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ABSTRACT: RATIONALE: The clinical effects of neuroprotective and/or neurorestorative therapies may vary according to location and size of the ischemic injury. Imaging techniques can be useful in stratifying patients for trials that may be beneficial against particular ischemic lesion characteristics. AIM: To test the hypothesis that the efficacy of NeuroAiD compared with placebo in improving functional outcome and reducing neurological deficit in patients with cerebral infarction of intermediate severity varies between sub-groups of patients randomized in the main Chinese Medicine Neuroaid Efficacy on Stroke study when categorized according to baseline imaging characteristics. DESIGN: This is a retrospective cohort sub-group analysis of patients who participated in the main Chinese Medicine Neuroaid Efficacy on Stroke study, a multicenter, double-blind, placebo-controlled trial that recruited 1100 patients within 72 h of ischemic stroke onset with National Institutes of Health Stroke Scale 6-14 and were randomized to either NeuroAiD or placebo taken four capsules three times daily for three months. Review of the baseline images to classify the acute stroke lesions in terms of size, location, and extent of involvement will be performed retrospectively by two readers who will remain blinded as to treatment allocation and outcomes of the subjects. STUDY OUTCOMES: The primary efficacy end-point in the main Chinese Medicine Neuroaid Efficacy on Stroke study is the modified Rankin Scale grades at three-months. Secondary efficacy end-points are the National Institutes of Health Stroke Scale score at three-months; difference of National Institutes of Health Stroke Scale scores between baseline and 10 days and between baseline and three-months; difference of National Institutes of Health Stroke Scale sub-scores between baseline and 10 days and between baseline and three-months; modified Rankin Scale at 10 days, one-month, and three-months; Barthel index at three-months; and Mini Mental State Examination at 10 days and three-months. Analysis of these primary and secondary end-points will be performed for sub-groups defined in this study after review of the baseline brain imaging: nonlacunar and lacunar, cortical and sub-cortical, hemispheric vs. brainstem, Alberta Stroke Program Early CT score <7 and 7-10, and score <8 and 8-10.
International Journal of Stroke 03/2013; · 2.38 Impact Factor
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ABSTRACT: The Canadian Neurological Scale (CNS) is one of the most reliable stroke severity assessment scales. There is a strong need for a simple and well validated stroke severity assessment scale among Thais.
To translate and perform a reliability and validity study of the Canadian Neurological Scale, Thai version (CNS-T).
Forward and backward translations of the original CNS version were independently performed. The final version of the CNS-T was prospectively tested for reliability and validity in acute ischemic stroke setting. Consecutive series of acute stroke patients were assessed by one of the six raters from three different types of healthcare providers: 2 stroke nurses, 2 internal medicine residents and 2 stroke fellows. Each patient was independently assessed twice at 3 weeks interval using video tape by all raters. Extent of infarction was measured by MRI lesion volume. Clinical outcome at 3 months was measured using modified Rankin Score (mRS). Correlation among the CNS-T and 3-mo mRS and MRI lesion volume were assessed. Inter and intra-observer reliabilities were evaluated.
A total of 38 patients were enrolled. Median CNS-T was 8.5. Intra-observer reliability demonstrated a high agreement with an intraclass correlation (ICC) of 0.99, 0.97, 0.98, 0.96, 0.93 and 0.98 for 2 stroke fellows, 2 internal medicine residents and 2 stroke nurses respectively. Inter-observer reliability between the 6 raters was excellent: ICC 0.87 (95% CI; 0.81-0.92). The Spearman rank correlation coefficient was -0.55 (p = 0.001) between the initial CNS-T score versus initial MRI lesion volume and -0.61 (p < 0.001) between the initial CNS-T score versus 3-mo mRS.
The CNS-T can be performed by trained nurses, internists and neurologists with an excellent reliability. The CNS-T is a valid and simple clinical tool for stroke severity assessment among Thais.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2013; 96 Suppl 2:S54-9.
