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Title: 'Brain attack' : a new approach to stroke and transient ischaemic attack
Author: Hand, Peter James
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2002
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This thesis proposes that patients with features of focal neurological dysfunctional, of abrupt onset, should be considered as suffering a brain attack. Brain attack is a neurological emergency, requiring a prompt and accurate diagnosis before treatment can be commenced. The hypothesis underlying this work was that key reliable and useful parts of the bedside clinical assessment, and currently available brain imaging techniques, could be identified to improve the assessment of patients with suspected acute stroke. The thesis is divided into three sections. Section I reviews the history of stroke and its terminology. Section II explores the clinical features of brain attack. A prospective study of 350 hospital presentations with brain attack is described to determine: 1) the conditions that cause brain attack; 2) if the clinician could distinguish between stroke and mimic; 3) the accuracy of the clinical diagnosis of the cause of brain attack; 4) the reasons for disagreement between the clinical diagnosis and the final diagnosis, and 5) whether the features of patients presenting within the first six hours differed from those presenting later. Univariate analyses identified several key items of history and examination that differentiated between stroke and mimic. An interrater study of the reliability of the clinical assessment, involving 98 patients and four clinicians, describes the items of history and physical examination that were reliable even when the observer had limited neurological training. A series of diagnostic models (of varying simplicity) are developed using multivariable logistic regression analysis, with strict attention to methodological details. The potential use of the models to differentiate between stroke and mimic at the bedside is discussed. Section III explores the influence of the CT scan on the diagnosis of brain attack for the 350 patients in the cohort. Results from this original research should help guide clinicians with an evidence-based streamlined approach to the emergency assessment of patients with brain attack.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available