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Intracerebral Hemorrhage

Subarachnoid Hemorrhage

Acute Ischemic Stroke

Stroke: Inpatient Management

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Personal Information

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Medical Information

The medical information contained in this web site is designed to be used only as a medical and educational reference tool. It is not intended to be used as a diagnostic decision-making system and must not be used to replace or overrule a physician's judgment or diagnosis. The responsibility for decisions regarding actual patient care rests solely with the physician treating a patient. While we try to keep the information as accurate as possible, we disclaim any implied warranty or representation about its accuracy, completeness, or appropriateness for a particular purpose. Please note that the stroke protocols are subject to change without notice, and are not intended for use without concurrent consultation with a Partners Acute Stroke Neurologist.

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You assume full responsibility for using the information at this site, and you understand and agree that Partners HealthCare System, Inc. and its affiliates, including Massachusetts General Hospital are not responsible or liable for any claim, loss, or damage resulting from its use.

Clinical Scales & Forms

Consent Forms

IA consent form
Disclaimer
Catheter-based therapy for acute ischemic stroke is offered at many institutions based on local medical policies or investigational review board approval. Written informed consent should, in general, be obtained prior to treatment. The following written consent form is one example of this. In exceptional circumstances where patients are eligible for treatment but for who no appropriate caregiver can be contacted, local legal counsel should be consulted regarding policies for treatment.

NIH Stroke scale materials

Cookie jar picture

Object naming

Phrases

Sentences

Scoring form

Barthel Index

Index Scoring Form

Source Publication

Related Web Resource

NIH Stroke Scale Training (NINDS website)

t-PA Dosing

Prior to making any medical decisions, please view our disclaimer. Use this calculator to determine tPA dosing information.


FUNC Score





The FUNC score is intended to provide guidance in clinical decision-making and patient selection for clinical trials. The components of FUNC score[2] (age, GCS, ICH location, ICH volume, and pre-ICH cognitive impairment) are obtained on evaluation of patients with ICH upon arrival to the hospital. Based on the number of points assigned within each category (see FUNC Score Prediction Tool inset or dropdown menu) of the individual components, a total FUNC score is calculated (range 0-11). For each individual ICH patient, a particular FUNC score value corresponds to the % probability of attaining functional independence (Glasgow Outcome Score greater than or equal to 4) at 90 days (Entire Cohort).

To eliminate the effects of early withdrawal of care on outcome, we also calculated the likelihood of long-term functional recovery in those ICH patients who survived to 90 days (Survivors Only), and their % probabilities of achieving functional independence at 90 days are presented below, as well. In our study, no patient assigned a FUNC score less than or equal to 4 achieved functional independence at 90 days, while greater than 80% with a score of 11 did in both patient cohorts.

Func prediction tool chart

Y-axis: % ICH patients who reach functional independence at 90 days.

X-axis: FUNC score categories.

Data table: % functionally independent patients among the entire cohort and survivors only (per FUNC score category).

Inset: FUNC score determinants provided to facilitate clinical use of this ICH outcome prediction tool.

References

Natalia S. Rost, Eric E. Smith, Yuchiao Chang, Ryan W. Snider, Rishi Chanderraj, Kristin Schwab, Emily FitzMaurice, Lauren Wendell, Joshua N. Goldstein, Steven M. Greenberg, and Jonathan Rosand

Prediction of Functional Outcome in Patients With Primary Intracerebral Hemorrhage: The FUNC Score. Stroke published 12 June 2008, 10.1161/STROKEAHA.107.512202

All FUNC score components are determined on admission, including ICH volume and location (determined on admission non-contrast head CT). Pre-ICH cognitive impairment is determined by family interview (IQCODE)[3] or known history of dementia.

Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry. 1988;152:209-213.

Clot Images

Catheter-based Clot Images

These sample images are from patients successfully treated with catheter-based Intra-arterial thrombolysis (IAT).

These blood clots were removed by a catheter. The catheter in this procedure, called Merci Retriever, is made by Concentric Medical. This catheter was given approval by the FDA in August 2005. This approval gave Concentric Medical authorization to develop its Merci Retriever structure, which helps do away with blood clots in patients' brains who are having an ischemic stroke.

For more information and a viewable web video on catheter-based blood clot removal, please visit Concentric Medical Merci Retriever.

Patient 1

Merci Retriever
Merci Retriever
Clot
Clot
Clot
Clot

Patient 2

Clot
Clot
Baseline
Baseline
After IAT
After IAT

Patient 3

Clot
Clot
Baseline
Baseline
After IAT
After IAT

Mechanical Thrombectomy

Mechanical Thrombectomy
Mechanical Thrombectomy

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