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Vorapun Senanarong,
Kamontip Harnphadungkit, Niphon Poungvarin,
Sathit Vannasaeng,
Samut Chongwisal,
Tipa Chakorn,
Piyanuch Jamjumrus,
Atthapon Raksthaput,
Sinisa Chaichanettee,
Nuttapol Aoonkaew,
Suthipol Udompunthurak,
Rachelle S Doody,
Jeffrey L Cummings
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ABSTRACT: BACKGROUND: A strong inverse rate of illness, functional limitation, and socioeconomic status has been established in western ageing society. Functional limitation can be related to chronic diseases, disuse, cognitive decline, and ageing. Among chronic diseases in Thai population, cerebrovascular diseases, diabetes, and arthritis are common. . These factors are known to contribute to disability and quality of life in elder population. Neuropsychiatric problems, cognitive decline, dementia, and cultural issues in elderly people can alter the perception of quality of life of the elderly. METHODS: The Dementia and Disability Project in Thai Elderly (DDP) aims at comprehensively assessing community dwelling Thai elderly to understand the relationship between motor function, daily activity function, neuropsychiatric issues, cognitive function, and chronic diseases as comorbidity. The DDP is the first study to look at the prevalence and etiology of dementia, the prevalence and risk factors of mild cognitive impairment (MCI) in Thai elders, and to explore the relationship of cognition, disability, small vessel diseases and cortical degeneration from neuroimaging in Thai elderly people. 1998 Thai elders were screened in 2004--2006 and diagnosed as having MCI or dementia. 223 elders with MCI, dementia and cognitively normal elderly had brain magnetic resonance imaging (MRI) study at baseline. 319 elders from the 3 groups had blood tests to investigate the risks and possible etiologies of dementia including genetic study at baseline. RESULTS: The mean age of elders in this study is 69.51(SD=6.71, min=60, max=95) years. 689(34.9%) are men and 1284(65.1%) are women. Mean body weight was 58.36(SD=11.20) kgs. The regression model reveals that performance on gait & balance and serum triglyceride predicts activity of daily living performance (adjusted r2 = 0.280, f=2.644, p=0.003). The majority of abnormal gait in Thai elders was lower level gait disturbance. Only 1.5% (29/1952) had highest level gait disorders. 39.5% of 1964 subjects were free of chronic diseases. Treatment gap (indicating those who have untreated or inadequate treatment) of diabetes mellitus and hypertension in Thai elders in this study was 37% and 55.5% accordingly. 62.6% of Thai elders have ApoE3E3 allele. Prevalence of positive ApoE4 gene in this study is 22.85%. 38.6% of Thai elders who had MRI brain study have moderate to severe white matter lesions. CONCLUSION: The large and comprehensive set of measurements in DDP allows a wide-ranging explanation of their functional and clinical features to be investigated in relation to white matter lesions or cortical atrophy of the brain in Thai elderly population. An almost 2 year follow up time was made available to follow those with MCI and dementia and some of the cognitively normal elderly. The longitudinal design will provide great understanding of the possible contributors to disability in the elderly and to the progression of cognitive decline in Thai elders.
