OBJECTIVE: To investigate the clinical, radiological and electroencephalographic characteristics among patients diagnosed with viral encephalitis and correlate these with functional outcome.
METHODOLOGY: Twenty-eight adult and 32 pediatric viral encephalitis patients in a tertiary hospital were investigated by thorough chart reviews. Outcome was assessed using the Modified Rankin Scale, with score of 0-2 as good outcome and score of 3-6 as poor outcome. Data were analyzed employing chi-square tests (p value 0.05) and multiple logistic regression analysis.
RESULTS: The mean age of patients was 20.2 +/- 16.5 years. There were 31 male and 29 female subjects. History of focal seizures was present in 30 percent of patients, while generalized tonic-clonic type in 63 percent of cases. Twelve percent of the population had status epilepticus. The mean Glasgow Coma Score (GCS) on admission was 11 (range, 4 to 15) Abnormal EEG was present in 84 percent of cases; findings were predominantly generalized slowing of the background activity. CT scan abnormalities were found in 67 percent of patients and these were mainly diffuse cerebral edema and low density lesions, majority involving the frontotemporal region. A total of 39 (67 percent) patients had good outcome and 19 (33 percent) had poor outcome on discharge. Of the 33 patients who had follow up at three months, 31 (94 percent) had good outcome and 2 (6 percent) had poor outcome On univariate analysis, the following factors were correlated with poor outcome on discharge: 1) Age /- 5 years (p On multiple logistic regression analysis, EEG patterns of epileptiform discharges and severe generalized slowing, as well as concomitant infection, were found to have correlation with poor outcome on discharge Of the 32 patients who had serologic tests for HSV, 17 (53 percent) was positive. Modified Rankin Scale scores on discharge and at three months did not differ between HSV-positive and HSV-negative patients (p values, 0.96 and 0.83, respectively). Case fatality rate for herpes encephalitis was 5.88 percent.
CONCLUSION: Age, GCS in the acute phase and the history of status epilepticus could influence the mortality and morbidity of the patients. Moreover, this study has demonstrated the prognostic significance of EEG patterns in viral encephalitis as they correlate with functional outcome on discharge.

Human ; Male ; Female ; Adult ; Seizures ; Encephalitis, Herpes Simplex ; Brain Edema ; Coma ; Status Epilepticus ; Encephalitis, Viral ; Prognosis ; Electroencephalography ; Tomography, X-ray Computed

BACKGROUND: Surgical management of patients with thalamic hemorrhage lacks evidence of benefit
GENERAL OBJECTIVE: To compare the outcomes of patients with thalamic hemorrhage managed surgically and non-surgically, and to determine the predictors of mortality
SPECIFIC OBJECTIVES: To describe baseline demographic and clinical characteristics of patients with thalamic hemorrhage, determine which are predictors of mortality, and to compare the mortality rate of those managed surgically and non-surgically
METHODOLOGY: Data from patients with thalamic hemorrhage admitted within July 1, 2000 to June 30, 2003 were recorded. Univariate and multivariate analyses were done using SPSS for Windows v9.0. P0.05 was considered significant.
RESULTS AND CONCLUSIONS: Among 119 patients, average age was 58 years, predominantly males (68.3 percent), hypertensive (90.8 percent) and had IVE (79 percent). Obstructive hydrocephalus was present in 43.7 percent. Most common sign and symptom was hemiparesis. Prognostic factors significantly associated with mortality were GCS 12 (p30 cc (p=0.023), presence of obstructive hydrocephalus (p=0.003), hypertension (p=0.005) and ischemic heart disease (0.009). Patients in the surgical arm had a higher mortality rate (65 percent vs 37 percent), but surgery was not shown to be a significant predictor of mortality (p=0.23). The poorer outcome in surgical patients may be secondary to their having lower GCS scores, bigger hematoma sizes and greater frequency of hydrocephalus.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Multivariate Analysis ; Arm ; Hydrocephalus ; Hypertension ; Coronary Artery Disease ; Cerebral Hemorrhage ; Hematoma ; Paresis ; Demography ; Prognosis

BACKGROUND AND OBJECTIVE

A growing body of evidence supports that inflammatory mechanisms are involved in secondary brain injury after intracerebral hemorrhage (ICH) which has implications on the morbidity and mortality of stroke patients. Neutrophil-to-lymphocyte ratio (NLR) is a comprehensive index marker of inflammation and immune status of a patient. The prognostic value of NLR in predicting in-hospital mortality and functional outcome of patients with spontaneous intracerebral hemorrhage will be assessed in this study.

