好色先生

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Abstract Details

Large vessel occlusion stroke presenting with coma: Not uncommon and poor prognostic sign
Cerebrovascular Disease and Interventional Neurology
P12 - Poster Session 12 (5:30 PM-6:30 PM)
6-002
To characterize the incidence and features of coma as a presentation of large vessel occlusion (LVO) stroke. 

Coma is an unresponsive state characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in stroke has been underexplored.

 

Individuals who presented with LVO were identified from 07/2018 to 12/2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIHSS item 1a.

28/638 (4.4%) patients with LVO stroke were identified as presenting with coma. Median age was 65 (IQR 48-78); 57% were female. Median NIHSS was 32 (IQR 29-34). Occlusion locations included basilar (10), vertebral (2), P1 posterior cerebral (2), internal carotid (4), M1 (6), and M2 middle cerebral arteries (4). In all 14 patients with anterior LVO, the acute LVO was unilateral. Of these 14, 6 had evidence of acute or chronic stroke involving the contralateral hemisphere; 1 experienced seizure; 1 experienced cardiac arrest; and 1 had chronic occlusion of the contralateral ICA. Overall, 20/28 died during admission. Of those who died, 9 presented with anterior LVO and 11 with posterior LVO. Eight patients were treated with EVT. For those untreated, reasons included established infarct with ASPECTS <6 (11), delayed presentation (2), pre-stroke disability (3), and absence of intracranial proximal occlusion on repeat imaging (2).  

 
It is not uncommon for patients with LVO stroke to present with coma, and 65% of patients not treated with EVT had delayed presentations or large established infarcts, emphasizing the need for maintaining a high index of suspicion. While more commonly thought to result from posterior LVO, coma in our cohort was similarly likely to result from anterior LVO. Further study of these patients may shed light on the pathophysiology of coma. Efforts to improve early diagnosis and care are crucial given poor outcomes. 
Authors/Disclosures
Michael Young, MD (Massachusetts General Hospital, Brigham, Harvard)
PRESENTER 		The institution of Dr. Young has received research support from NIH/NINDS. The institution of Dr. Young has received research support from Department of Defense. The institution of Dr. Young has received research support from Chen Institute.
Amine Mohamed Marc Awad, BM BCh Dr. Awad has nothing to disclose.
Alexander Andreev, MD (BIDMC) Dr. Andreev has nothing to disclose.
Anna K. Bonkhoff, MD (Mass General Brigham) Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier).
Markus D. Schirmer, PhD (Massachusetts General Hospital) The institution of Dr. Schirmer has received research support from National Institute of Aging.
James Rabinov James Rabinov has nothing to disclose.
Christopher Stapleton (Massachusetts General Hospital) Christopher Stapleton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Johnson & Johnson MedTech. Christopher Stapleton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll Circulation, Inc.. Christopher Stapleton has received publishing royalties from a publication relating to health care.
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Aman Patel Aman Patel has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Aman Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra.
Robert W. Regenhardt, MD, PhD Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genomadix. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. Dr. Regenhardt has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Buckley, Theroux, Kline, & Cooley Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.