Coma of vascular aetiology: evaluation and prognosis
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Severe stroke outcomes are linked to deep coma, ischemic cause, and intraventricular hemorrhage. This study analyzed 450 CVA patients to identify key prognostic factors for better patient management.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Cerebrovascular Accident (CVA) is a leading cause of mortality and long-term disability.
- Accurate prognostic indicators are crucial for managing CVA patients and optimizing treatment strategies.
Purpose of the Study:
- To identify factors predicting poor prognosis in patients diagnosed with Cerebrovascular Accident (CVA).
- To correlate vascular risk factors, age, and coma severity with neurological disability at discharge.
Main Methods:
- Retrospective analysis of 450 CVA patients admitted to the emergency service over 3 years.
- Inclusion criteria: RLS/85 coma scale score ≥3, confirmed diagnosis (CAT, angiography, autopsy).
- Evaluation using Glasgow Coma Scale and correlation of risk factors (hypertension, diabetes) with discharge disability.
Main Results:
- Factors significantly associated with poor prognosis include coma severity (RLS/85 scale ≥4), ischemic etiology, and intraventricular hemorrhage.
- Age and vascular risk factors like hypertension and diabetes were also evaluated for their prognostic value.
Conclusions:
- Deep coma, ischemic stroke, and intraventricular hemorrhage are strong predictors of adverse outcomes in CVA patients.
- Identifying these factors aids in risk stratification and clinical decision-making for CVA management.
Abstract:
The authors have done a revision of 450 patients admitted during the last 3 years to the emergency service of the Hospital de S. José with the diagnosis of CVA. In this retrospective study were included the patients of greater than or equal to 3 degree of the RLS/85 coma scale, the diagnostic being confirmed by CAT, angiography and/or autopsy, and simultaneously evaluated by the Glasgow coma scale. The studied population was grouped into: SAH; ICH with or without ventricular drowning, cerebellar haematoma, brainstem haematoma, ischaemic CVA. The factors of vascular risk: diabetes and hypertension, the age of the patients and coma level were correlated with the degree of cerebral disability of discharge in all patients. The following factors are clearly related with bad prognosis: coma of degree greater than or equal to 4 in the RLS/85 scale; ischaemic aetiology; intraventricular haemorrhage.