METHODS

We retrospectively selected 151 hemorrhagic stroke patients, and demographic and clinical characteristics were collected and computed for NLR. Receiver operating characteristic analysis using Youden’s index was utilized to determine the NLR cut-off value with the best sensitivity and specificity. The association of NLR with the inhospital mortality and functional outcome was assessed using Logistic regression analysis. Pearson Product Model Correlation was employed to evaluate the correlation of NLR with ICH volume.

RESULTS

Admission NLR >7 showed a significant association (p = <0.001 OR 7.99) with in-hospital mortality with a sensitivity of 70.83% and specificity of 72.82%. Furthermore, computed NLR of more than 6.4 showed significant association (p = 0.040 OR 2.92) with poor functional outcome. However, our study revealed that admission NLR showed a low level of correlation (r=0.2968, p=0.002) with the volume of ICH.

CONCLUSION

This study demonstrated that ICH patients with an elevated NLR is associated with increased inhospital mortality and poor functional outcome and that NLR can be used to predict clinical outcome among patients with spontaneous ICH.

Cerebral Hemorrhage ; Intracerebral Hemorrhage ; Hospital Mortality ; In-hospital Mortality

Background: Various epidemiologic studies reported different stroke incidence and prevalence rates in the Philippines. Thus, there is a need to synthesize existing information on these indicators to depict more accurate evidence on the burden on stroke in the country. Objective: The objective of this systematic review is to provide evidence on the incidence and prevalence of stroke in the Philippines, as well as its associated risk factors. Methods: PubMed and HERDIN were searched for available full-text Philippine epidemiologic studies on stroke incidence and prevalence, whether population or hospital-based, and its associated risk factors. We used three tools for risk of bias assessment, namely, the Newcastle Ottawa Scale for cohort studies, the Quality assessment checklist of Hoy et al. for cross-sectional prevalence studies, and the AXIS tool for general cross-sectional studies. Results: A total of 14 studies were included in this review. Based on these studies, the national stroke incidence rate ranged from 3.95% to 5.61%, while the national stroke prevalence rate ranged from 0.486% to 6.0%. Hypertension remains the commonly reported risk factor of stroke alongside diabetes, smoking, and high cholesterol level. Conclusions Despite limitations, we were able to perform a complete assessment of the risk of bias in included studies which provide information on the studies with reliable information. Based on this systematic review, there is variability on data and limited studies on the national epidemiology of stroke in the Philippines. It is recommended that the national government consider establishing a system such as a national registry for better data collection and analysis.
Systematic Review ; Stroke ; Prevalence ; Incidence ; Epidemiology

Endovascular thrombectomy (EVT) has revolutionized the management of acute ischemic stroke (AIS) caused by large-vessel occlusion, significantly improving outcomes worldwide. This single-center case series evaluated the early outcomes of EVT in AIS patients treated at this institution, focusing on its implications within a low- or middleincome country setting. The study aimed to assess the feasibility, safety, and efficacy of EVT, analyzing premorbid comorbidities, time to treatment, revascularization rates, procedural complications, and clinical outcomes. Five consecutive cases of AIS due to large-vessel occlusion treated with EVT were analyzed. The patients in this series were aged 21 to 75 years, all with a baseline modified Rankin Scale (mRS) score of 0. The average NIH Stroke Scale (NIHSS) score on admission was 17. Four patients received Alteplase before EVT within four hours of symptom onset. Successful recanalization (TICI 2b-3) was achieved in all cases. Post-thrombectomy, two patients developed re-occlusion, with one resulting in mortality. Among the patients, 40% achieved a favorable outcome, defined as a modified Rankin Scale (mRS) score of 2 at three months. This initial experience demonstrates promising results in achieving successful recanalization and improving clinical outcomes in AIS patients with large-vessel occlusion. However, the study also highlights challenges such as procedural complications and post-thrombectomy re-occlusion, underscoring the need for ongoing evaluation and optimization of patient selection and procedural protocols in lowresource settings. Future studies with larger sample sizes are warranted to further validate these findings and refine EVT protocols tailored to local healthcare contexts.

