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The Impact of Comprehensive Stroke Care Capacity on the Hospital Volume of Stroke Interventions: A Nationwide Study in Japan: J-ASPECT Study
We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009.Results: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise...
Source: Journal of Stroke and Cerebrovascular Diseases - October 7, 2013 Category: Neurology Authors: Koji Iihara, Kunihiro Nishimura, Akiko Kada, Jyoji Nakagawara, Kazunori Toyoda, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Shinya Matsuda, Koichi B. Ishikawa, Akifumi Suzuki, Hisae Mori, Fumiaki Nakamura, Tags: Original Articles Source Type: research

The SAH Score: A Comprehensive Communication Tool
Background: The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the “SAH score.”Methods: The aSAH database at our institution was analyzed for factors affecting in-hospital mortality using multiple logistic regression analysis. Scores were weighted based on relative risk of mortality after stratification of each of these variables. Glasgow Coma Scale (GCS) was subdivided into groups of ...
Source: Journal of Stroke and Cerebrovascular Diseases - October 7, 2013 Category: Neurology Authors: Neeraj S. Naval, Robert G. Kowalski, Tiffany R. Chang, Filissa Caserta, J. Ricardo Carhuapoma, Rafael J. Tamargo Tags: Original Articles Source Type: research

Isolated Cortical Vein Thrombosis Associated with Prothrombin Gene Mutation
We report a 47-year-old female patient who had a frontal hemorrhage with headache associated with contralateral hemiparesis and hemisensory deficit on presentation. This hemorrhagic stroke was localized in a nonarterial territory, and it was caused by ipsilateral and isolated thrombosis of the vein of Labbe found on catheter angiogram that demonstrated a filling defect of the vein of Labbe at its connection with the transverse sinus. There were no filling defects in the superficial middle cerebral veins. Our patient had a family history of cardiovascular disease, stroke, and factor V Leiden mutation and cigarette smoking a...
Source: Journal of Stroke and Cerebrovascular Diseases - July 8, 2013 Category: Neurology Authors: Elias A. Giraldo, Rohan Arora, Robert A. Koenigsberg Tags: Case Reports Source Type: research

Nascent Deep Microbleeds and Stroke Recurrences
This study investigated the contributions of nascent deep MBs to stroke recurrence.Methods: We prospectively analyzed nascent deep MBs in patients admitted to our hospital who were treated for index strokes between April 2004 and November 2009. The number of nascent deep MBs was counted on T2∗-weighted MRI scans around 1 year after the index strokes, and compared to previous MRIs on admission. Stroke recurrence–free rate curves were generated using the Kaplan–Meier method using the log-rank test. The odds ratio for nascent deep MBs was derived using a multivariate logistic regression model that was based on recurren...
Source: Journal of Stroke and Cerebrovascular Diseases - June 24, 2013 Category: Neurology Authors: Toshio Imaizumi, Shigeru Inamura, Ikuhide Kohama, Kazuhisa Yoshifuji, Tatsufumi Nomura, Katsuya Komatsu Tags: Original Articles Source Type: research

Short-term Bleeding Events Observed with Clopidogrel Loading in Acute Ischemic Stroke Patients
Discussion: Contrary to our original hypothesis, patients with AIS receiving clopidogrel loading doses within 24 hours of symptom onset did not appear to experience a higher rate of new serious bleeding events during acute hospitalization when compared with patients who did not receive loading doses. The Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke trial is expected to provide insight into the safety of clopidogrel loading as an acute intervention after cerebral ischemia.
Source: Journal of Stroke and Cerebrovascular Diseases - April 1, 2013 Category: Neurology Authors: Lester Y. Leung, Karen C. Albright, Amelia K. Boehme, Joseph Tarsia, Kamal R. Shah, James E. Siegler, Erica M. Jones, Gayle R. Pletsch, Timothy M. Beasley, Sheryl Martin-Schild Tags: Original Articles Source Type: research

