicted with a clinical rule and reduced with urgent treatment. Delay in accessing assessment and vascular risk factor modification should therefore be as short as possible, yet little is known in the UK about where patients seek care and the key influences of the time to contact healthcare services. However, using cohort studies to answer questions on healthcare access requires an assessment of how well such cohorts represent the wider population. Within the primary care consultation, the recognition of TIA is an important step in the care pathway as definitive treatment is initiated by specialists, yet TIA presentations are not common for individual GPs and difficulties in diagnosis may be due to low clinical exposure in routine practice or inadequacies in training. For patients where GPs suspect that TIA may be the cause of symptoms, inaccurate risk prediction and diagnosis of TIA can result in delay to definitive care and the existing tools for prognosis and diagnosis have been exclusively derived from clinical assessments in secondary care rather than primary care.

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34

Schieferdecker, Nicola [Verfasser], and Martin [Akademischer Betreuer] Dichgans. "Platelet-associated miRNAs as potential diagnostic biomarkers after acute ischemic stroke / Nicola Schieferdecker ; Betreuer: Martin Dichgans." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2021. http://nbn-resolving.de/urn:nbn:de:bvb:19-281797.

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35

Osborne, Jesse. "A Protocol Driven Stroke Code's Impact on Door-to-Needle Times." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etd/3754.

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Tissue plasminogen activator (tPA) is most effective the faster it is able to be administered to a patient that has been affected by stroke. A Stroke Code is a strategy that acute care facilities implement to reduce the time from diagnosing a stroke to administering tPA. The purpose of this study was to determine if the initiation of a Stroke Code in an acute care hospital reduces the door-to-needle time for patients affected by a stroke. In particular, does a Stroke Code reduce door-to-needle times. The research was conducted using data from April 1, 2014 to December 31, 2014 (pre-Stroke Code period) and September 1, 2015 to December 31, 2016 (post-Stroke Code period). The population of this study was treated at Holston Valley Medical Center in Kingsport, Tennessee. The analysis revealed a decrease in door-to-needle times after a Stroke Code was implemented at the acute care facility.

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36

Pacheco, Aline Cristina. "Disfagia no acidente vascular cerebral: diagnóstico, preditores e desfechos associados." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17140/tde-23032018-121751/.

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Este estudo foi realizado com os seguintes objetivos: identificar a frequência e os preditores de disfagia em pacientes com Acidente Vascular Cerebral (AVC); avaliar o impacto da disfagia quanto aos desfechos dependência funcional e óbito em três meses após o AVC; e validar o teste de rastreio para disfagia Toronto Bedside Swallowing Screening Test (TOR-BSST©) em pacientes com AVC de um hospital público no Brasil. Participaram do estudo pacientes admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e incluídos no Registro de Acidente Vascular Encefálico (REAVER) no período de abril de 2015 a setembro de 2016, maiores de 18 anos, com diagnóstico de AVC agudo (<10 dias entre o AVC e a admissão hospitalar) confirmado por exames de neuroimagem. Foram excluídos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, ictus antigo, AVC hemorrágico de causa secundária ou aqueles que não concordaram em participar do estudo. As características demográficas e clínicas foram coletadas de forma prospectiva pelos coordenadores de pesquisa do REAVER. A deglutição foi avaliada na primeira semana da admissão hospitalar à beira do leito, por três fonoaudiólogas, com um protocolo de avaliação clínica utilizando as consistências pastosa e líquida. Os pacientes foram avaliados com o teste TORBSST© e com a videofluoroscopia após a alta hospitalar. A escala modificada de Rankin, o Índice de Barthel e a Medida de Independência Funcional (MIF) foram utilizados para avaliar os desfechos funcionais de três meses após o AVC. No período do estudo foram admitidos 831 pacientes com AVC, sendo que 353 pacientes foram excluídos de acordo com os critérios de inclusão e exclusão. Dos pacientes elegíveis, 53 foram removidos das análises por receberem alta antes da avaliação da deglutição, portanto, foram incluídos 425 pacientes. Dentre os pacientes incluídos, 28,2% não apresentaram condições para avaliação clínica da deglutição e foram considerados no grupo de disfagia presumida. Desta forma, foram examinados com avaliação clínica da deglutição 305 pacientes, sendo que 45,2% foram diagnosticados com disfagia. Idade (p=0,017), história médica conhecida de apneia obstrutiva do sono (p=0,003) e gravidade do AVC na admissão hospitalar (p<0,001) se associaram independentemente com disfagia. Os pacientes disfágicos apresentaram maior tempo de internação (p=0,001), maior frequência de reabilitação (p<0,001) e uso de sonda para alimentação (p<0,001) dentro de três meses após o AVC. A presença de disfagia detectada na avaliação clínica da deglutição foi independentemente associada com dependência funcional ou óbito em três meses após o AVC (p<0,001). O teste TORBSST© apresentou sensibilidade de 85% para detectar disfagia comparado a videofluoroscopia, e concordância moderada entre os avaliadores (K=0,44). Portanto, neste estudo, disfagia foi diagnosticada em quase metade dos pacientes (45,2%). Idade, história médica conhecida de apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, sendo esta independentemente associada com morte ou dependência funcional em três meses após o AVC. O teste de rastreio para disfagia TOR-BSST© apresentou alta sensibilidade para detectar disfagia em pacientes com AVC comparado ao padrão ouro.
This study was carried out with the following objectives: to identify the frequency and the predictors of dysphagia in stroke patients; to assess the impact of dysphagia on outcomes functional dependence and death at three months post-stroke; and to validate the Toronto Bedside Swallowing Screening Test (TOR-BSST©) screening test in stroke patients from a public hospital in Brazil. All consecutive eligible patients newly admitted to the Emergency Unit of the Hospital Clinics of School of Medicine of Ribeirao Preto - University of São Paulo (HCFMRP-USP) and captured by REAVER (an institution based prospective registry for stroke patients) between April 2015 and September 2016 were approached and consented. Eligible patients were those that met the following criteria: age>18 years and medical diagnosis of acute stroke (<10 days between stroke and hospital admission) confirmed from neuroimage exams. Patients with transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, not acute stroke, hemorrhagic stroke with secondary cause or those who did not agree to participate in the study were excluded. The demographic and clinical characteristics were prospectively collected by REAVER research coordinators. Swallowing was evaluated by three Speech and Language Pathologists in the first week of hospital admission at the bedside with clinical assessment using paste and liquid consistency. Patients were assessed with TOR-BSST© and with videofluoroscopy after discharge from hospital. Modified Rankin scale, Barthel Index and Functional Independence Measure (FIM) were used to assess functional outcomes three months after stroke. In the period of the study, 831 stroke patients were admitted, 353 patients were excluded according to the inclusion and exclusion criteria. Of the eligible patients, 53 were removed because they were discharged before clinical assessment of swallowing, therefore 425 patients were included in this study. Among the included patients, 28.2% did not present conditions for clinical swallowing assessment and were considered in the presumed dysphagia group. Thus, 305 patients were examined with clinical swallowing assessment and 45.2% of them had dysphagia. Age (p=0.017), known medical history of obstructive sleep apnea (p=0.003) and stroke severity at hospital admission (p<0.001) were independently associated with dysphagia. Dysphagic patients had longer length of stay (p=0.001), higher frequency of rehabilitation (p<0.001) and higher frequency of use of tube feeding (p<0.001) within three months after stroke. The presence of dysphagia detected in clinical swallowing assessment was independently associated with functional dependence or death within three months after stroke (p<0.001). The TORBSST© showed sensitivity of 85% to detect dysphagia compared to videofluoroscopy and moderate agreement among the screeners (K=0.44). Therefore, in this study, dysphagia was diagnosed in almost half of the patients (45.2%). Age, known medical history of obstructive sleep apnea and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months post-stroke. The TOR-BSST© presented high sensitivity to detect dysphagia in stroke patients compared to the gold standard.

