Sakthivel, S (2023) A Study on Clinical Significance of Hematological Indices, Electro Cardiographic Changes by using National Institute of Health Stroke Score (NIHSS) in Acute Ischemic Stroke in Tertiary Care Centre. Masters thesis, Madras Medical College, Chennai.
|
Text
2001 001 23 Sakthivel S.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Acute ischemic stroke results from sudden loss of blood circulation to an area of brain leading to irreversible injury and neurological deficits persisting for more than 24 hours or until death. It accounts for 80-87% of all strokes. Platelets activation and aggregation are critical in the pathogenesis of acute ischemic stroke. Acute Ischemic stroke is an inflammatory event where the ischemic tissue releases chemokines and cytokines, and recruit peripheral circulating leucocytes. Lymphocytes also infiltrate the ischemic tissues and mediate inflammatory responses. Among the leucocytes, neutrophils were found to be an important mediator and early neutrophilia was found to be associated with larger stroke volumes and poor prognosis. In the recent years, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been emerged as the well accepted biomarkers for the assessment of overall inflammatory status. These are simple and cost effective biomarkers. Elevated levels of NLR and PLR have found to be related to oxidative stress and increased cytokine production in patients presenting with Acute ischemic stroke. The NLR has been used as an indicator to reflect the prevalence of intracranial atherosclerosis and is considered to be an independent risk factor for ischemic stroke and a poor prognosis. The PLR has been used to predict poor prognosis, the rate of insufficient recanalization and the size of infarcted area following stroke. Ecg changes in acute ischemic stroke, are new onset QT prolongation and T wave inversion in precordial leads associated with poor Outcome. NIHSS grade severe is associated with significant poor outcome. If these parameters are taken together, predicting outcome will become easy and it will be helpful in taking appropriate interventions in initial hours by focusing on the correctable parameters in order to prevent mortality in acute stroke. AIMS AND OBJECTIVES: To assess the correlation of Hematological indices, Electrocardiographics changes among the patients presenting with acute ischemic stroke by the application of NIHSS score. MATERIAL AND METHODS: The prospective observational study is proposed to be conducted after obtaining informed consent from the patients admitted in Medical emergency department and medical wards,IIM,MMC & RGGGH. In our study, 80 patients are selected as per inclusion and exclusion criteria, detailed history will be elicited. Clinical examination done after stabilization of Airway, Breathing, Circulation. Grading the Patients mild,moderate, moderate to severe & Severe stroke by using NIHSS scale. After initial clinical evaluation, Grading of the patient, Hematological indices including Neutophil-Lymphocyte ratio and Platelet-Lymphocyte ratio and Renal function test, Lipid profile ECG, Chest X ray and CT Brain done for all patients. Comparing the above parameters of the patients based upon the NIHSS Grading and find out the disease severity and outcomes. RESULTS: ➢ There was statistically significant correlation was found between NLR and NIHSS score at the time of admission and value of NLR increased proportionately with the increasing NIHSS score.(P=<0.001). ➢ There was statistically significant correlation found between PLR and NIHSS score at the time of admission. The value of PLR increased proportionately with the increasing NIHSS score. (p=<0.001). ➢ In our study participants, who had severe NIHSS during admission, ST depression (57%), QT prolongation (57%), T wave inversion (42%). CONCLUSION: High levels of NLR and PLR were associated with the highest risk of unfavourable functional outcomes. Severe grade of National institute of health stroke scale is associated with statistically significant poor outcome. ST-T changes and QT prolongation in ECG had higher mortality and poor outcome. These parameters are taken together, predicting outcome will become easy and it will be helpful in taking appropriate interventions in initial hours by focusing on the correctable parameters in order to prevent mortality in acute stroke.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | Reg.No.200120100527 |
| Uncontrolled Keywords: | Clinical Significance, Hematological Indices, Electro Cardiographic Changes, National Institute of Health Stroke Score (NIHSS), Acute Ischemic Stroke, Tertiary Care Centre. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Thavamani K |
| Date Deposited: | 24 May 2022 00:44 |
| Last Modified: | 17 Mar 2024 15:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/20151 |
Actions (login required)
 |
View Item |