Prognosis of Intracerebral Hemorrhage after Conservative Treatment
Background: The aim of this population-based study was to determine the short-term prognosis of patients treated conservatively for spontaneous intracerebral hemorrhage (ICH), a disease with a high rate of mortality.Methods: During a 39-month period beginning in October 2007, 594 patients (mean age 72 ± 12 years; 52% female; median National Institutes of Health Stroke Scale [NIHSS] score 9) with spontaneous ICH were enrolled in this prospective, population-based study.Results: Of 594 patients, 74 (12%) died during hospitalization (10.3 ± 7 days). Adjusted logistic regression analyses revealed that the in-hospital mor...
Source: Journal of Stroke and Cerebrovascular Diseases - January 28, 2013 Category: Neurology Authors: Mohamed Al-Khaled, Jürgen Eggers, QugSS2 Study Tags: Original Articles Source Type: research

Warfarin-associated Intracerebral Hemorrhage is Increasing in Prevalence in the United States
Background: Warfarin-associated intracerebral hemorrhage (WAICH) is expected to increase in prevalence as the population ages. We sought to evaluate national trends, characteristics, and in-hospital outcomes among intracerebral hemorrhage (ICH) patients taking warfarin at baseline.Methods: We reviewed the Nationwide Inpatient Sample to identify all admissions with primary diagnosis of ICH by International Classification of Diseases, Ninth Revision code (431) from 2005 to 2008. We identified premorbid warfarin use by the V code (V58.93) and calculated the proportion of WAICH among all ICH patients in each year. We employed ...
Source: Journal of Stroke and Cerebrovascular Diseases - January 3, 2013 Category: Neurology Authors: Eric M. Liotta, Shyam Prabhakaran Tags: Original Articles Source Type: research

Recovery of Swallowing after Dysphagic Stroke: An Analysis of Prognostic Factors
Background: Dysphagia is a major complication of stroke, but factors influencing its recovery are incompletely understood. The goal of this study was to identify important prognostic variables affecting swallowing recovery after acute ischemic stroke.Methods: We retrospectively reviewed our patient database to identify acute ischemic stroke patients who developed dysphagia after stroke but were free of other confounding conditions affecting swallowing. Of the 1774 patients screened, 323 met the study criteria. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of co...
Source: Journal of Stroke and Cerebrovascular Diseases - October 24, 2012 Category: Neurology Authors: Sandeep Kumar, Christopher Doughty, Gheorghe Doros, Magdy Selim, Sourabh Lahoti, Sankalp Gokhale, Gottfried Schlaug Tags: Original Articles Source Type: research

Stroke Outcomes of Japanese Patients With Major Cerebral Artery Occlusion in the Post-Alteplase, Pre-MERCI Era
This study examined outcomes of patients with acute ischemic stroke (AIS) with major cerebral artery occlusion after the approval of intravenous recombinant tissue-type plasminogen activator (IV rt-PA) but before approval of the MERCI retriever. We retrospectively enrolled 1170 consecutive patients with AIS and major cerebral artery occlusion (496 women; mean age, 73.9 ± 12.3 years) who were admitted within 24 hours after the onset of symptoms to 12 Japanese stroke centers between October 2005 and June 2009. Cardioembolism was a leading cause of AIS in this group (68.2%). The occlusion sites of the major cerebral arteries...
Source: Journal of Stroke and Cerebrovascular Diseases - June 21, 2012 Category: Neurology Authors: Kaoru Endo, Masatoshi Koga, Nobuyuki Sakai, Hiroshi Yamagami, Eisuke Furui, Yasushi Matsumoto, Yoshiaki Shiokawa, Shinichi Yoshimura, Yasushi Okada, Jyoji Nakagawara, Toshio Hyogo, Yasuhiro Hasegawa, Hisashi Nagashima, Toshiyuki Fujinaka, Akio Hyodo, Tomo Tags: Original Articles Source Type: research

Seasonal Variation and Trends in Stroke Hospitalizations and Mortality in a South American Community Hospital
Numerous studies have reported the presence of temporal variations in biological processes. Seasonal variation (SV) in stroke has been widely studied, but little data have been published on this phenomenon in the Southern Hemisphere, and there have been no studies reported from Argentina. The goals of the present study were to describe the SV of admissions and deaths for stroke and examine trends in stroke morbidity and mortality over a 3-year period in a community hospital in Argentina. Hospital discharge reports from the electronic database of vital statistics between 1999 and 2001 were examined retrospectively. Patients...
Source: Journal of Stroke and Cerebrovascular Diseases - May 21, 2012 Category: Neurology Authors: Alejandro Díaz, Eliana Roldan Gerschcovich, Adriana A. Díaz, Fabiana Antía, Sergio Gonorazky Tags: Original Articles Source Type: research