BMC Neurology 01/2013; 13(1):3. · 2.17 Impact Factor
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ABSTRACT: BACKGROUND: Data concerning quality of acute stroke care and outcome are scarce in developing countries. OBJECTIVE: This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand. METHODS: We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications. RESULTS: A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35). CONCLUSIONS: Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2013;
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ABSTRACT: Limited information is available on the association between the metabolic syndrome (MetS) and stroke. Whether or not MetS confers a risk greater than the sum of its components is controversial. This study aimed to assess the association of MetS with stroke, and to evaluate whether the risk of MetS is greater than the sum of its components. The Thai Epidemiologic Stroke (TES) study is a community-based cohort study with 19,997 participants, aged 45-80 years, recruited from the general population from 5 regions of Thailand. Baseline survey data were analyzed in cross-sectional analyses. MetS was defined according to criteria from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III, the American Heart Association/National Heart, Lung, and Blood Institute (revised NCEP), and International Diabetes Federation (IDF). Logistic regression analysis was used to estimate association of MetS and its components with stroke. Using c statistics and the likelihood ratio test we compared the capability of discriminating participants with and without stroke of a logistic model containing all components of MetS and potential confounders and a model also including the MetS variable. We found that among the MetS components, high blood pressure and hypertriglyceridemia were independently and significantly related to stroke. MetS defined by the NCEP (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.32-2.04), revised NCEP (OR, 2.27; 95% CI, 1.80-2.87), and IDF definitions (OR, 1.70; 95% CI, 1.37-2.13) was significantly associated with stroke after adjustment for age, sex, geographical area, education level, occupation, smoking status, alcohol consumption, and low-density lipoprotein cholesterol. After additional adjustment for all MetS components, these associations were not significant. There were no statistically significant difference (P = .723-.901) in c statistics between the model containing all MetS components and potential confounders and the model also including the MetS variable. The likelihood ratio test also showed no statistically significant (P = .166-.718) difference between these 2 models. Our findings suggest that MetS is associated with stroke, but not to a greater degree than the sum of its components. Thus, the focus should be on identification and appropriate control of its individual components, particularly high blood pressure and hypertriglyceridemia, rather than of MetS itself.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2012;
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ABSTRACT: Stroke and HIV infection are major health problems in Thailand. There is limited data regarding the etiology and risk factors of stroke in HIV-infected Thai patients.
To study the risk factors, types, and mechanisms of stroke in HIV-infected patients.
The authors reviewed records of consecutive HIV-infected patients with acute first stroke in a large urban medical center from August 1, 2009 through December 31, 2010. Age-matched controls of HIV-infected patients without stroke were consecutively recruited at a 2:1 ratio. Data collection included demographics, stroke subtypes, risk factors of stroke, and HIV disease parameters. Multiple logistic regression analysis (p < 0.05) identified factors associated with stroke in HIV-infected patients.
There were 37 subjects and 74 controls. In HIV-positive stroke patients, 81.1% were males and mean age was 50.5 years. There were 33 and 4 cases of ischemic and hemorrhagic strokes respectively. HIV infection was previously diagnosed in 70%, mean CD4 count was 287 cells/uL and 33% had CD4 counts < 200 cells/uL. Prior antiretroviral medications were used in 49%. TOAST classification of stroke was as follows: large artery atherosclerosis 2 (6.1%), small vessel occlusion 9 (27.3%), cardioembolism 2 (6.1%), other determined etiology 9 (27.3%) (vertebral artery dissection 1, anti-thrombin III deficiency 1, thrombotic thrombocytopenic purpura 1, tuberculous meningitis 4, cryptococcal meningitis 1, intravenous heroin 1) and undetermined 11 (33.2%) (incomplete evaluation 10, negative evaluation 1). Multivariate analysis demonstrated the following to be significant risk factors of stroke: smoking p = 0.001, adjusted OR 6.9 (95% CI 12.3, 21.1) and tuberculous meningitis p = 0.034, adjusted OR 11.9 (95% CI 1.2, 117.2).
Stroke etiology in HIV-infected patients is more heterogeneous than in non-immunocompromised hosts. Smoking and concurrent tuberculous meningitis were significantly associated with stroke in HIV-infected Thai patients. Further prospective cohort studies should be performed in a larger population of more severely immunocompromised patients in Thailand.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2012; 95 Suppl 2:S227-34.
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ABSTRACT: Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.
Neurology International 11/2011; 3(3):e13.
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ABSTRACT: To assess stroke prevalence and stroke risk factors in Thailand.
Thai Epidemiologic Stroke (TES) Study is an ongoing, community based cohort study that has been conducted in five geographic regions of Thailand. Baseline health status survey was started in 2004 and enrollment continued until the end of 2006. All participants who were suspicious of being stroke victims were verified. In this analysis, baseline data of 19,997 participants aged 45 to 80 years were identified and analyzed as a cross-sectional analysis.