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37

Akasaka, Thai. "Detection of suspected brain infarctions on CT can be significantly improved with temporal subtraction images." Kyoto University, 2019. http://hdl.handle.net/2433/242382.

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38

Juega, Mariño Jesús María. "Diagnóstico Avanzado en la Fase Aguda del Ictus Criptogénico." Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/673398.

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Introducció L'abordatge diagnòstic de la causa de l'ictus isquèmic és d'especial importància atès que les recurrències són habitualment fruit de la mateixa patologia que l'ictus previ. Fins a un 25% dels ictus són catalogats com ictus criptogènic o de causa desconeguda després d'un ingrés hospitalari. L'objectiu és implementar un protocol diagnòstic en la fase aguda de l'ictus criptogènic que identifiqui etiologies d'alt potencial embolígeno causants d'ictus severs per a l'optimització de la prevenció secundària de l'ictus. mètodes: Anàlisi prospectiu de pacients amb ictus criptogénicos amb disseny d'estratègies per a la detecció de fonts embòliques, Es va avaluar en un cohort de pacients la monitorització cardíaca amb Holter tèxtil d'inici precoç en fase hospitalària i de manera continuada fins a complir 28 dies de monitorització ambulatòria. Es van analitzar la taxa de detecció de Fibril·lació Auricular (FA) i els marcadors predictius de detecció mitjançant una anàlisi multimodal combinant predictors clínics, de neuroimatge i cardíacs basals de cada pacient. En una altra cohort de pacients es va avaluar la utilitat de la ecocardioscopia de mà ultra portàtil per a la detecció de cardiopaties embolígenes majors identificades com a fracció d'ejecció severament deprimides o valvulopaties embolígenes i la seva fiabilitat pel que fa a l'estudi ecocardiogràfic estàndard, es van analitzar els predictors de detecció de fonts cardioembólicas gran mitjançant estudis ecocardiogràfics focalitzats en la fase aguda de l'ictus criptogènic. resultats Entre 296 pacients, 264 pacients van completar el monitoratge amb una taxa de detecció de FA paroxística de l'23,1% (61/264) després de monitorització durant 28 dies de manera precoç i contínua. Els pacients amb detecció de FA van ser més grans [odds ratio (OR) 1.04, interval de confiança 95% (CI) 1.01-1.08], van tenir majors taxes de transformació hemorràgica (OR 4.03, 95% CI 1.44-11.22), van presentar major detecció d'oclusió de gran vas intracranial (OR 4.29, 95% CI 2.31-7.97) (P <0.0001), van tenir volums indexats de aurícula esquerra més grans (OR 1.03, 95% CI 1.01-1.1) (P = 0.0002) i van tenir nivells analítics majors de pèptid natriurètic cerebral (OR 1.01, 95% CI 1.0-1.1). La major edat i la presència d'oclusió de got intracranial van estar independentment associats a la detecció de FA paroxística (OR 1.06, 95% CI 1.00-1.16, i OR 4.58, 95% CI 2.27- 21.38, respectivament). En una altra cohort es va realitzar un estudi amb ecocardioscopia ultra portàtil de mà en la fase aguda de l'ictus en 130 pacients, amb una concordança de l'0.95 pel que fa a l'estudi estàndard, es van detectar cardiopaties embolígenes al 16% (17/104) dels ictus criptogénicos en l'estudi focalitzat amb ecocardioscopia ultra portàtil. L'oclusió de gran vas intracranial (OR: 4.24, 95% CI: 1.01-17.85) i la insuficiència cardíaca crònica (OR: 13.25, 95% CI: 3.54-49.50) van ser predictors independents de detecció de cardiopatia embolígena més gran. conclusions Les estratègies diagnòstiques mitjançant estudis focalitzats amb ecocardioscopia ultra portàtil de mà en fase aguda i la tecnologia tèxtil Holter wearable d'inici precoç i continuada són útils en l'estudi etiològic de l'ictus criptogènic. L'oclusió de gran vas intracranial, l'edat de l'pacient i l'antecedent d'insuficiència cardíaca van ser marcadors independents de detecció de font embòlica i de detecció de FA.
Introducción El abordaje diagnóstico de la causa del ictus isquémico es de especial importancia dado que las recurrencias son habitualmente fruto de la misma patología que el ictus previo. Hasta un 25% de los ictus son catalogados como ictus criptogénico o de causa desconocida tras un ingreso hospitalario. El objetivo es implementar un protocolo diagnóstico en la fase aguda del ictus criptogénico que identifique etiologías de alto potencial embolígeno causantes de ictus severos para la optimización de la prevención secundaria del ictus. Métodos: Análisis prospectivo de pacientes con ictus criptogénicos con diseño de estrategias para la detección de fuentes embólicas, Se evaluó en un cohorte de pacientes la monitorización cardiaca con Holter textil de inicio precoz en fase hospitalaria y de manera continuada hasta cumplir 28 días de monitorización ambulatoria . Se analizaron la tasa de detección de Fibrilación Auricular (FA) y los marcadores predictivos de detección mediante un análisis multimodal combinando predictores clínicos, de neuroimagen y cardíacos basales de cada paciente. En otra cohorte de pacientes se evaluó la utilidad de la ecocardioscopia de mano ultra portátil para la detección de cardiopatías embolígenas mayores identificadas como fracción de eyección severamente deprimidas o valvulopatías embolígenas y su fiabilidad con respecto al estudio ecocardiográfico estándar, se analizaron los predictores de detección de fuentes cardioembólicas mayores mediante