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Neurological Sciences

, Volume 40, Issue 4, pp 745–752 | Cite as

Predicting cerebral edema in ischemic stroke patients

  • Antonio MuscariEmail author
  • Luca Faccioli
  • Maria Vittoria Lega
  • Andrea Lorusso
  • Marco Pastore Trossello
  • Giovanni M. Puddu
  • Luca Spinardi
  • Marco Zoli
Original Article

Abstract

Objectives

To produce a scoring system for predicting the development of edema in ischemic stroke patients without edema on admission.

Methods

This retrospective study included 572 ischemic stroke patients (73.3 ± 13.0 years, 300 male) without signs of cerebral edema on the first CT scan, which was performed on admission. Another scan was normally performed 3 days later, and subsequently whenever needed. Edema was defined as cerebral hypodensity with compression of lateral ventricles. The main clinical, laboratory, and instrumental variables obtained during the first 24 h were related to the appearance of edema on the CT scans performed after the first one.

Results

Cerebral edema occurred in 158 patients (27.6%) after a median time of 4 days. The variables independently associated with edema development were (odds ratio, 95% CI) the following: (1) total anterior circulation syndrome (4.20, 2.55–6.93; P < 0.0001), (2) hyperdense appearance of middle cerebral artery (4.12, 2.03–8.36; P = 0.0001), (3) closed eyes (2.53, 1.39–4.60; P = 0.002), (4) vomiting (3.53, 1.45–8.60; P = 0.006), (5) lacunar cerebral syndrome (0.36, 0.17–0.77; P = 0.008); and (6) white matter lesions (0.53, 0.33–0.86; P = 0.01). Counting one positive point for the first four variables and one negative point for the last two variables, a scoring system (E-score) was built. Cerebral edema could be predicted when the score was ≥ 1 (positive predictive value 61.6%, specificity 85.3%, sensitivity 62.0%). The area under the receiver operating characteristic curve was 0.78.

Conclusions

In ischemic stroke patients, six variables obtained during the first 24 h of hospitalization were predictive of subsequent cerebral edema development.

Keywords

Brain CT scan Cerebral edema Determinants Ischemic stroke Predictors 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Stroke Unit – Medical Department of Continuity of Care and DisabilityS.Orsola-Malpighi HospitalBolognaItaly
  2. 2.Department of Medical and Surgical Sciences, Stroke Unit, S.Orsola-Malpighi HospitalUniversity of BolognaBolognaItaly
  3. 3.Diagnostic and Interventional Neuroradiology UnitS.Orsola-Malpighi HospitalBolognaItaly

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