Three hundred and seventy six subjects were proved to have a stroke thus resulting the crude prevalence of stroke to be 1.88% (95% CI, 1.69 to 2.07). Age standardization to Segi world standard population was 1.81% (95% CI, 1.62 to 1.99). Crude prevalence among adults aged > or = 65 years was 2.70% (95% CI, 2.28 to 3.11). Stroke prevalence differed among five geographic regions of the country (Bangkok 3.34%, Central region 2.41%, Southern 2.29%, Northern 1.46% and Northeastern 1.09%). Using multiple logistic regression analysis, factors associated with higher stroke prevalence were male gender (p < 0.001), occupational class (p < 0.001), geographic region (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p = 0.002) and hypercholesterolemia (p = 0.026).
Stroke prevalence in Thailand from TES study is higher than previous studies, but it is lower than developed countries, probably due to high case fatality rate in Thai population. Geographic variation in stroke prevalence is found more in Bangkok, Central and Southern regions. Longitudinal follow-up of TES cohort study will provide further information on risk factors and incidence of stroke.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 04/2011; 94(4):427-36.
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ABSTRACT: Stroke is a common cause of morbidity and mortality in adults worldwide. Because patent foramen ovale (PFO) is commonly found in normal population, we need to identify a subset of cryptogenic stroke patients who are likely to have experienced paradoxical embolization. Various factors need to be considered such as atrial anatomic variation (PFO size, atrial septal aneurysm, eustachian valve anatomy), hemodynamic parameters, presence of venous thrombosis and presence ofhypercoagulable state. The presence of any of these findings increase the chance of PFO contributing to stroke. We describe a 54-year-old patient with a history of well controlled hypertension and dyslipidemia who presented with 3 attacks of expressive aphasia lasting 5 minutes each. General medical and neurological examinations were normal. Transesophageal echocardiography with agitated saline injection revealed presence of PFO flap. Transcranial Doppler ultrasonography with three agitated saline injections showed multiple unilateral microembolism signals in the M1 of left middle cerebral artery. Aspirin was given as well as percutaneous endovascular PFO closure was performed with no immediate complication. Patient has had no further attack of stroke after 6 months follow-up.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2011; 94 Suppl 1:S264-8.
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ABSTRACT: The combination of decreased cerebrospinal fluid (CSF) levels of beta-amyloid (1-42) and increased levels of phosphorylated tau (ptau-181) or total tau protein are known to be biomarkers ofAlzheimer's disease (AD). These biomarkers can also be used as predictors of disease progression in persons with mild cognitive impairment. Utilizing biomarkers to differentiate Alzheimer's disease (AD) against non-Alzheimer dementia (non-AD) needs to be explored.
To evaluate the clinical use ofCSF biomarker: beta-amyloid (1-42), phosphorylated tau (ptau-181) and total tau protein for distinguishing Alzheimer's disease (AD) from non-Alzheimer dementia (non-AD) in Thai patients.
Thirty patients diagnosed of dementia during 2005-2007 at Siriraj hospital were offered CSF analysis for beta-amyloid (1-42), phosphorylated tau (ptau-181) and total tau protein. Diagnosis of dementia was performed by a concensus diagnostic group utilizing a standard criteria for diagnosis of AD and other dementia. All CSF testing was performed by Enzyme-Linked Immunoassay (ELISA) technique of the INNOTESTM to analyze these biomarkers.
Thirty demented patients were recruited in the study. Fourteen had AD and 16 had non-AD including 5 vascular dementia, 5 normal pressure hydrocephalus, 4 frontotemporal lobar degeneration and others. Mean age of the AD group was 67.79 (12.30) and that of non-AD group was 65.75 (15.04). Twelve AD had decreased levels of CSF /3-amyloid (1-42) (less than 487 pg/ml). Only one patient with AD had increased CSF phosphorylated tau (ptau-181) (more than 61 pg/ml). None of theAD patient had increased CSF total tau (more than 425 pg/ml). Eight patients with non-AD had decreased levels of CSF p-amyloid (1-42), one had increased CSF total tau protein, and none had increased CSF phosphorylated tau (ptau-181) protein. The sensitivity of decreased level of CSF beta-amyloid (1-42) in AD against non-AD dementia was 85.71%. Those of increased CSF total tau and phosphorylated tau (ptau-181) protein in AD against non-AD dementia were 7.14% and 0% consecutively. The specificity of decreased level of CSF beta-amyloid (1-42) in AD against non-AD dementia was 50%. The specificity of increased CSF total tau and phosphorylated tau (ptau-181) protein in AD against non-AD dementia were 100% and 93.75% sequentially. The combination of 2 biomarkers would increase specificity but decrease sensitivity.
