. Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, Pefanis AV, Mountokalakis TD (Sotiria Hospital, Athens, Greece). A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med 2002; 252: 121–129.



Purpose. To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking.



Methods. Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end-point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study).



Results. Amongst 235 patients (119 males, mean age 70.6 ± 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer-based scoring system: number of points=6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 ± 10.8 years, 31 (18.5%) with ICH], when the cut-offs ≤3 points for CIF and ≥11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems.



Conclusions. The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2796.2002.01013.x

A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Posterior reversible encephalopathy syndrome is a disorder of reversible subcortical vasogenic brain edema in the context of different diseases or exposure to cytotoxic drugs such as fludarabine. We present the case of a pediatric patient with β-thalassemia who develops a fludarabine-induced posterior reversible encephalopathy while he received an induction regimen to achieve an allogenic hematopoietic cell transplantation. The clinical presentation consists in altered mental state, headache, status epilepticus, visual disturbance, and hypertension. His treatment was carried out with the suspension of the medication and the control of hypertension and status epilepticus; the final outcome was positive without additional complications. There are published reports about fludarabine toxicity in the central nervous system with different doses of the drug in different clinical context. We also made a review of the literature available and conclude that fludarabine is not an extraordinary cause of posterior reversible encephalopathy syndrome.

Fludarabine-Induced Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With β-Thalassemia: Case Report and Literature Review.

India has predominantly poor rural population where brain CT scan, most often advised investigation in patients of stroke, may not always be available, hence Indian physician in such setting base his diagnosis on bed side sign evaluation for which Siriraj Stroke Score (SSS) could be helpful. Objective of study: to assess the utility of SSS in patients of stroke. Methodology: sixty subjects of stroke were evaluated on SSS and 'probable' diagnosis so made was compared with CT scan's (brain) 'certain' diagnosis. Main findings: by using SSS, the probable bedside diagnosis was cerebral infarct (score +1) in 24 subjects while 4 subjects had indeterminant score (-1 to +1). Fifty subjects had their probable diagnosis matched with brain CT scan certain diagnosis. The above findings showed that SSS had 93.7% sensitivity, 76.6% specificity, 81.2% positive predictive value, 92% negative predictive value with an overall accuracy as 93.7% for diagnosis of cerebral infarction. For patients of cerebral haemorrhage the sensitivity was 83.3%, specificity was 92.5%, positive predictive value was 86.9%, negative predictive values was 92.5% with overall accuracy as 83.3%. Principal conclusion: physicians in the rural settings may find SSS to be quite useful in the management of stroke especially where more sophisticated radiological investigations may not be available for confirmation of diagnosis due to high cost or attended due to transportation risk. (Med J Indones 2007; 10: 164-8) Keywords: stroke, cerebrovascular accident, infarction, haemorrhage

/pdf/assessment-of-utility-of-siriraj-stroke-score-sss-in-stroke-13h8759q6q.pdf

Assessment of utility of Siriraj Stroke Score (SSS) in stroke patients of Pt. BD Sharma PGIMS hospital, Rohtak, India

Stroke scoring systems

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A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke

Fludarabine-Induced Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With β-Thalassemia: Case Report and Literature Review.

Assessment of utility of Siriraj Stroke Score (SSS) in stroke patients of Pt. BD Sharma PGIMS hospital, Rohtak, India