Inter-rater reliability of the simplified Modified Rankin Scale as an outcome measure for treated cerebral aneurysm patients.

BACKGROUND: The modified Rankin scale (mRS) is commonly used as a clinical outcome measure in aneurysm trials, but inter-observer reliability in treated patients has not been tested. METHODS: We reviewed the literature on inter-observer reliability studies of the mRS. Sixty patients with ruptured (n=47) or unruptured (n=13) aneurysms treated with endovascular methods (n=34) or surgical clipping (n=26) were independently evaluated by a neurosurgeon, a stroke neurologist, and a novice research assistant, and a simplified mRS score assigned. Results were analyzed using Gwet's AC1/2 reliability coefficients (KG). RESULTS: No previous reports validating the reliability of the mRS in treated aneurysm patients were identified. Using the mRS 0-5, inter-rater agreement was almost perfect (KG=0.89 [0.86-0.93]). Agreement between raters remained almost perfect regardless of the rater's expertise. Agreement was almost perfect (KG=0.87 [0.77-0.96] when the mRS was dichotomized 0-2 vs 3-5, but fell to moderate when dichotomized 0-1 vs 2-5 (KG=0.59 (0.42-0.75). Agreement using the 0-2 vs 3-5 dichotomized mRS remained almost perfect for coiled (KG=0.90), clipped (KG=0.82), ruptured (KG=0.84), and unruptured (KG=0.95) aneurysms. Dichotomization of results at 0-1 vs 2-5 would have resulted in an (undesirable) significant difference in good outcomes between raters (P=.003), but not at 0-2 vs 3-5 (P=.52). CONCLUSION: The simplified mRS appears to be a reliable clinical outcome measure for treated cerebral aneurysm patients. When needed, dichotomization is more reliable at mRS 0-2 vs 3-5 than at 0-1 vs 2-5. The simplified mRS is a promising tool in the functional assessment of aneurysm patients recruited in pragmatic care trials.

Bilateral perisylvian infarct: a rare cause and a rare occurrence.

Foix-Chavany-Marie opercular syndrome is a severe form of pseudobulbar palsy occurring due to bilateral anterior opercular lesions. We report a case of a 51-year-old man with sudden onset of inability to speak and dysphagia, and a history of synovial sarcoma of the right hand. Detailed language evaluation was normal. The patient had right upper motor neuron facial paresis and absent gag reflex bilaterally. Magnetic resonance (MR) imaging revealed acute and subacute infarcts involving the bilateral insular cortex. Two-dimensional echocardiography and cardiac MR imaging showed a mobile mass in the left atrium attached to the interatrial septum, which was likely a myxoma. Chest radiograph and computed tomography imaging of the chest revealed multiple cannonball shadows that were suggestive of secondaries in the lung. The probable cause of the cerebral lesions was the mass lesion in the heart or metastatic lesions from the synovial sarcoma. The cardiac surgeon and surgical oncologist recommended palliative care.

Reversible pancallosal signal changes in febrile encephalopathy: report of 2 cases.

Transient CC involvement has been reported in encephalopathies/encephalitis of different etiologies. Here we report 2 patients with AFE, who showed transient pancallosal involvement with restricted diffusion on neuroimaging. Both patients had excellent clinical outcomes: The lesion disappeared completely in 1, though there was mild residual gliosis in the other. Serology for dengue virus was positive in 1 of the patients.