CSF biomarker analysis should be encouraged to use as diagnostic aid in memory clinic especially to help diagnosis of atypical presentation of AD. The usefulness of longitudinal data needs to be explored.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2011; 94 Suppl 1:S77-83.
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ABSTRACT: There are limited data concerning accuracy of portable coagulometer in emergency setting. Objective: To evaluate the accuracy of the CoaguChek XS international normalized ratio (INR) monitor compared to the standard laboratory method in emergency department.
Emergency room patients who required coagulation test were recruited. Parallel INR measurements between portable coagulometer and standard laboratory were performed.
Fifty-five patients with a mean age of 59.1 +/- 15.7 years (20-87) were included. Men constituted 56.4%. Indications for testing were as follows: acute stroke 72.7%; abnormal bleeding 7.3%; taking anticoagulant 7.3%; and others 12.7%. Mean time +/- SD used from blood drawn to INR result report was 65.02 +/- 24.5 minutes for standard laboratory and 1 minute for portable coagulometer. Mean difference of INR result from portable coagulometer and standard laboratory was 0.02 +/- 0.13 and an excellence correlation between INR (r = 0.969) was demonstrated. There was no significant difference between the INR value from the two methods (p = 0.34).
The use of portable coagulometer (CoaguChek XS) in emergency setting was accurate and required less time. Acute ischemic stroke patients are likely to benefit from a timely clinical decision making for thrombolysis medication.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2011; 94 Suppl 1:S89-93.
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ABSTRACT: Relationship between high sensitivity C-reactive protein (hs-CRP), Ankle Brachial index (ABI), severity of atherosclerosis and risk of ischemic stroke has been well documented. Studies concerning the association of ABI, hs-CRP and initial disability level in acute ischemic stroke are scarce.
This study aimed to investigate the relationship between hs-CRP, ABI and level of initial disability in acute stroke setting.
We conducted a prospective observational study in patients with acute ischemic stroke within 48 hours of onset. Initial ABI, hs-CRP were measured. Disability level was assessed at admission and 3 months using the modified Rankin scale (mRS) and the National Institue of Health Stroke scale (NIHSS). Statistical analysis was performed using Pearson's correlation coefficient.
This study included 36 patients with a mean +/-SD age of 67.8 +/- 9.3 years. Sixteen (44.4%) were male. Median NIHSS and mRS were 10 and 4 respectively. Correlation between initial ABI and hs-CRP was poor (r(s) = -0.11, p = 0.57). There was a significant negative relationship between ABI and mRS at 0 and 3 months with a correlation coefficient of -0.45 (p = 0.006) and -0.41 (p = 0.02), respectively.
There was a significant inverse relationship between ABI and initial stroke disability. However, correlation coefficient indicated only fair agreement beyond chance. This findings suggest that ABI may be used as a clinical predictor of initial disability level in acute stroke.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2011; 94 Suppl 1:S94-8.
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ABSTRACT: To evaluate the efficacy, safety, and optimum dose of a highly purified Clostridium botulinum type A toxin-hemagglutinin complex (Dysport) for migraine prophylaxis.
Botulinum toxin type-A has demonstrated good efficacy in several open-label studies of patients with migraine, involving either individualized or standardized protocols, although data from placebo-controlled trials have been conflicting.
A 12-week, double-blind, randomized trial of Dysport (120 or 240 units) vs placebo was conducted in 6 centers in Thailand to evaluate the efficacy, safety, and optimum dose of botulinum toxin type-A (Dysport) for migraine prophylaxis. A total of 128 patients with migraine without aura were enrolled. The primary end point was the change in the mean number of migraine attacks per 4-week period from the pre-treatment period to 8-12 weeks post injection. Secondary efficacy measures included the change in the mean total intensity score from the pre-treatment period to 8-12 weeks, the investigator and patient global assessments of change at each visit compared with pre-treatment, and Migraine Disability Assessment and Short Form-36 scores.