estudios ecocardiográficos focalizados en la fase aguda del ictus criptogénico. Resultados Entre 296 pacientes, 264 pacientes completaron la monitorización con una tasa de detección de FA paroxística del 23,1% (61/264) tras monitorización durante 28 días de manera precoz y continua. Los pacientes con detección de FA fueron mayores [odds ratio (OR) 1.04, intervalo de confianza 95% (CI) 1.01–1.08], tuvieron mayores tasas de transformación hemorrágica (OR 4.03, 95% CI 1.44–11.22), presentaron mayor detección de oclusión de gran vaso intracraneal (OR 4.29, 95% CI 2.31–7.97) (P < 0.0001), tuvieron volúmenes indexados de aurícula izquierda más grandes (OR 1.03, 95% CI 1.01–1.1) (P =0.0002) y tuvieron niveles analíticos mayores de péptido natriurético cerebral (OR 1.01, 95%CI 1.0–1.1). La mayor edad y la presencia de oclusión de vaso intracraneal estuvieron independientemente asociados a la detección de FA paroxística (OR 1.06, 95% CI 1.00–1.16, y OR 4.58, 95% CI 2.27– 21.38, respectivamente). En otra cohorte se realizó un estudio con ecocardioscopia ultra portátil de mano en la fase aguda del ictus en 130 pacientes, con una concordancia del 0.95 con respecto al estudio estándar, se detectaron cardiopatías embolígenas en el 16% ( 17/104) de los ictus criptogénicos en el estudio focalizado con ecocardioscopia ultra portátil . La oclusión de gran vaso intracraneal (OR: 4.24, 95% CI: 1.01–17.85) y la insuficiencia cardíaca crónica (OR: 13.25, 95% CI: 3.54–49.50) fueron predictores independientes de detección de cardiopatía embolígena mayor. Conclusiones Las estrategias diagnósticas mediante estudios focalizados con ecocardioscopia ultra portátil de mano en fase aguda y la tecnología textil Holter wearable de inicio precoz y continuada son útiles en el estudio etiológico del ictus criptogénico. La oclusión de gran vaso intracraneal, la edad del paciente y el antecedente de insuficiencia cardíaca fueron marcadores independientes de detección de fuente embólica y de detección de FA.
Introduction: The diagnostic approach to the cause of ischemic stroke is of special importance, because stroke recurrences are usually the result of the same pathology as the previous one, up to 25% of strokes are classified as cryptogenic stroke or of unknown cause after hospital admission. The objective is to implement a diagnostic protocol in the acute phase of cryptogenic stroke to identify etiologies of high embolic potential that cause severe strokes for the optimization of secondary stroke prevention. Methods: Prospective analysis of patients with cryptogenic strokes to analyze strategies designed for the detection of embolic sources. In a cohort of patients, cardiac holter textile monitoring was assessed at the early onset of the acute stroke in the hospital phase, and continuously monitoring was carried until 28 days of outpatient stage. The detection rate of Atrial Fibrillation and the predictive detection markers were analyzed by means of a multimodal analysis combining different clinical, neuroimaging and baseline cardiac predictors of each patient. In another cohort of patients, the utility of ultra-portable hand-held echocardiography was evaluated for the detection of major cardio embolic heart disease, that were identified as severely depressed ejection fraction or embolic valve disease. It has been evaluated the reliability of hand held echocardiography in comparison to the standard echocardiographic study as well as the predictors of major cardioembolic source detection. Results Among 296 patients, 264 patients completed monitoring with a paroxysmal AF detection rate of 23.1% (61/264) after early and continuous monitoring for 28 days. Patients with detection of AF were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08], had higher rates of hemorrhagic transformation by neuroimaging (OR 4.03, 95% CI 1.44–11.22), presented greater detection of large intracranial vessel occlusion (OR 4.29, 95% CI 2.31–7.97) (P <0.0001), had larger indexed left atrial volumes (OR 1.03, 95% CI 1.01–1.1) (P = 0.0002) and had higher analytical levels of brain natriuretic peptide (OR 1.01, 95% CI 1.0–1.1) compared to patients without AF detection. The elderly age and the presence of intracranial vessel occlusion were independently associated with the detection of paroxysmal AF (OR 1.06, 95% CI 1.00–1.16, and OR 4.58, 95% CI 2.27– 21.38, respectively). In another cohort, a study with ultra-portable handheld echocardiography was carried out in the acute phase of stroke in 130 patients with a concordance of 0.95 in comparison to the standard study. Major cardio embolic source was detected in 16% (17/104) of cryptogenic strokes in the focused study with ultra-portable echocardiography. Large vessel occlusion of intracranial vessel (odds ratio [OR]: 4.24, 95% confidence interval [CI]: 1.01_17.85) and chronic heart failure (OR: 13.25, 95% CI: 3.54_49.50) were independent predictors of detection of major cardioembolic source. Conclusions Diagnostic strategies through focused studies with ultra-portable hand-held echocardiography in the acute phase and early-onset continuous holter wearable textile are useful in the etiological study of cryptogenic stroke. Large intracranial vessel occlusion, age of the patient and chronic heart failure were independent markers of embolic sources and detection of Atrial Fibrillation.
Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina

