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Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury
Published on: November 9, 2018
¿Este paciente está teniendo un derrame cerebral?
Larry B Goldstein1, David L Simel
1Department of Medicine, Duke Center for Cerebrovascular Disease, Durham, NC 27710, USA. golds004@mc.duke.edu
JAMA
|May 19, 2005
Resumen
La evaluación precisa del accidente cerebrovascular se basa en los hallazgos del examen neurológico. Centrarse en la paresis facial, la deriva del brazo y el habla puede mejorar la precisión del diagnóstico para el accidente cerebrovascular y el ataque isquémico transitorio.
Área de la Ciencia:
- Neurología Neurología.
- Precisión en el diagnóstico.
- Examen clínico El examen clínico.
Sus antecedentes:
- La evaluación precisa de la sospecha de accidente cerebrovascular o ataque isquémico transitorio (AIT) es crucial para el tratamiento oportuno y la prevención secundaria.
- Una revisión sistemática anterior de 1994 destacó la importancia de la evaluación clínica.
Objetivo del estudio:
- Revisar y actualizar sistemáticamente la evidencia sobre la precisión y confiabilidad de los síntomas clínicos y los hallazgos del examen neurológico para el diagnóstico de accidente cerebrovascular y AIT.
- Proporcionar datos actualizados de precisión diagnóstica para los médicos que manejan pacientes con sospechas de eventos cerebrovasculares.
Principales métodos:
- Se realizó una búsqueda exhaustiva de la literatura para los artículos publicados entre 1994 y 2005.
- Los estudios seleccionados proporcionaron datos primarios sobre la precisión (sensibilidad, especificidad, ratios de probabilidad) y / o confiabilidad (estadísticas kappa) de los hallazgos clínicos para el diagnóstico de accidente cerebrovascular.
- El diagnóstico final en los estudios incluidos fue confirmado por neuroimagen y pruebas de laboratorio.
Principales resultados:
- La presencia de paresis facial aguda, deriva del brazo o un habla anormal aumenta significativamente la probabilidad de accidente cerebrovascular (LR + = 5,5).
- La ausencia de estos tres hallazgos disminuye la probabilidad de accidente cerebrovascular (LR- = 0,39).
- Los síntomas específicos como cambios repentinos en el habla, pérdida visual y debilidad mostraron un alto acuerdo diagnóstico (kappa = 0.60); escalas estandarizadas como la Escala de Accidentes Cerebrovasculares de los NIH pueden mejorar la confiabilidad.
Conclusiones:
- La historia clínica y el examen neurológico siguen siendo fundamentales para evaluar a los pacientes con sospecha de accidente cerebrovascular.
- Una evaluación enfocada de paresis facial, deriva del brazo y anomalías del habla puede mejorar la precisión y confiabilidad del diagnóstico en la evaluación del accidente cerebrovascular.
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