MDCalc » Neurology

Hunt and Hess Classification of Subarachnoid Hemorrhage (SAH)

admin — Mon, 02 Mar 2009 18:47:36 +0000

Intracerebral Hemorrhage (ICH) Score

admin — Mon, 02 Mar 2009 18:46:49 +0000

ABCD2 Score for TIA

admin — Fri, 27 Feb 2009 14:30:49 +0000

Higher ABCD2 score predicts patients most likely to have true transient ischemic attack. Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC. Stroke. 2008 Nov;39(11):3096-8. Epub 2008 Aug 7.
A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z. Lancet. 2005 Jul 2-8;366(9479):29-36.
Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S. Lancet. 2007 Jan 27;369(9558):283-92.

Phenytoin/Dilantin Correction for Albumin or Renal Failure

admin — Tue, 10 Feb 2009 14:56:28 +0000

The Sheiner-Tozer Equation is Used for an Accurate Estimate:
Corrected Phenytoin = Measured Phenytoin Level / ( (adjustment x albumin) + 0.1)

Adjustment = 0.2; In patients with Creatinine Clearance < 20, adjustment = 0.1.

Martin E, Tozer TN, Sheiner LB, Riegelman S. The clinical pharmacokinetics of phenytoin. J Pharmacokinet Biopharm. 1977 Dec;5(6):579-96.

San Francisco Syncope Rule to Predict Serious Outcomes

admin — Fri, 02 Jan 2009 04:27:13 +0000

Note: This rule has a 96% sensitivity and 62% specificity for serious outcome. Negative predictive value: 99.2%; positive predictive value 24.8%.

Serious Outcome in this study is defined as "death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return ED visit and hospitalization for a related event."

The San Francisco Syncope Rule to Predict Patients with Serious Outcomes

Glasgow Coma Scale/Score

admin — Fri, 02 Jan 2009 03:53:42 +0000

CSF WBC Correction for RBCs

admin — Fri, 02 Jan 2009 03:48:42 +0000

CSF WBC (predicted) = CSF WBCs Detected - (WBC in Blood * RBC in CSF / RBC in Blood)

Source: Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 6th ed.,

CHADS2 Score for Atrial Fibrillation Stroke Risk

admin — Fri, 02 Jan 2009 03:44:18 +0000

Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

Glasgow Coma Scale (GCS)	3-4 +2 5-12 +1 13-15 +0
Age ≥ 80?	Yes +1
ICH Volume ≥ 30ml?	Yes +1
Intraventricular Hemorrhage?	Yes +1
Infratentorial Origin of Hemorrhage?	Yes +1
Score	points

Age ≥ 60?	Yes +1
BP ≥ 140/90 mmHg at initial evaluation?	Yes +1
Clinical Features of the TIA:	Unilateral Weakness +2 Speech Disturbance without Weakness +1
Duration of Symptoms?	10-59 minutes +1 ≥ 60 minutes +2
Diabetes Mellitus in Patient's History?	Yes +1
Score	points

Patient's calculated Creatinine Clearance < 20?	Yes
Phenytoin Level	mg/L
Serum Albumin	g/dL
Corrected Phenytoin	mg/L

Congestive Heart Failure history?	Yes +1
Hematocrit < 30%?	Yes +1
ECG Abnormal ?	Yes +1
Shortness of Breath History?	Yes +1
Systolic BP < 90 mmHg at Triage?	Yes +1
Score	points

Best Eye Response	No eye opening. +1 Eye opening to pain. +2 Eye opening to verbal command. +3 Eyes open spontaneously. +4
Best Verbal Response	No verbal response. +1 Incomprehensible sounds. +2 Inappropriate words. +3 Confused. +4 Oriented. +5
Best Motor Response	No motor response. +1 Extension to pain. +2 Flexion to pain. +3 Withdrawal from pain. +4 Localizes pain. +5 Obeys commands. +6
Score	points

Signs/Symptoms:
Mild Headache, Alert and Oriented, Minimal (if any) Nuchal Rigidity Full Nuchal Rigidity, Moderate-Severe Headache, Alert and Oriented, No Neuro Deficit (Besides CN Palsy) Lethary or Confusion, Mild Focal Neurological Deficits Stuperous, More Several Focal Deficit Comatose, showing signs of severe neurological impairment (ex: posturing)
Grade

CSF WBCs Detected	cells/µL
CSF RBCs	cells/µL
Blood WBCs	cells/µL
Blood RBCs	cells/µL
Corrected CSF WBCs	cells/µL

Congestive Heart Failure history?	Yes +1
Hypertension history?	Yes +1
Age ≥ 75?	Yes +1
Diabetes Mellitus history?	Yes +1
Stroke symptoms previously or TIA?	Yes +2
Score	points

The adjusted stroke rate was the expected stroke rate per 100 person-years derived from the multivariable model assuming that aspirin was not taken.