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Fatah, Jabir Al, and Ala'a Alshaban. "An agent-based decision support model for assessment of stroke patient transport policies: The case of choosing hospital for diagnosis." Thesis, Malmö universitet, Fakulteten för teknik och samhälle (TS), 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-20298.

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The Southern Swedish hospital region is the home of nearly 2 million people, inwhich 5,684 individuals were diagnosed by stroke during 2016, according tostatistics from the hospitals in the region. With this large number ofstroke-diagnosed patients across the region, an effective stroke transport policy isinevitably important to provide fast treatment for these patients.In this thesis, we developed an agent-based simulation model for evaluating theperformance of transport logistics policies. We followed the Design ScienceResearch methodology in order to design and develop the model. Using the model,we assessed two transport logistics policies for the Southern Swedish hospitalregion. We used a synthetic set of stroke patients, which we generated using Montecarlo simulation, for the processes of developing the model and assessing our twostroke transport logistics policies.We argue that the assessment of transport logistics policies is important for theability to improve the planning process, for example, when choosing hospital fordiagnosis of patients showing stroke symptoms. The optimization of the strokelogistics process aims to ensure the quality and operational efficiency of the hospitalsector as well as to increase the chance of survival of stroke patients.

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Sahlin, Carin. "Sleep apnea and sleep : diagnostic aspects." Doctoral thesis, Umeå : Umeå universitet, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-18959.

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Liebl, Diana Andrea [Verfasser]. "Delir auf Stroke-Unit und neurologischer Intensivstation : Analyse von Vitalparametern, Risikofaktoren und Diagnosen im klinischen Setting / Diana Andrea Liebl." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2020. http://d-nb.info/1238074170/34.

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Fordell, Helena. "Virtual Reality for Enriched Rehabilitation of Stroke Patients with Spatial Neglect : Diagnostics and the Rehabilitation Effect on Spatial Attention and Neuronal Activity." Doctoral thesis, Umeå universitet, Institutionen för farmakologi och klinisk neurovetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-141920.

