Clinical Profile and Outcomes of Early Seizures in Asian Patients With Acute Intracerebral Hemorrhage.

BACKGROUND: Seizures are one of the most common complications of stroke. We aimed to establish the incidence and clinical profile of post-stroke early seizure (ES) in patients with intracerebral hemorrhage (ICH). METHODS: Patients with ICH within 10 days of onset who were admitted to Landseed International Hospital were recruited consecutively between January 1, 2006, and December 31, 2009. The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale were used to access patients initial stroke severity and functional outcome at discharge, respectively. The occurrence of epileptic seizures within 30 days after onset of the index ICH was recorded. Early post-ICH seizure was defined by the occurrence of clinically identifid seizure episodes or non-epileptic seizure within 7 days after the stroke onset. RESULTS: A total of 297 ICH patients were included. The mean age of the participants was 62 ± 16 years, and 72% of them were male. A total of 9 (3%) participants had seizures during acute hospitalization. Patients with seizures had higher median NIHSS scores at baseline (34 vs. 16, p = 0.004). No difference was noted in the cortical involvement of ICH (22% for patients with seizures and 14% for those without, p = 0.156). Patients with seizures had higher in-hospital mortality ( 56% vs. 23%, p = 0.024). The multivariate Cox regression model showed the factors significantly associated with ES were higher initial NIHSS scores on admission (adjusted odds ratio [aOR] = 1.1 per 1 point increased, 95% confidence interval [CI] = 1.0-1.2) and coronary artery disease (aOR = 7.0, 95% CI = 1.3-36.4). CONCLUSIONS: The NIHSS scores and coronary heart disease were associated with ES in ICH, whereas cortical involvement was not. These findings may reflect difference in post-stroke seizure and primary ICH between Asian and Western populations.

C-reactive protein as an indicator of bacterial infection of adult patients in the emergency department.

BACKGROUND: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests. METHODS: One hundred and fifty adult atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled. Seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups. RESULTS: SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8%), but it had a 37.9% false-positive rate. BT and WBC count were more specific (at 89.7% and 84.5%) but less sensitive (at 48.1% and 43.0%, respectively). Using Youden's Index, the best cut-off value for CRP was 60 mg/l (sensitivity 67.1%, specificity 94.8%, positive predictive value 94.6%, and negative predictive value 67.9%). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67) (all p < 0.05). CONCLUSION: CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection.

Button battery ingestion: an analysis of 25 cases.

BACKGROUND: Button batteries represent a distinct type of foreign body. Serious complications can be resulted, particularly when the battery is impacted in the esophagus. The potentially detrimental effects of button battery ingestion have often been overlooked in Taiwan. We surveyed patients following button battery ingestion to define the characteristics and outcomes of this population. METHODS: The records of 25 patients with button battery ingestion that had been reported to the Taipei Veterans General Hospital Poison Control Center from July 1988 through January 1998 were retrospectively reviewed. RESULTS: Button battery ingestion occurred most commonly in male children (N=20; 80%) and children under 3 years of age (N= 19; 76%). Most children were asymptomatic (N=22; 88%). Two children suffered abdominal pain, and one suffered dyspnea and stridor. Reported complications included black stools (N=3) and tracheoesophageal fistula formation (N= 1). Two children underwent endoscopic battery removal, and batteries passed the entire gastrointestinal tract in all other subjects. The interval between battery ingestion and passage when documented (N= 16) was never more than 5 days. CONCLUSION: Most ingested batteries passed through the gastrointestinal tract without any adverse effects. An initial roentgenogram should be obtained promptly to determine battery location and diameter, and the battery's chemical composition should be determined when possible. Esophageal impaction of the batteries requires emergency endoscopic or surgical removal. For patients without esophageal impaction, conservative intervention is recommended in the absence of symptoms and signs of injury.