Human ; Ischemic Stroke ; Thrombectomy ; Time-to-treatment

Introduction: Stroke can be a complication and/or a presenting sign of COVID-19 infection. Although there is growing evidence on stroke in COVID-19 infection, only a few of these studies were done in Asia and there is very scarce evidence in the local setting. Objective: This study aimed to characterize the clinical profile, management, and functional outcome of patients with acute stroke and COVID-19 infection. Methods: This was a single-center retrospective study from March 30 to October 20, 2020. The demographic characteristics, respiratory symptoms, risk factors, neuroimaging, stroke characteristics, ancillary test results, treatment given, and functional outcome were obtained through a review of medical records. Computation of the mean, standard deviation, median, interquartile range, total count, and percentage was done for data analysis. Results: Out of 2,018 patients with COVID-19 infection, 41 (2%) developed an acute stroke. The mean age of patients was 59.05 ± 14.04 years. Majority were men (n=24, 59%). Ischemic stroke (n=28, 68%) was the most common stroke with the anterior circulation commonly involved (n=21, 72%). The most common risk factors were hypertension (n=31, n=76%), cigarette smoking (n=18, 44%), dyslipidemia (n=16, 39%), and ethanol use (n=16, 39%). Among those with stroke and COVID-19 infection, 42% had mild infection and 29% had critical disease. The inflammatory markers were elevated in these patients. Upon discharge, 83% had a poor functional outcome (mRS 3–6). The overall mortality rate was high (n=24, 59%) with pulmonary cause as the most common cause of death. Conclusion Ischemic stroke was the most common stroke type in patients infected with COVID-19. The common risk factors were hypertension, dyslipidemia, smoking, ethanol use, and diabetes mellitus. The functional outcome was generally poor and the mortality rate was high. More studies are needed that compare these subsets of patients with a control group, including a longer follow up.
Cerebrovascular Disorders ; COVID-19 ; Stroke

BACKGROUND

Thrombolysis, or the administration of intravenous recombinant tissue plasminogen activator (IV rTPA) within the narrow therapeutic window following ischemic stroke onset, has emerged as a critical intervention in acute stroke care with the potential to restore blood flow and improve chances of functional recovery.

OBJECTIVES

This study aimed to describe the demographic profile, risk factors, ischemic stroke subtypes, clinical course, and outcomes of stroke thrombolysis in a tertiary hospital in the Philippines over the past five years. It also aimed to evaluate key performance indicators in terms of benchmark times in the administration of IV rTPA.

METHODS

This study used a retrospective observational design including all adult acute ischemic stroke patients who received IV rTPA at the University of the Philippines - Philippine General Hospital (UP-PGH). Data was collected through census and chart review.

RESULTS

One hundred eighty-eight patients received IV rTPA, majority were males (57.45%) with a median age of 60 years old. Hypertension (76.60%) was the most common risk factor for ischemic stroke. Partial anterior circulation infarcts (67.55%) and large artery atherosclerosis (49.47%) were the most common ischemic stroke subtype and etiology, respectively. The median door to needle time was 48 minutes, and the median length of hospital stay was five days. There was improvement in median NIHSS from 13 to 4, with a median modified Rankin scale of 3 indicating moderate disability upon discharge. Less than five percent (4.79%) had symptomatic intracerebral hemorrhage. The inhospital all-cause mortality rate among thrombolysed patients was 13.83%, mostly from non-neurologic causes. Nosocomial pneumonia and the need for neurosurgical interventions after thrombolysis were significantly associated with poor outcome (p < 0.05).

CONCLUSION

Our findings support the use of IV rTPA in the treatment of acute ischemic stroke. Existing stroke protocols in our institution are able to achieve the recommended thrombolysis benchmark times, leading to better functional outcomes for stroke patients.

Human ; Ischemic Stroke ; Philippines