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Background: Approximately a third of all stroke patients develop spatial neglect, a debilitating symptom associated with poor outcome. Spatial neglect is clinically defined as a deficit in processing and responding to stimuli presented on the contralesional side of the body, or the space surrounding that side of the body. The heterogenetic, multi-sensory nature of the symptoms renders it difficult to diagnose and treat; therefor effective methods for screening and intervention for neglect are needed. Virtual reality (VR) is a method of brain–computer interaction that involves realtime simulation of an environment, scenario or activity that allows for user interaction and targets multiple senses. We hypothesize that VR can facilitate identification of spatial neglect in stroke patients and that training with this interface will improve patient’s functional outcome, through stimulation to neuronal networks including those controlling attention. Objective: The objective was to construct and validate a computerized test battery for spatial neglect and to investigate its usability in stroke patients. Also to design and develop a VR rehabilitation method for spatial neglect and to evaluate its effects on spatial attention and on neuronal activity in the brain. Method: We designed, developed and evaluated a new concept for assessment (VR-DiSTRO®) and training (RehAtt®) of spatial attention, using VR technology. The hardware consisted of a PC, monitor, 3D-glasses and a force feedback device to control the tasks (i.e., a robotic pen). The software enabled targets to be moved, rotated and manipulated in the 3D environment using the robotic pen. RehAtt® made it possible to combine intense visual scanning training, multi-sensory stimulation (i.e., audio, visual, tactile) and sensory-motor activation of the contralesional arm. In a first study on 31 stroke patients we performed a construct validation of VR-DiSTRO® against Rivermead Behavioural Test Battery (BIT) and investigated the usability. In a second study, 15 subjects with chronic spatial neglect (symptoms >6 month) had self-training, 3 x 1 hour for 5 weeks using RehAtt®. Outcome were measured by changes in neglect tests and in Cathrine Bergego Scale (CBS). Training-related changes in neuronal activity of the brain was studied using fMRI during task and in resting state. Results: VR-DiSTRO® correctly identified all patients with neglect. The sensitivity was 100% and the specificity 82% for VR-DiSTRO® compared to BIT. Usability was high and no side-effects were noted. Using repeated measurement analysis, improvements due to the RehAtt® intervention were found for Baking tray task (p < 0.001), Star cancellation test (p = 0.006) and Extinction test (p = 0.05). Improvements were also seen in the Posner task as fewer missed targets (p = 0.024). Improvement in activities of daily living (CBS) was shown immediately after training (p < 0.01) and patients still reported improvement at 6 months follow-up. Trainingrelated changes in neuronal activity were seen as an increased task-evoked brain activity in prefrontal and temporal cortex, mainly outside the attention network but in related cortical areas. During resting state, changes in network connectivity were seen after intervention with RehAtt® in the Dorsal Attention Network (DAN) and interhemispheric connectivity. Conclusion: VR-DiSTRO® identified visuospatial neglect in stroke patients quickly and with a high accuracy. RehAtt® training improved in spatial attention in chronic neglect with transfer to functions in daily living. Increased neuronal brain activity was found in and between attention networks and related brain structures. This could represent a compensatory effect in addition to sign of a restorative effect from the RehAtt training. The results obtained in this study are promising, encourage further development of the methods and merit for further studies.

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Chueh, Juyu. "Mechanical Flow Restoration in Acute Ischemic Stroke: A Model System of Cerebrovascular Occlusion: A Dissertation." eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/493.

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Stroke is the third most common cause of death and a leading cause of disability in the United States. The existing treatments of acute ischemic stroke (AIS) involve pharmaceutical thrombolytic therapy and/or mechanical thrombectomy. The Food and Drug Administration (FDA)-approved recombinant tissue plasminogen activator (tPA) administration for treatment of stroke is efficacious, but has a short treatment time window and is associated with a risk of symptomatic hemorrhage. Other than tPA, the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever system and the Penumbra Aspiration system are both approved by the FDA for retrieval of thromboemboli in AIS patients. However, the previous clinical studies have shown that the recanalization rate of the MERCI system and the clinical outcome of the Penumbra system are not optimal. To identify the variables which could affect the performance of the thrombectomy devices, much effort has been devoted to evaluate thrombectomy devices in model systems, both in vivo and in vitro, of vascular occlusion. The goal of this study is to establish a physiologically realistic, in vitro model system for the preclinical assessment of mechanical thrombectomy devices. In this study, the model system of cerebrovascular occlusion was mainly composed of a human vascular replica, an embolus analogue (EA), and a simulated physiologic mock circulation system. The human vascular replica represents the geometry of the internal carotid artery (ICA)/middle cerebral artery (MCA) that is derived from image data in a population of patients. The features of the vasculature were characterized in terms of average curvature (AC), diameter, and length, and were used to determine the representative model. A batch manufacturing was developed to prepare the silicone replica. The EA is a much neglected component of model systems currently. To address this limitation, extensive mechanical characterization of commonly used EAs was performed. Importantly, the properties of the EAs were compared to specimens extracted from patients. In the preliminary tests of our model system, we selected a bovine EA with stiffness similar to the thrombi retrieved from the atherosclerotic plaques. This EA was used to create an occlusion in the aforesaid replica. The thrombectomy devices tested included the MERCI L5 Retriever, Penumbra system 054, Enterprise stent, and an ultrasound waveguide device. The primary efficacy endpoint was the amount of blood flow restored, and the primary safety endpoint was an analysis of clot fragments generated and their size distribution. A physiologically realistic model system of cerebrovascular occlusion was successfully built and applied for preclinical evaluation of thrombectomy devices. The recanalization rate of the thrombectomy device was related to the ability of the device to capture the EA during the removal of the device and the geometry of the cerebrovasculature. The risk of the embolic shower was influenced by the mechanical properties of the EA and the design of the thrombectomy device.

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Hingot, Vincent. "Development of ultrasound localization microscopy to measure cerebral perfusion during stroke : a study in mouse models prior to its translation in humans." Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS562.

