Predicting Motor Outcome in Acute Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE: Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS: We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS: Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS: Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.

Estudio descriptivo de úlceras cutáneas en la residencia de ancianos de Forcall / Descriptive study of cutaneous ulcers in the Forcall nursing home

Las úlceras cutáneas son uno de los problemas más frecuentes con los que se encuentra el personal de enfermería que trabaja en el campo de la geriatría. Es por ello que la atención diaria y la relación directa enfermeraanciano juega un gran papel en el cuidado de las úlceras cutáneas (1-3). La prevención, detección, tratamiento y curación de las úlceras cutáneas es uno de los objetivos que persigue el equipo de enfermería de la "Residencia de Ancianos de Forcall". Dada su importancia se realiza un estudio descriptivo retrospectivo para determinar la prevalencia y describir las características de las úlceras cutáneas en el centro desde su apertura en junio de 1998. En este estudio se evidencia la necesidad de aplicar medidas preventivas y de tratamiento adecuadas, pues son determinantes para la correcta evolución de las úlceras cutáneas. Asimismo cabe destacar que el seguimiento continuado (registros de úlceras cutáneas) y la unificación de criterios en el cuidado y tratamiento de las úlceras cutáneas ha contribuido a la evolución favorable de las mismas (AU)