¿What is the evidence, from behavioural and imaging data, that we can predict how well people recover after ischemic stroke?
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Universidad Industrial de Santander
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Introducción: la incidencia de enfermedad cerebro vascular en países desarrollados está en aumento y es la primera causa de discapacidad permanente en países desarrollados. La predicción temprana de futura funcionalidad es importante para el tratamiento de la enfermedad cerebro vascular. Se pretende revisar si la severidad del déficit inicial y los hallazgos radiológicos podrían predecir la recuperación funcional a largo plazo tras un accidente cerebro vascular isquémico. Metodología de búsqueda: se desarrolló una búsqueda bibliográfica en la base de datos PubMed, para identificar estudios que evalúen cómo el déficit neurológico inicial y los hallazgos radiológicos pueden predecir la recuperación a largo plazo en accidente cerebro vascular isquémico. Se seleccionaron 35 artículos para desarrollar una revisión no sistemática de la literatura y se usó como modelo de niveles de evidencia del centro de medicina basada en la evidencia de Oxford, para evaluar la calidad de la literatura encontrada. Resultados: la edad y el déficit inicial evaluado con la escala de enfermedad cerebro vascular de los Institutos Nacionales de Salud, fueron los mejores predictores de recuperación a largo plazo tras un accidente cerebro vascular isquémico. La severidad del déficit en categorías específicas, como por ejemplo, función del miembro superior, marcha y
actividades de la vida diaria, tuvieron un nivel menor de evidencia en predicción de discapacidad posaccidente cerebro vascular. Un valor pronóstico definitivo para el tamaño del infarto no ha sido convincentemente demostrado. La localización de la lesión, particularmente el compromiso del tracto cortico espinal evaluado con imágenes de difusión por tensión, parece ser un buen predictor de recuperación. El patrón de activación cerebral tras un accidente cerebro vascular evaluado con resonancia magnética funcional y tomografía por emisión de positrones tuvo un moderado nivel de evidencia como predictor de recuperación tras un accidente cerebro vascular. Conclusiones: la severidad del déficit inicial puede ser usado para predecir recuperación neurológica tras un accidente cerebro vascular isquémico y nuevas técnicas radiológicas son muy prometedoras en la predicción de recuperación a largo plazo de la enfermedad cerebro vascular isquémica. (MÉD.UIS.2012;25(3):229-38)
Background: the incidence of stroke in developing countries is increasing and it is the leading cause of longstanding disability in developed countries. Early prediction of future functional abilities is important for stroke management. It is intended to review whether the initial severity of the deficit and the imaging findings could predict long term recovering after ischemic stroke. Methods: the PubMed database was searched to identify studies evaluating how the initial neurological deficit and the imaging findings could predict long term recovery after ischemic stroke. 35 articles were selected to develop a non systematic review and the Oxford Centre for Evidence-based Medicine Levels of Evidence model was used to grade the quality of the found evidence. Results: age and initial deficit evaluated with the National Institutes of Health Stroke Scale were the best predictors of long term recovery after ischemic stroke. The severity of the deficit in specific categories such as upper limb functions, walking and activities of the daily life had a lower level of evidence on prediction of post-stroke disability. Not a definite prognostic value had been convincingly demonstrated for size of infarction. Location of the lesion, particularly the compromise of the cortico-spinal tract evaluated with diffusion tensor imaging appeared to be a good predictor of recovery, and the pattern of brain activation after stroke evaluated with functional magnetic resonance imaging or positron emission tomography scan had a moderate level of evidence as predictor of recovery after stroke. Conclusion: the severity of the initial deficit can be used to predict how well subjects will recover from an ischemic stroke and novel imaging techniques are very promising tools to predict long time recovery after ischemic stroke. (MÉD.UIS. 2012;25(3):229-38)
Background: the incidence of stroke in developing countries is increasing and it is the leading cause of longstanding disability in developed countries. Early prediction of future functional abilities is important for stroke management. It is intended to review whether the initial severity of the deficit and the imaging findings could predict long term recovering after ischemic stroke. Methods: the PubMed database was searched to identify studies evaluating how the initial neurological deficit and the imaging findings could predict long term recovery after ischemic stroke. 35 articles were selected to develop a non systematic review and the Oxford Centre for Evidence-based Medicine Levels of Evidence model was used to grade the quality of the found evidence. Results: age and initial deficit evaluated with the National Institutes of Health Stroke Scale were the best predictors of long term recovery after ischemic stroke. The severity of the deficit in specific categories such as upper limb functions, walking and activities of the daily life had a lower level of evidence on prediction of post-stroke disability. Not a definite prognostic value had been convincingly demonstrated for size of infarction. Location of the lesion, particularly the compromise of the cortico-spinal tract evaluated with diffusion tensor imaging appeared to be a good predictor of recovery, and the pattern of brain activation after stroke evaluated with functional magnetic resonance imaging or positron emission tomography scan had a moderate level of evidence as predictor of recovery after stroke. Conclusion: the severity of the initial deficit can be used to predict how well subjects will recover from an ischemic stroke and novel imaging techniques are very promising tools to predict long time recovery after ischemic stroke. (MÉD.UIS. 2012;25(3):229-38)
Keywords
Accidente cerebrovascular, Predicción, Recuperación de la Función, Diagnóstico por Imagen, Stroke, Forecasting, Recovery of Function, Diagnostic Imaging