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L’échographie est une technique d’imagerie médicale employant des ultrasons. Un examen classique se base sur deux modes principaux, le mode B pour l’imagerie anatomique et le mode Doppler pour l’imagerie des flux sanguins.Dans le contexte des maladies cérébro-vasculaires, l’échographie sert principalement à estimer les altérations du flux sanguin dans les artères cérébrales majeures au travers du Doppler transcranien. Cependant, la faible qualité des images à travers le crâne ne permet pas à l’échographie d’être aussi performante que l’imagerie par résonance magnétique.Les récents progrès en échographie ont permis l’émergence de nouveaux modes d’imagerie, en particulier une technique de super-résolution ultrasonore qui permet d’augmenter la résolution ainsi que le contraste de l’imagerie vasculaire. Elle se base sur l’imagerie rapide de microbulles couramment utilisées comme agents de contraste pour l’échographie. En utilisant cette méthode, il a été possible d’imager jusqu’aux plus petits vaisseaux et permettrait chez l’homme l’imagerie de la perfusion cérébrale de manière plus performante que le Doppler transcranien. Cela pourrait rendre possible une prise en charge plus précoce et plus efficace des patients victimes d’accidents vasculaires cérébraux. Avant d’être utilisée dans un contexte médical, la technique de super-résolution ultrasonore doit être mieux comprise, mieux réalisée, et adaptée au contexte particulier des accidents vasculaires cérébraux. En particulier, ce manuscrit discutera des meilleures méthodes de formation d’image, et se penchera sur les performances réelles de l’imagerie super résolue. Nous discuterons également des possibilités de corriger les artefacts dus aux mouvements physiologiques et des possibilités d’utiliser l’imagerie super résolue dans divers organes et en particulier les reins, les tumeurs et la moelle épinière. L’étude approfondie par imagerie super résolue de modèles d’ischémie cérébrale chez le rongeur permettra de construire des biomarqueurs vasculaires adaptés au diagnostic des pathologies cérébro-vasculaires et devrait aider la translation vers des patients humains
Ultrasonography is a medical imaging technique that uses ultrasound. A typical examination is based on two main modes, B-mode for anatomical imaging and Doppler mode for blood flowimaging. In the context of cerebrovascular diseases, ultrasonography is used primarily to estimate alterations in blood flow in major cerebral arteries through transcranial Doppler. However, the low quality of the images through the skull does not allow ultrasound to be as efficient as magnetic resonance imaging. Recent advances in ultrasound have led to the emergence of new modes of imaging, particularly a super-resolution ultrasound technique that increases the resolution and contrast of vascular imaging. It is based on the rapid imaging of microbubbles commonly used as contrast agents for ultrasound. This method has shown that it can image even the smallest vessels and allows to perform cerebral perfusion imaging more effectively than Transcranial Doppler. This would allow earlier and more effective management of stroke patients. Before being used in a medical context, this ultrasound super-resolution technique must be better understood, better realized, and adapted to the particular context of cerebrovascular diseases. In particular, this manuscript will discuss how to best form images, and will look at the actual performance of super-resolved imaging. We will also discuss the possibilities of correcting artefacts due to physiological movements and the possibilities of using super-resolved imaging in various organs, particularly the kidneys, tumors and spinal cord. Finally, imaging of models of cerebral ischemia in rodents will enable the construction of vascular biomarkers suitable for the diagnosis of cerebrovascular pathologies and should aid translation into human patients

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Brand, Jannik [Verfasser]. "Präklinische Diagnostik und Therapie in einer Mobilen Stroke Unit zur Verkürzung der Zeit bis zur intravenösen Thrombolyse beim akuten ischämischen Schlaganfall / Jannik Brand." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2020. http://d-nb.info/1219507865/34.

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Msayib, Yunus. "Quantifying impaired metabolism following acute ischaemic stroke using chemical exchange saturation transfer magnetic resonance imaging." Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:a98323ce-5998-436d-bca4-09df549cf191.

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In ischaemic stroke a disruption of cerebral blood flow leads to impaired metabolism and the formation of an ischaemic penumbra in which tissue at risk of infarction is sought for clinical intervention. In stroke trials, therapeutic intervention has largely been based on perfusion-weighted measures, but these have not been shown to be good predictors of tissue outcome. The aim of this thesis was to develop analysis techniques for magnetic resonance imaging (MRI) of chemical exchange saturation transfer (CEST) in order to quantify metabolic signals associated with tissue fate in patients with acute ischaemic stroke. This included addressing robustness for clinical application, and developing quantitative tools that allow exploration of the in-vivo complexity. Tissue-level analyses were performed on a dataset of 12 patients who had been admitted to the John Radcliffe Hospital in Oxford with acute ischaemic stroke and recruited into a clinical imaging study. Further characterisation of signals was performed on stroke models and tissue phantoms. A comparative study of CEST analysis techniques established a model-based approach, Bloch-McConnell model analysis, as the most robust for measuring pH-weighted signals in a clinical setting. Repeatability was improved by isolating non-CEST effects which attenuate signals of interest. The Bloch-McConnell model was developed further to explore whether more biologically-precise quantification of CEST effects was both possible and necessary. The additional model complexity, whilst more reflective of tissue biology, diminished contrast that distinguishes tissue fate, implying the biology is more complex than pH alone. The same model complexity could be used reveal signal patterns associated with tissue outcome that were otherwise obscured by competing CEST processes when observed through simpler models. Improved quantification techniques were demonstrated which were sufficiently robust to be used on clinical data, but also provided insight into the different biological processes at work in ischaemic tissue in the early stages of the disease. The complex array of competing processes in pathological tissue has underscored a need for analysis tools adequate for investigating these effects in the context of human imaging. The trends herein identified at the tissue level support the use of quantitative CEST MRI analysis as a clinical metabolic imaging tool in the investigation of ischaemic stroke.