Change in number of migraine attacks from pre-treatment to weeks 8-12 was not significantly different. There was a greater improvement in total intensity score at weeks 8-12 with Dysport-240 (not significant), and interim visit data showed that this was significant at weeks 0-4 (P = .03 Dysport-240 vs placebo). The mean duration of headache during weeks 0-4 was lower with Dysport-240 (P = .04 vs placebo). Improvements in patient and investigator global assessments of change between weeks 0-4 and 8-12 were significant for the Dysport-240 group (both P < .05 vs placebo).
Limitations in study design and assessment tools employed may have contributed to the inconclusive nature of the primary end point data. Dysport-240 showed significant benefit over placebo at some end points and further trials with more appropriate outcome measures are required to evaluate effectively this treatment.
Headache The Journal of Head and Face Pain 11/2010; 51(1):52-63. · 2.52 Impact Factor
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Yongchai Nilanont,
Sucheera Phattharayuttawat,
Pipat Chiewit,
Songkram Chotikanuchit,
Juljak Limsriwilai,
Lultrita Chalernpong,
Napaporn Yamkaew,
Niramol Lirathpong,
Pornpimol Anprasertporn,
Chulaluk Komoltri,
Naraporn Prayoonwiwat, Niphon Poungvarin
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ABSTRACT: The National Institute of Health Stroke Scale (NIHSS) is a well validated stroke severity assessment scale. The scale is used to assess neurological deficits, progression and degree of recovery in acute stroke settings. To date, no Thai version exists.
This study aimed to adapt and validate a Thai version of the NIHSS (NIHSS-T).
A cross-cultural adaptation of the NIHSS was developed according to the methods recommended by the International Quality of Life Assessment Project Group. Forward and backward translations were performed. A final version of the NIHSS-T was validated against initial MRI infarction volume and modified Rankin Scale (mRS) at 3 months in a consecutive series of acute stroke patients. The patients were prospectively evaluated by 3 different types of health care providers: 2 stroke fellows, 2 internists, and 2 stroke nurses. Mean NIHSS-T scores from all raters were used in the analysis.
The study included 32 acute ischemic stroke patients with a mean age (+/- SD) of 64.53 +/- 14.97 years of age. Men comprised 71.9%. Mean NIHSS-T score (+/- SD) was 7.49 +/- 7.02. Intra-observer reliability demonstrated a high agreement with an intraclass correlation (ICC) of 0.98, 0.98, 0.96, 0.98, 0.90 and 0.98 for 2 stroke fellows, 2 internists and 2 stroke nurses respectively. Inter-observer reliability between 6 raters was excellent, i.e.; ICC, 0.99 (0.98, 0.99). Spearman rank correlation coefficients between the initial NIHSS-T score versus initial MRI lesion volume and mRS at 3 months were 0.53 and 0.69 with a p-value of 0.002 and < 0.001 respectively.
The Thai version of NIHSS is valid for assessing acute stroke severity. The scale is also reliable when administered in a Thai-speaking setting by trained healthcare professionals.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 01/2010; 93 Suppl 1:S171-8.
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ABSTRACT: The Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) are among the most reliable stroke severity assessment scales. The CNS requires less extensive neurological evaluation and is quicker and simpler to administer.
Our aim was to develop and validate a simple conversion model from the CNS to the NIHSS.
A conversion model was developed using data from a consecutive series of acute-stroke patients who were scored using both scales. The model was then validated in an external dataset in which all patients were prospectively assessed for stroke severity using both scales by different observers which consisted of neurology residents or stroke fellows.
