PURPOSE: To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). MATERIALS AND METHODS: A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg’s funnel plot and additional the Trim and Fill method. RESULTS: Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354–0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395–3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787–1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1.187–1.976) and pneumonia (OR, 1.613; 95% CI, 1.172–2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767–1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively. CONCLUSION: General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.
Anesthesia ; Anesthesia, General ; Conscious Sedation ; Follow-Up Studies ; Humans ; Intracranial Hemorrhages ; Methods ; Mortality ; Odds Ratio ; Pneumonia ; Population Characteristics ; Publication Bias ; Stroke

Natural language processing (NLP) is a computerized approach to analyzing text that explores how computers can be used to understand and manipulate natural language text or speech to do useful things. In healthcare field, these NLP techniques are applied in a variety of applications, ranging from evaluating the adequacy of treatment, assessing the presence of the acute illness, and the other clinical decision support. After converting text into computer-readable data through the text preprocessing process, an NLP can extract valuable information using the rule-based algorithm, machine learning, and neural network. We can use NLP to distinguish subtypes of stroke or accurately extract critical clinical information such as severity of stroke and prognosis of patients, etc. If these NLP methods are actively utilized in the future, they will be able to make the most of the electronic health records to enable optimal medical judgment.

Natural language processing (NLP) is a computerized approach to analyzing text that explores how computers can be used to understand and manipulate natural language text or speech to do useful things. In healthcare field, these NLP techniques are applied in a variety of applications, ranging from evaluating the adequacy of treatment, assessing the presence of the acute illness, and the other clinical decision support. After converting text into computer-readable data through the text preprocessing process, an NLP can extract valuable information using the rule-based algorithm, machine learning, and neural network. We can use NLP to distinguish subtypes of stroke or accurately extract critical clinical information such as severity of stroke and prognosis of patients, etc. If these NLP methods are actively utilized in the future, they will be able to make the most of the electronic health records to enable optimal medical judgment.

Background: Most aneurysmal subarachnoid hemorrhages (SAHs) are accompanied by focal neurological deficits caused by a thunderclap headache. The neurological symptoms of aneurysmal SAH rarely present as vasospasm-induced cerebral ischemia.Case Report: A 51-year-old male presented to the emergency department with weakness in the left upper and lower limbs combined with dysarthria, which developed on the day of admission. An initial brain computed tomography scan revealed no clear signs of hemorrhage. However, the patient’s age (51 years) and history of thunderclap headache prompted further evaluation. Finally, the patient was diagnosed with vasospasm-induced ischemic stroke, caused by a ruptured cerebral aneurysm. Conclusion For patients with abrupt focal neurological deficits and severe thunderclap headaches, further consideration of aneurysmal rupture and the resulting vasospasm-induced cerebral ischemia may prevent the worst complications of stroke due to misdiagnosis.

Background: Most aneurysmal subarachnoid hemorrhages (SAHs) are accompanied by focal neurological deficits caused by a thunderclap headache. The neurological symptoms of aneurysmal SAH rarely present as vasospasm-induced cerebral ischemia.Case Report: A 51-year-old male presented to the emergency department with weakness in the left upper and lower limbs combined with dysarthria, which developed on the day of admission. An initial brain computed tomography scan revealed no clear signs of hemorrhage. However, the patient’s age (51 years) and history of thunderclap headache prompted further evaluation. Finally, the patient was diagnosed with vasospasm-induced ischemic stroke, caused by a ruptured cerebral aneurysm. Conclusion For patients with abrupt focal neurological deficits and severe thunderclap headaches, further consideration of aneurysmal rupture and the resulting vasospasm-induced cerebral ischemia may prevent the worst complications of stroke due to misdiagnosis.

Background: Most aneurysmal subarachnoid hemorrhages (SAHs) are accompanied by focal neurological deficits caused by a thunderclap headache. The neurological symptoms of aneurysmal SAH rarely present as vasospasm-induced cerebral ischemia.Case Report: A 51-year-old male presented to the emergency department with weakness in the left upper and lower limbs combined with dysarthria, which developed on the day of admission. An initial brain computed tomography scan revealed no clear signs of hemorrhage. However, the patient’s age (51 years) and history of thunderclap headache prompted further evaluation. Finally, the patient was diagnosed with vasospasm-induced ischemic stroke, caused by a ruptured cerebral aneurysm. Conclusion For patients with abrupt focal neurological deficits and severe thunderclap headaches, further consideration of aneurysmal rupture and the resulting vasospasm-induced cerebral ischemia may prevent the worst complications of stroke due to misdiagnosis.

OBJECTIVE: The aim of this study was to compare titanium and cobalt alloy clip induced artifacts in 16- and 64-row multislice computed tomography angiograms. METHODS: A total of 40 intracranial aneurysms in 37 patients treated using titanium or cobalt-alloy clips were enrolled in this study. Computed tomography angiography (CTA) was performed using a 16-row (12 aneurysms; cobalt-alloy clips in 8 and titanium clips in 4) or 64-row (28 aneurysms; cobalt-alloy clips in 14 and titanium clips in 14) multislice CT machine after surgical clipping. Clip-induced artifacts were divided into white and black components, and artifact sizes were quantified by measuring the areas of these components. RESULTS: The titanium clips (634.9 +/- 308.44 mm2) produced smaller artifacts than cobalt alloy clips (2,797.4 +/- 3,121.98 mm2) by CTA (p=0.006), but the mean size of titanium clip induced artifacts was smaller for 64-row (544.0 +/- 68.77 mm2) than for 16-row (953.3 +/- 279.95 mm2) multislice CTA (p=0.026). On the other hand, cobalt alloy clip related artifacts were similarly sized (64-row, 2,191.5 +/- 2,072.86 mm2 versus 16-row, 3,857.6 +/- 4,386.56 mm2, p=0.246). CONCLUSION: Titanium clips produce smaller artifacts than cobalt-alloy clips and 64-row multislice CTA reduced titanium clip-induced artifacts as compared with 16-row multislice CTA. However, cobalt-alloy clip artifacts were huge and were not reduced by the higher row CTA unit.
Alloys ; Aneurysm ; Angiography ; Artifacts ; Cobalt ; Hand ; Humans ; Intracranial Aneurysm ; Multidetector Computed Tomography ; Surgical Instruments ; Titanium