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Maier, Martina. "The Principles of advanced virtual reality-based neurorehabilitation how the training in virtual reality and based on principles can support the recovery and diagnosis of disabilities after stroke." Doctoral thesis, Universitat Pompeu Fabra, 2020. http://hdl.handle.net/10803/669676.

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The increase in stroke survivors poses a global challenge for the current health care system. The way that standard therapy is provided today impacts long-term disability and dependency in ADL insufficiently. The associated need for long-term care and the increase in health-care costs hence demand for novel therapeutic approaches. For this reason, we need to obtain gain a better understanding of the manifold consequences and the recovery process after stroke. In this dissertation we will advance the idea that besides increasing the intensity other factors need to be considered. Rehabilitation must incorporate learning strategies that induce recovery by changing the impaired behaviour. The principles of learning can be obtained from animal and human learning neuroscientific literature. As symptoms are neurologically and behaviourally interrelated, they can be addressed by common learning methods. We argue that technology is an aptly medium to implement and test these methods. Technology-based rehabilitation systems are not only cost-efficient, scalable and accessible, but also allow us to induce virtual manipulations which enhances learning in a way that is not possible in reality. The main goal of this dissertation is to design, test and deliver advanced neuroscience-based therapies in virtual reality that exploit principles of learning. We first offer a synthesis of known principles of learning obtained from human and animal behaviour and show that VR-based systems that incorporate these principles can have a significant impact on recovery. We then explore in three studies how augmented sensorimotor performance, individualized challenges and goal-oriented embodied training in a VR-based rehabilitation system can modify behaviour to address physical, cognitive and social post-stroke consequences. Lastly, we offer two possibilities how the information gained through the VR-based training can help to understand deficits better and therefore complement diagnostics. The contribution of the scientific work presented in this dissertation is that a systematic principle-based approach that augments learning with the advantages of technology can address a variety of post-stroke deficits and advance the understanding of recovery.

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Velupandian, Uma Maheshwari. "The diagnosis of Patent Foramen Ovale, its importance in migraine, and an insight into its genetic basis." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/the-diagnosis-of-patent-foramen-ovale-its-importance-in-migraine-andan-insight-into-its-genetic-basis(d13d4a0b-b1f3-437a-899a-960015f9b33f).html.

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Background: Patent Foramen Ovale (PFO), a remnant of the foetal circulation, is emerging as a new cause of disease. It has been found to be associated with cryptogenic stroke in young adults, peripheral arterial embolism and neurological decompression sickness in divers. The detection of PFO remains a diagnostic challenge; transoesophageal echocardiogram being currently considered the ‘gold standard’. The development of a non-invasive technique is crucial for the identification of a venous-to-arterial shunt (v-aCS) which may permit paradoxical embolism. Little is known about the genetic basis of PFO and our limited knowledge is based on animal studies and gene mutations detected in patients with other cardiac septal defects. Methods: Study 1: PFO Detection and Evaluation: This study was designed to evaluate transcranial Doppler (TCD), transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE) with administration of contrast via arm and femoral veins. We then developed a standardized protocol for PFO detection and quantification using TCD. Study 2: PFO and Migraine: The PFO detection protocol developed from the first study formed the diagnostic technique to detect v-aCS in an adequately powered matched case control study to explore the association between PFO and migraine. Study 3: The Genetic basis of PFO: This study was designed to explore the genetic basis of a PFO using a candidate gene approach. Results: Study 1 - PFO Detection Study: When compared with TOE with femoral vein contrast injection as the ‘gold standard’, TCD with arm vein contrast was 100% sensitive and 97.4% specific for detecting a PFO. We defined a PFO positive (+ve) study on TCD as > 15 microbubbles entering the cerebral circulation, on TCD following arm vein injection and >16 microbubbles with a femoral contrast injection. A ‘major’ PFO+ve v-aCS was defined as >35 microbubbles with arm vein injection or >90 microbubbles with femoral vein injection. We then developed a new diagnostic pathway for PFO detection in clinical practice. Study 2 - PFO Migraine study: A significant difference in prevalence of v-aCS between migraine with aura M+A) and their matched controls was demonstrated with adjusted OR=3.72 (1.48-9.38) p=0.005 for a PFO+ve v-aCS, and a highly significant difference between M+A and controls for a ‘major’ PFO+ve v-aCS with adjusted OR = 6.38 (1.89 – 21.48) p = 0.003. There was significant association with APC resistance and migraine on thrombophilia screen. Study 3 - The PFO Genetics Study: This study detected mutations of GATA4 and NKX2-5 in both PFO+ve cases and PFO-ve controls. Two novel non synonymous mutations of GATA4, c.461T>A and c.994G>A were found only in PFO positive individuals and may be associated with a PFO. All the PFO+ve cases with a GATA4 gene mutation had a major PFO+ve v-aCSConclusion:TCD detects PFO with a sensitivity of 100% and specificity of 92.3% and is the most reliable non-invasive technique for PFO detection. When arm vein injections are used both cough and valsalva provocation is essential. There was a highly significant association between PFO+ve v- aCS and M+A, especially with a ‘major’ PFO+ve v-aCS. GATA 4 mutations though infrequent were found PFO+ve cases and all had major v-aCS.

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Brunner, Clément. "Functional ultrasound imaging (fUSi) to assess brain function in physiological and pathological conditions : application to stroke." Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB123/document.