In all, 168 patients were included in the model development, with a median age of 73 years (20-94). Men constituted 51.8%. The median NIHSS score was 6 (0-31). The median CNS score was 8.5 (1.5-11.5). The relationship between CNS and NIHSS could be expressed as the formula: NIHSS = 23 - 2 x CNS. A cohort of 350 acute-stroke patients with similar characteristics was used for model validation. There was a highly significant positive correlation between the observed and predicted NIHSS score (r = 0.87, p < 0.001). The predicted NIHSS score was on average 0.61 higher than the observed NIHSS score (95% CI = 0.31-0.91).
The CNS can be reliably converted to the NIHSS using a simple conversion formula: NIHSS = 23 - 2 x CNS. This finding may have a practical impact by permitting reliable comparisons with NIHSS-based evaluations and simplifying the routine assessment of acute-stroke patients in more diverse settings.
Cerebrovascular Diseases 01/2010; 30(2):120-6. · 2.72 Impact Factor
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Niphon Poungvarin,
Naraporn Prayoonwiwat,
Disya Ratanakorn,
Somchai Towanabut,
Tassanee Tantirittisak,
Nijasri Suwanwela,
Kamman Phanthumchinda,
Somsak Tiamkoa,
Siwaporn Chankrachang,
Samart Nidhinandana,
Somsak Laptikultham,
Sansern Limsoontarakul,
Suthipol Udomphanthuruk
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ABSTRACT: Prognosis of cerebral venous sinus thrombosis (CVST) has never been studied in Thailand. A simple prognostic score to predict poor prognosis of CVST has also never been reported. The authors are aiming to establish a simple and reliable prognostic score for this condition.
The medical records of CVST patients from eight neurological training centers in Thailand who received between April 1993 and September 2005 were reviewed as part of this retrospective study. Clinical features included headache, seizure, stroke risk factors, Glasgow coma scale (GCS), blood pressure on arrival, papilledema, hemiparesis, meningeal irritation sign, location of occluded venous sinuses, hemorrhagic infarction, cerebrospinal fluid opening pressure, treatment options, length of stay, and other complications were analyzed to determine the outcome using modified Rankin scale (mRS). Poor prognosis (defined as mRS of 3-6) was determined on the discharge date.
One hundred ninety four patients' records, 127 females (65.5%) and mean age of 36.6 +/- 14.4 years, were analyzed Fifty-one patients (26.3%) were in the poor outcome group (mRS 3-6). Overall mortality was 8.4%. Univariate analysis and then multivariate analysis using SPSS version 11.5 revealed only four statistically significant predictors influencing outcome of CVST They were underlying malignancy, low GCS, presence of hemorrhagic infarction (for poor outcome), and involvement of lateral sinus (for good outcome). Thai venous stroke prognostic score (TV-SPSS) was derived from these four factors using a multiple logistic model.
A simple and pragmatic prognostic score for CVST outcome has been developed with high sensitivity (93%), yet low specificity (33%). The next study should focus on the validation of this score in other prospective populations.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 11/2009; 92(11):1413-22.
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ABSTRACT: Serious delayed encephalopathy and cognitive sequelae following acute carbon monoxide intoxication constitutes a rare and a distinct entity. A case of delayed encephalopathy and cognitive sequelae after acute carbon monoxide poisoning is presented. The patient is a 50-year-old Thai female with a history of carbon monoxide poisoning during her vacation tour in Arizona in winter. She developed encephalopathy 4 weeks after recovery from the acute stage. Her MRI-brain found abnormal white matter change of cerebral hemispheres bilaterally and abnormal signal intensity at both putamens and caudate nuclei. She regained some improvement in her memory and other cognitive function after 4 weeks of treatment including hyperbaric oxygen therapy (HBOT).
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2009; 92(10):1374-9.