Predictors of In-hospital Mortality and the Risk of Symptomatic Intracerebral Hemorrhage after Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke
This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 ± 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 ± 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. Univariate and multivariate regression analyses were performed to estimate the predictors of IHM. Eighty-three of the 1007 patients (8.2%) died during hospitalization (mean duration of hospitalization, 10 ± 1.8 days). Logistic regression estimated the...
Source: Journal of Stroke and Cerebrovascular Diseases - May 14, 2012 Category: Neurology Authors: Mohamed Al-Khaled, Christine Matthis, Jürgen Eggers Tags: Original Articles Source Type: research

Cause-specific Mortality after Stroke: Relation to Age, Sex, Stroke Severity, and Risk Factors in a 10-Year Follow-up Study
We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were performed by cause-specific Co...
Source: Journal of Stroke and Cerebrovascular Diseases - May 14, 2012 Category: Neurology Authors: Ulla Brasch Mogensen, Tom Skyhøj Olsen, Klaus Kaae Andersen, Thomas Alexander Gerds Tags: Original Articles Source Type: research

Antihypertensives Are Administered Selectively in Emergency Department Patients with Subarachnoid Hemorrhage
Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP) ≥160 mmHg is associated with increased risk of rebleeding and neurologic decline. In a population-based study, we determined the frequency of antihypertensive therapy in emergency department (ED) patients with SAH and the proportion of those patients with SBP ≥160 mmHg who received this therapy. In 2005, nontraumatic SAH cases were retrospectively ascertained at 16 hospitals in our region by scree...
Source: Journal of Stroke and Cerebrovascular Diseases - April 12, 2012 Category: Neurology Authors: Virginia Culyer, Erin McDonough, Christopher J. Lindsell, Kathleen Alwell, Charles J. Moomaw, Brett M. Kissela, Matthew L. Flaherty, Pooja Khatri, Daniel Woo, Simona Ferioli, Joseph P. Broderick, Dawn Kleindorfer, Opeolu Adeoye Tags: Original Articles Source Type: research

Racial and Ethnic Disparities in the Use of Intravenous Recombinant Tissue Plasminogen Activator and Outcomes for Acute Ischemic Stroke
This study investigated possible racial and ethnic disparities in the administration and outcome of recombinant tissue plasminogen activator (rtPA) therapy for acute ischemic stroke in whites, blacks, Hispanics, and Asian/Pacific Islanders. Using the National Inpatient Sample for 2001-2008, we selected patients with a primary diagnosis of acute ischemic stroke who received treatment with rtPA. Patient data were stratified by race (white, black, Hispanic, and Asian/Pacific Islander). We analyzed the association of patient race on rtPA utilization rate, in-hospital morbidity (ie, discharge to long-term facility), intracrania...
Source: Journal of Stroke and Cerebrovascular Diseases - December 12, 2011 Category: Neurology Authors: Deena M. Nasr, Waleed Brinjikji, Harry J. Cloft, Alejandro A. Rabinstein Tags: Original Articles Source Type: research

Geotopographic and Environmental Characteristics of Communities and the Seasonality of Stroke Occurrences
We read with great interest the study by Takizawa et al that was recently published in the Journal of Stroke and Cerebrovascular Diseases describing seasonality in the occurrence of stroke in Japan. The authors analyzed 35,631 registered stroke cases (29,238 ischemic and 6,393 hypertensive hemorrhagic stroke patients) occurring between 1998 and 2007 from the Japanese Standard Stroke Registry Study (JSSRS) database, which is currently the world’s largest hospital-based stroke database, accumulating records from 163 Japanese institutions throughout Japan. To examine seasonal variation in the incidence of ischemic and noni...
Source: Journal of Stroke and Cerebrovascular Diseases - November 24, 2011 Category: Neurology Authors: Tanvir Chowdhury Turin, Adrian V. Specogna, Nahid Rumana Tags: Letter to the Editor Source Type: research

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