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Stroke: management and prevention
Acute stroke treatment requires clear protocols to rapidly triage patients – using appropriate investigations – for mechanical thrombectomy and intravenous thrombolysis. Computed tomography (CT) excludes haemorrhage, CT angiography locates the occluded vessel, and CT perfusion and perfusion magnetic resonance imaging identify viable tissue. An organized approach to str oke care in a specialist environment reduces disability and saves lives. Adoption of a ‘care bundle’ approach, including the active management of pyrexia and hyperglycaemia, and early screening for swallowing difficulties, is beneficial.
Source: Medicine - July 25, 2023 Category: Internal Medicine Authors: Gina Hadley, Ivie I. Gbinigie, Joyce S. Balami, Alastair M. Buchan Tags: Acute neurology Source Type: research

'Dense Inverted Triangle Sign' in Cerebral Venous Thrombosis
Intern Med. 2022 Nov 30. doi: 10.2169/internalmedicine.0764-22. Online ahead of print.ABSTRACTThe early diagnosis of cerebral venous thrombosis in the emergency department is challenging. A 70-year-old man presented to the emergency department after falling with new-onset convulsions. Brain unenhanced computed tomography (CT) revealed right frontal hemorrhage indicative of traumatic subarachnoid hemorrhage (SAH). Brain unenhanced CT on day 2 revealed increased density in the anterior superior sagittal sinus (SSS), namely 'dense inverted triangle sign.' Brain magnetic resonance venography showed a filling defect in the ante...
Source: Internal Medicine - November 30, 2022 Category: Internal Medicine Authors: Akiyuki Hiraga Yutaka Watabe Satoshi Kuwabara Source Type: research

A clinical application study of a stent placement assessment
Discussion: Currently, no prospective controlled data exist regarding the efficacy and safety of carotid stenting in the acute phase. Previously, we had developed an ECASES stent placement system for acute carotid artery occlusion. The present study will evaluate the efficacy and safety of ECASES in a randomized, double-blind prospective study and clarify its guiding significance in acute atherosclerotic carotid artery occlusion surgery.
Source: Medicine - November 25, 2022 Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research

Neurophysiology tools to lower the stroke onset to treatment time during the golden hour: microwaves, bioelectrical impedance and near infrared spectroscopy
Ann Med. 2022 Dec;54(1):2658-2671. doi: 10.1080/07853890.2022.2124448.ABSTRACTReperfusion therapy administration timing in acute ischaemic stroke is the main determinant of patients' mortality and long-term disability. Indeed, the first hour from the stroke onset is defined the "golden hour", in which the treatment has the highest efficacy and lowest side effects. Delayed ambulance transport, inappropriate triage and difficulty in accessing CT scans lead to delayed onset to treatment time (OTT) in clinical practice. To date brain CT scan is needed to rule out intracranial haemorrhage, which is a major contraindication to t...
Source: Annals of Medicine - September 26, 2022 Category: Internal Medicine Authors: Lazzaro di Biase Adriano Bonura Maria Letizia Caminiti Pasquale Maria Pecoraro Vincenzo Di Lazzaro Source Type: research

Non-Hodgkin's lymphoma revealed by a cerebral vascular stroke: A case report
We report the case of a 75-year-old patient admitted to the emergency room following a classic hemorrhagic stroke. The CT scan showed a hyperdense tumor-like process with perilesional edema, the diagnosis reinforced by (MRI). The patient underwent macroscopically total surgical excision and the anatomo pathological examination concluded a diffuse non-Hodgkin's B large cell lymphoma. The follow up was marked by a clear clinical improvement. Primary cerebral lymphomas can be polymorphic, so this diagnosis should always be kept in mind during stroke manifestations. This case illustrates the diagnostic difficulty of this rare ...
Source: Annals of Medicine - April 7, 2022 Category: Internal Medicine Authors: Oufaa Jamal Marouane Makhchoune Yassin Tahrir Khadija El Guettabi Abdelhakim Lakhdar Source Type: research

Craniocervical Artery Dissections: A Concise Review for Clinicians
Craniocervical artery dissection (CAD), although uncommon, can affect the young and lead to devastating complications, including stroke and subarachnoid hemorrhage. It starts with a tear in the intima of a vessel with subsequent formation of an intramural hematoma. Most CAD occurs spontaneously or after minor trauma. Patients with CAD may exhibit isolated symptoms of an underlying subclinical connective tissue disorder or have a clinically diagnosed connective tissue disorder. Emergent evaluation and computed tomography angiography or magnetic resonance imaging/angiography of the head and neck are required to screen for and to diagnose CAD.
Source: Mayo Clinic Proceedings - April 1, 2022 Category: Internal Medicine Authors: Zafer Keser, James F. Meschia, Giuseppe Lanzino Tags: Concise review Source Type: research

