Subject(s)
Intracranial Hemorrhage, Traumatic/etiology , Ischemic Attack, Transient/etiology , Plasmacytoma/diagnosis , Skull Neoplasms/diagnosis , Aged , Biopsy , Bone Marrow Examination , Cerebral Angiography , Female , Humans , Intracranial Hemorrhage, Traumatic/radiotherapy , Ischemic Attack, Transient/radiotherapy , Magnetic Resonance Angiography , Plasmacytoma/complications , Plasmacytoma/radiotherapy , Skull Neoplasms/complications , Skull Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Percutaneous endoscopic gastrostomy (PEG) tubes are commonly needed for early nutrition in patients with acute ischemic stroke. We evaluated the relationship between the NIH Stroke Scale (NIHSS) score and the need for PEG tube placement. Patients with acute ischemic stroke were included in this study. We collected information on patient demographics, stroke severity as indicated by the NIHSS, and risk factors for vascular disease. We ascertained the swallowing evaluation and PEG tube placement during the same hospitalization. A hierarchical optimal classification tree was determined for the best predictors. A total of 187 patients (mean age, 67.2 years) were included, only 33 (17.6%) of whom had a PEG tube placed during the course of hospitalization. Those who had the PEG were slightly older (73.8 vs 65.8 years), had severe stroke (median NIHSS score, 18 vs 4), and a longer hospital stay (median 12 vs 4 days). Independent predictors for PEG placement included bulbar symptoms at onset, higher NIHSS score, stroke in the middle cerebral artery distribution, and aspiration pneumonia. Hierarchical analysis showed that patients with aspiration pneumonia and NIHSS score >or=12 had the highest likelihood (relative risk [RR] = 4.67; P < .0001) of requiring a PEG tube. In the absence of pneumonia, NIHSS score >or=16 yielded a moderate likelihood of requiring PEG (RR = 1.80; P < .0001). Our findings indicate that the presence of pneumonia and high NIHSS score are the best predictors for requiring PEG tube insertion in patients with ischemic stroke. These findings may have benefits in terms of early decision making, shorter hospitalization, and possible cost savings.
Subject(s)
Deglutition Disorders/therapy , Gastrostomy/statistics & numerical data , Intubation, Gastrointestinal/statistics & numerical data , Severity of Illness Index , Stroke/complications , Aged , Aged, 80 and over , Deglutition Disorders/etiology , Gastrostomy/methods , Humans , Intubation, Gastrointestinal/methods , Middle Aged , National Institutes of Health (U.S.) , Predictive Value of Tests , Statistics, Nonparametric , Stroke/physiopathology , United StatesABSTRACT
Biologic therapy with tumor necrosis factor (TNF)-alpha antagonists for rheumatoid arthritis has been well established. We describe two patients with rheumatoid arthritis who developed chronic inflammatory demyelinating polyneuropathy (CIDP) during their course of therapy with TNF-alpha antagonists. A 45-year-old woman and a 49-year-old man, both with a history of rheumatoid arthritis, were treated with etanercept and infliximab, respectively. Clinical signs of peripheral neuropathy developed 2 weeks and 12 months after the initiation of TNF-alpha antagonists. Electrodiagnostic studies at variable points during the disease course showed signs of acquired demyelination consistent with CIDP. Cerebrospinal fluid examination showed albuminocytologic dissociation (total protein concentration 118 mg/dl and 152 mg/dl, respectively). Both patients failed to improve after discontinuation of the offending agent, and they responded poorly to corticosteroids. However, there was clinical and electrophysiologic recovery after initiation of intravenous immunoglobulin (IVIg) therapy. CIDP may occur early or late during the treatment course with TNF-alpha antagonists. IVIg may reverse and stabilize the inflammatory process.