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Depuis le milieu du XXème siècle, les techniques d’imagerie fonctionnelles ont un rôle grandissant dans notre compréhension sur les fonctions du cerveau en conditions physiologique et pathologique. Bien que l’IRMf fasse partie des techniques les plus communément utilisées pour l’imagerie du cerveau complet lors d’études préclinique et clinique, cette modalité souffre de sa résolution spatiotemporelle et sa sensibilité pour enregistrer finement les fonctions et activités cérébrales. Récemment l’imagerie fonctionnelle par ultrason (ifUS) a subi des développements permettant d’être complémentaires à l’IRMf ainsi qu’aux autres techniques d’imagerie cérébrales classiquement employées. Contrairement aux ultrasons focalisés conventionnels, l’imagerie hémodynamique proposé par l’ifUS repose sur une illumination ultrasonore plane permettant la détection des globules rouges en mouvement et la mesure de leur vitesse dans les micro-vaisseaux cérébraux. De ce fait, l’ifUS est indirectement lié à l’activité cérébrale d’où l’importance d’une meilleure compréhension des mécanismes du couplage neuro-vasculaire liant l’activité neuronale et les variations cérébrales d’apport en sang. De plus, cette technique a le potentiel pour fournir des informations précises sur les processus de certaines pathologies à la fois sur des modèles précliniques et chez l’homme. Dans un premier temps, j’exposerais mes travaux sur les récents développements techniques permettant l’ifUS in vivo (i) en condition chronique, (ii) sur l’animal éveillé, libre de mouvement et effectuant une tache comportementale et (iii) des vaisseaux capillaires chez le rongeur et l’homme. Dans un second temps, je démontrerais que l’ifUS in vivo peut fournir des informations nouvelles sur des pathologies telles que l’accident vasculaire cérébrale
Since the middle of the 20th century, functional imaging technologies are making an increasing impact on our understanding on brain functions in both physiological and pathological conditions. Even if fMRI is nowadays one of the most used tool for whole brain imaging in pre-clinical and clinical studies, it lacks sufficient spatiotemporal resolution and sensitivity to assess fine brain function and activity. Functional ultrasound imaging (fUSi) has been recently developed and presents a potential to complement fMRI and other existing brain imaging modalities. Contrary to conventional ultrasound using focus beams, fUSi relies on hemodynamic imaging based on ultrasound plane-wave illumination to detect red blood cells movement and velocity in brain micro-vessels. Consequently, the fUSi signal is indirectly related to brain activity and it is therefore important to better understand the mechanisms of the neurovascular coupling linking neural activity and cerebral blood changes. Here again, fUSi may provide relevant information about disease processes in preclinical models but also in humans. First, I will present recent technical developments allowing in vivo fUSi (i) in chronic condition, (ii) in freely moving and behaving rats and (iii) in rodents and human brain capillaries. Second, I will demonstrate how fUSi could provide new insights in brain pathologies such as stroke

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Walvick, Ronn P. "Magnetic Resonance Imaging of Neural and Pulmonary Vascular Function." Digital WPI, 2010. https://digitalcommons.wpi.edu/etd-dissertations/372.

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"Magnetic resonance imaging (MRI) has emerged as the imaging modality of choice in a wide variety experimental and clinical applications. In this dissertation, I will describe novel MRI techniques for the characterization of neural and pulmonary vascular function in preclinical models of disease. In the first part of this dissertation, experimental results will be presented comparing the identification of ischemic lesions in experimental stroke using dynamic susceptibility contrast (DSC) and a well validated arterial spin labeling (ASL). We show that DSC measurements of an index of cerebral blood flow are sensitive to ischemia, treatment, and stroke subregions. Further, we derived a threshold of cerebral blood flow for ischemia as measured by DSC. Finally, we show that ischemic lesion volumes as defined by DSC are comparable to those defined by ASL. In the second part of this dissertation, a methodology of visualizing clots in experimental animal models of stroke is presented. Clots were rendered visible by MRI through the addition of a gadolinium based contrast agent during formation. Modified clots were used to induce an experimental embolic middle cerebral artery occlusion. Clots in the cerebral vasculature were visualized in vivo using MRI. Further, the efficacy of recombinant tissue plasminogen activator (r-tPA) and the combination of r-tPA and recombinant annexin-2 (rA2) was characterized by clot visualization during lysis. In the third part of this dissertation, we present results of the application of hyperpolarized helium (HP-He) in the characterization of new model of experimental pulmonary ischemia. The longitudinal relaxation time of HP-He is sensitive to the presence of paramagnetic oxygen. During ischemia, oxygen exchange from the airspaces of the lungs to the capillaries is hindered resulting in increased alveolar oxygen content which resulted in the shortening of the HP-He longitudinal relaxation time. Results of measurements of the HP-He relaxation time in both normal and ischemic animals are presented. In the final part of this dissertation, I will present results of a new method to measure pulmonary blood volume (PBV) using proton based MRI. A T1 weighted, inversion recovery spin echo sequence with cardiac and respiratory gating was developed to measure the changes in signal intensity of lung parenchyma before and after the injection of a long acting intravascular contrast agent. PBV is related to the signal change in the lung parenchyma and blood before and after contrast agent. We validate our method using a model of hypoxic pulmonary vasoconstriction in rats."

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Дисертації з теми "Diagnosis of strokes «Strokeml»"

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