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ABSTRACT: The purpose of this study was to explore factors that influence the clinical safety and tolerability associated with galantamine administration in Thai Alzheimer's disease patients with or without cerebrovascular disease and vascular dementia. This was an analysis of previous study. Tolerability and safety profile were analyzed according to sex, age, body weight, Thai mental state examination (TMSE) score, Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) score, and Alzheimer's disease cooperative study/activities of daily living (ADCS/ADL) score. The most common adverse events were nausea, dizziness, and weight loss which more often occurred during the dose-escalation phase. Mean body weight lost at week 24 was 0.9 kg. Sex, age, body weight, and ADAS-cog score did not influence the incidence of any adverse events. Dizziness was more likely to occur in patients with low TMSE and high ADCS/ADL score (p = 0.02 and p = 0.050, respectively). Patients with TMSE score equal or higher than 23 more often experienced muscle cramps and fatigue than who had TMSE lower 23 (p < 0.05). However, flexible dose escalation of galantamine with a 4-week schedule was safe and well tolerated in Thai AD patients.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 04/2009; 92 Suppl 2:S12-8.
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ABSTRACT: To analyze CT findings in hemorrhagic stroke patients correlation with clinical outcome and assess the interobserver agreement of hemorrhagic stroke identification on CT imaging.
CT imaging features of 131 cases and clinical data were verified and collected at Siriraj Hospital from Jan 2004 to Dec 2005 and retrospectively analyzed for type, location, mass effect, size of hemorrhage, intraventricular extension, initial level of consciousness (GCS), hospital length of stay and patient outcome. The percentages, predictive values, kappa were calculated.
From all types of hemorrhagic stroke, intracerebral hemorrhage remains a common and devastating clinical problem. The most common site was the thalamus and basal ganglia. In the present study, the authors found that fifty-three cases (53/131 cases, 40.5%) with thalamic-ganglionic hemorrhage, nineteen cases (19/131 cases, 14.5%) in lobar hemorrhage, five cases (5/131 cases, 3.8%) in cerebellum, five cases (5/131 7 cases, 3.8%) in brainstem and eight cases (8/131 cases, 6.1%) occurred in multiple locations. There were twenty-five cases (25/131 cases, 19.1%) of subarachnoid hemorrhage, thirteen cases (13/131 cases, 9.9%) of subdural hemorrhage and three cases (3/131 cases, 2.3%) of intraventricular hemorrhage. Two variables on CT imaging, identified as significant as early mortality predictors, were hematoma volume more than 60 cm3, and presence of intraventricular hemorrhage extension (p < 0.05). The mass effect defined as midline and/or enlargement of contralateral ventricle was not significant (p = 0.067). The present study found concordance between CT brain interpretation by two neuroradiologists for the type of hemorrhagic stroke was very good, Kappa = 0.861 as well as for location was 0.866.
CT imaging is an imaging instrument for early identification of hemorrhagic stroke patients and providing imaging evidence of high mortality risk.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 01/2009; 92(1):73-86.
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ABSTRACT: To study the effect of Galantamine on sleep quality in Thai Alzheimer's disease (AD) patients with or without cerebrovascular disease.
A 6 month, multicenter open-label, uncontrolled trial was undertaken in 75 mild to moderate Alzheimer's disease patients with or without cerebrovascular disease. Eligible patients received a flexible-dose of Galantamine 16 or 24 mg/day for 24 weeks. The Pittsburgh Sleep Quality Index (PSQI) with self-analysis questionnaires were used to evaluate sleep quality. Analyses were based on the intent-to-treat population.
Seventy-five eligible patients with mild to moderate Alzheimer's disease with or without cerebrovascular disease (male:female = 32:43, age range 74.5 +/- 0.9) were included and 58 patients (79%) completed the present study. The global PSQI scores showed some improvement over baseline (week 0 = 5.10 +/- 3.08, week 4 = 4.37 +/- 2.48, week 8 = 4.65 +/- 2.71, week 24 = 3.70 +/- 2.12) but were not yet statistical significant. In contrast, most of each component scores such as sleep quality, sleep latency, sleep duration, sleep disturbances, sleep medication, and daytime dysfunction except sleep efficiency, showed significant differences from baseline after week 8. Moreover, there were no significant differences in global PSQI and component scores between mild and moderate stages of Thai AD patients or between men and women patients.
The result of the present study may be consistent with Galantamine being safe and can maintain good sleep quality for mild to moderate Thai AD patients with or without VaD. Galantamine doses of 16-24 mg/day were well tolerated.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 10/2008; 91(9):1343-9.
