Effects of Golden Hour Thrombolysis A Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) Substudy

ImportanceThe effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour.ObjectiveTo determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome.Design, Setting, and ParticipantsThe prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availability of a specialized ambulance (stroke emergency mobile unit (STEMO) from May 1, 2011, through January 31, 2013. We included 6182 consecutive adult patients for whom a stroke dispatch (44.1% male; mean [SD] age, 73.9 [15.0] years) or regular care (45.0% male; mean [SD] age, 74.2 [14.9] years) were included.InterventionsThe STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (during control weeks, when the unit was already in operation, or during maintenance), patients received conventional care. The STEMO is equipped with a computed tomographic scanner plus a point-of-care laboratory and telemedicine connection. The unit is staffed with a neurologist trained in emergency medicine, a paramedic, and a technician. Thrombolysis was started in STEMO if a stroke was confirmed and no contraindication wa...
Source: JAMA Neurology - Category: Neurology Source Type: research

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ConclusionsThis retrospective study suggests that SHPD may play a protective role in HT appearance and evolution, which requires verification by a randomized clinical trial.
Source: Neurological Sciences - Category: Neurology Source Type: research
AbstractMost of the acute ischemic events, such as acute coronary syndromes and stroke, are attributed to vulnerable plaques. These lesions have common histological and pathophysiological features, including inflammatory cell infiltration, neo-angiogenesis, remodelling, haemorrhage predisposition, thin fibrous cap, large lipid core, and micro-calcifications. Early detection of the presence of a plaque prone to rupture could be life-saving for the patient; however, vulnerable plaques usually cause non-haemodynamically significant stenosis, and anatomical imaging techniques often underestimate, or may not even detect, these ...
Source: Annals of Nuclear Medicine - Category: Nuclear Medicine Source Type: research
Purpose of review Since the development of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke (AIS), functional outcome has improved when treatment occurs within 4.5 h of stroke onset and treatment benefits are greater with earlier treatment. Endovascular revascularization also is better the sooner it is delivered. Recent findings The Get with the Guidelines Stroke registry found that less than one-third of treatment-eligible AIS patients receive intravenous tPA within 60 min of hospital arrival. Initiatives have tried to improve public education and awareness of stroke symptoms to decrease t...
Source: Current Opinion in Critical Care - Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research
Magnetic resonance imaging (MRI) has revolutionized medicine, but MRI scanners are so demanding that access to them is still a challenge. MRI machines typically require specially built rooms with magnet quench vent pipes, entry systems that check peo...
Source: Medgadget - Category: Medical Devices Authors: Tags: Emergency Medicine Neurology Neurosurgery Radiology Source Type: blogs
In our sample of 402 nonlacunar ischemic strokes, the main predictors of hemorrhagic transformation were as follows: (a) cerebral lesion diameter, (b) blood glucose, (c) prior anticoagulant therapy, (d) cerebral edema with mass effect, (e) hemoglobin concentration. A simple relationship between cerebral lesion diameter and the timing of hemorrhagic transformation has been found, which could be considered in deciding when starting anticoagulation after a cardioembolic stroke. AbstractObjectivesWe performed this retrospective cohort study to establish which factors are mostly indicative of the appearance of hemorrhagic trans...
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Conclusions: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores. PMID: 31908703 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
We report a 71-year-old woman with a past medical history of hypertension, type two diabetes and no history of renal disease. She was admitted to our cardiology department with symptoms of recurrent angina. She had a history of unstable angina two years ago and had undergone a percutaneous coronary intervention without incident. Three hours after un-elective coronary angiography, she experienced a sudden, transitory deterioration in her consciousness's level with neurovegetative symptoms (high blood pressure, high temperature). The cerebral Computer Tomography scan ruled out any acute hemorrhagic or ischemic stroke. In...
Source: Neurology India - Category: Neurology Authors: Source Type: research
In our sample of 402 nonlacunar ischemic strokes, the main predictors of hemorrhagic transformation were as follows: (a) cerebral lesion diameter, (b) blood glucose, (c) prior anticoagulant therapy, (d) cerebral edema with mass effect, (e) hemoglobin concentration. A simple relationship between cerebral lesion diameter and the timing of hemorrhagic transformation has been found, which could be considered in deciding when starting anticoagulation after a cardioembolic stroke. AbstractObjectivesWe performed this retrospective cohort study to establish which factors are mostly indicative of the appearance of hemorrhagic trans...
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Publication date: Available online 9 December 2019Source: NeuroImage: ClinicalAuthor(s): Yunzhe Xue, Fadi G. Farhat, Olga Boukrina, A.M. Barrett, Jeffrey R. Binder, Usman W. Roshan, William W. GravesAbstractAutomatic identification of brain lesions from magnetic resonance imaging (MRI) scans of stroke survivors would be a useful aid in patient diagnosis and treatment planning. It would also greatly facilitate the study of brain-behavior relationships by eliminating the laborious step of having a human expert manually segment the lesion on each brain scan. We propose a multi-modal multi-path convolutional neural network sys...
Source: NeuroImage: Clinical - Category: Radiology Source Type: research
AbstractIntroductionSymptomatic intracerebral hemorrhage (sICH) following systemic thrombolysis for ischemic stroke is often devastating, and open surgical evacuation is considered dangerous due to the increased risk of perioperative bleeding, and stereotactic placement of a catheter is too time-consuming. We therefore evaluated the feasibility of a free-hand bedside catheter technique for emergency hematoma evacuation.MethodsPatients who had a supratentorial sICH after thrombolysis, a hematoma volume  >  30 ml, and an ensuing reduction in vigilance were consecutively treated with acute minimally inva...
Source: Neurocritical Care - Category: Neurology Source Type: research
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