Computed tomography and clinical parameters predict intracerebral hemorrhage expansion
This study aimed to evaluate the association of imaging signs, and to establish a predictive model through selecting highly relevant imaging signs in combination with clinical parameters for hematoma expansion. Intracerebral Hemorrhage (ICH) patients who received 2 consecutive noncontrast computed tomography scans were examined and recruited through January 2014 to December 2020. Demographic information and clinical characteristics were collected. Two experienced radiologists reviewed baseline noncontrast computed tomography images to assess the imaging characteristics. Correlation analysis was analyzed with Pearson and...
Source: Medicine - March 4, 2022 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion: A case report
Rationale: Systemic lupus erythematosus (SLE) is an important cause of stroke, more than a half the cases present as acute ischemic stroke. Thrombolysis is an effective choice in most cases, but for large vessel occlusion, mechanical thrombectomy is more effective. Here we reported a case of SLE-related stroke with left middle cerebral artery (MCA) occlusion, who was successfully treated by MT and tirofiban. Patient concern: A 38-year-old female suffered from right hemiplegia and aphasia for 8 hours. She was diagnosed with SLE 20 years ago, and neuropsychiatric SLE was considered 8 months before this onset...
Source: Medicine - May 7, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Wrist-hand extension function recovery in spastic hemiplegia patient by botulinum toxin injection plus surface electromyography biofeedback therapy: A case report
We reported a 46-year-old male suffered a spastic hemiplegia with wrist- hand extension deficit. Diagnoses: Computed tomography showed cerebral hemorrhage in the left basal ganglia region. Interventions: Four hundred units of BoNTA were injected into the spasticity flexors, and four-week post injection surface electromyography (sEMG) biofeedback therapy was applied to the patient. Outcomes: The patient exhibited post-intervention improvement in wrist-hand extensors performance (strength, range of motion, sEMG signals), the flexors spasticity, and upper extremity function. Lessons: The present ca...
Source: Medicine - April 9, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Anticoagulant management by low-dose of low molecular weight heparin in patients with nonvalvular atrial fibrillation following hemorrhagic transformation and complicated with venous thrombosis: Five case reports and literature review
For patients with nonvalvular atrial fibrillation (NVAF) following hemorrhagic infarction (HI)/hemorrhage transformation (HT) and complicated with venous thrombosis, the management of anticoagulation is controversial. Our study intends to explore the safety and effectiveness of using low-dose of low molecular weight heparin (LMWH) to treat NVAF patients with HI (or HT) and complicated with venous thrombosis. Between January 2018 and January 2019, NVAF related acute ischemic stroke patients with HT/HI, hospitalized in the department of neurology or rehabilitation in our hospital, are enrolled retrospectively. Among them,...
Source: Medicine - February 19, 2021 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Stroke in the acute setting
Acute stroke and transient ischaemic attack (TIA) are focal neurological syndromes of vascular origin and should be treated as medical emergencies. Brain imaging with computed tomography or magnetic resonance imaging is required to distinguish ischaemic stroke from intracerebral haemorrhage, recognize non-stroke pathologies that mimic stroke, and guide investigation into the underlying mechanism. Acute interventions of benefit in ischaemic stroke include intravenous thrombolysis with alteplase, endovascular thrombectomy, with imaging permitting treatment in a wider range of patients, stroke unit care, aspirin, and combinat...
Source: Medicine - January 27, 2021 Category: Internal Medicine Authors: Keith W. Muir Tags: Acute medicine II Source Type: research

Stroke: management and prevention
Acute stroke treatment requires clear protocols to rapidly triage patients – using appropriate investigations – for endovascular thrombectomy and intravenous thrombolysis. Computed tomography (CT) excludes haemorrhage, CT angiography locates the occluded vessel, and perfusion magnetic resonance imaging identifies viable tissue. An organized approach to stroke care in a specialist environment reduces disability and saves lives. Adoption of a ‘care bundle’ approach including the active management of pyrexia and hyperglycaemia, and early screening for swallowing difficulties, is beneficial.
Source: Medicine - July 24, 2020 Category: Internal Medicine Authors: Gina Hadley, Ivie I. Gbinigie, Alastair M. Buchan Tags: Acute neurology Source Type: research

Successful dabigatran reversal after subdural hemorrhage using idarucizumab in a mobile stroke unit: A case report
Rationale: Idarucizumab is a specific reversal agent for patients with bleeding related to the anticoagulant dabigatran. There are no prior descriptions of Idarucizumab administration in the prehospital setting for intracranial hemorrhage. Patient concerns: An 82-year-old woman treated with dabigatran for atrial fibrillation developed acute focal weakness. This led to activation of emergency medical services and assessment in the mobile stroke unit (MSU). Diagnosis: Computed tomography of the brain performed in the MSU revealed an acute subdural hematoma. Interventions: The patient was treated with Idarucizumab ...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Reducing delays to administration of prothrombin complex concentrate in patients with vitamin K antagonist-related intracerebral haemorrhage.
Abstract BACKGROUND/AIMS: Four-factor prothrombin complex concentrate is the first-line treatment in vitamin K antagonist-related intracerebral haemorrhage. Early administration is associated with improved patient outcomes. A quality improvement project investigated delays in prothrombin complex concentrate administration in vitamin K antagonist-related intracerebral haemorrhage in order to reduce the time from computed tomography scan confirming intracerebral haemorrhage to prothrombin complex concentrate administration (scan-to-needle time). METHOD: Twenty patients were identified by retrospective audit ove...
Source: British Journal of Hospital Medicine - February 1, 2020 Category: Internal Medicine Authors: Marrinan E, Chen L, Werring D, Turner D Tags: Br J Hosp Med (Lond) Source Type: research

Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous thrombolysis: A meta-analysis
Conclusion: The systematic review showed that male, age, diabetes, NIHSS, OTT, atrial fibrillation, post stroke, infarct size, and ischemic signs of CT were significantly correlated with hemorrhagic transformation (HT). PROSPERO Registration number: CRD42019127499.
Source: Medicine - February 1, 2020 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

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