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World Stroke Organization Global Stroke Services Guidelines and Action Plan
Every two seconds, someone across the globe suffers a symptomatic stroke. ‘Silent’ cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence‐based approaches to stroke prevention, acute stroke management, and stroke recovery. The current challenge lies in implementing these interventions, particularly in regions ...
Source: International Journal of Stroke - September 23, 2014 Category: Neurology Authors: Patrice Lindsay, Karen L. Furie, Stephen M. Davis, Geoffrey A. Donnan, Bo Norrving Tags: Guidelines Source Type: research

Posterior circulation stroke is associated with prolonged door‐to‐needle time
ConclusionsPosterior circulation stroke patients had a delay in neurology evaluation after initial emergency department evaluation and a delay in intravenous tissue plasminogen activator administration compared with anterior circulation stroke patients. There may be difficulties in rapidly recognizing the symptoms of posterior circulation stroke, in contrast to anterior circulation stroke, in the emergency department.
Source: International Journal of Stroke - April 1, 2013 Category: Neurology Authors: Amrou Sarraj, Sarah Medrek, Karen Albright, Sheryl Martin‐Schild, Wafi Bibars, Farhaan Vahidy, James C. Grotta, Sean I. Savitz Tags: Research Source Type: research

Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation
ConclusionAtrial fibrillation is associated with greater volumes of more severe baseline hypoperfusion, leading to higher infarct growth, more frequent severe hemorrhagic transformation and worse stroke outcomes.
Source: International Journal of Stroke - March 12, 2013 Category: Neurology Authors: Hans T. H. Tu, Bruce C. V. Campbell, Soren Christensen, Patricia M. Desmond, Deidre A. De Silva, Mark W. Parsons, Leonid Churilov, Maarten G. Lansberg, Michael Mlynash, Jean‐Marc Olivot, Matus Straka, Roland Bammer, Gregory W. Albers, Geoffrey A. Donnan Tags: Research Source Type: research

Burden of stroke in Estonia
Estonia is the smallest of the three Baltic countries. The decline in incidence of first‐ever stroke during the 1990s has left Tartu, Estonia with a relatively low stroke incidence. However, the incidence rates for younger age groups, and the 28‐day case fatality rate are higher compared with several other studies. Developments in the national health care system in recent years have been positive: the decline of mortality rate of stroke in Estonia is greater than the European Union average. However, the mortality of cardiovascular diseases is higher compared with several European countries. The prevalence of most strok...
Source: International Journal of Stroke - April 1, 2013 Category: Neurology Authors: Janika Kõrv, Riina Vibo Tags: Panorama Source Type: research

Heart rate variability and baroreceptor sensitivity in acute stroke: a systematic review
BackgroundAutonomic nervous system dysfunction is common after acute stroke and is associated with elevated risk of cardiac arrhythmia and mortality. Heart rate variability and baroreceptor sensitivity have been investigated as parameters of autonomic nervous system dysfunction for the prediction of stroke outcome. SummaryWe performed a systematic literature review on heart rate variability and baroreceptor sensitivity as parameters for autonomic nervous function in acute stroke. Twenty‐two studies were included. Associations between heart rate variability or baroreceptor sensitivity and stroke severity, early and late c...
Source: International Journal of Stroke - July 23, 2015 Category: Neurology Authors: Laetitia Yperzeele, Robbert‐Jan van Hooff, Guy Nagels, Ann De Smedt, Jacques De Keyser, Raf Brouns Tags: Systematic review Source Type: research

Body mass index and acute ischemic stroke outcomes
ConclusionsBeing overweight or obese is associated with a better functional outcome and reduced mortality in patients of acute ischemic stroke. However, the definition of an ‘optimal’ body mass index, in relation to stroke outcomes, may be affected by age, gender, and use of thrombolytic therapy.
Source: International Journal of Stroke - October 22, 2013 Category: Neurology Authors: M. Saini, M. Saqqur, A. Shuaib, Tags: Research Source Type: research

Predictors of in‐hospital death and symptomatic intracranial hemorrhage in patients with acute ischemic stroke treated with thrombolytic therapy: Paul Coverdell Acute Stroke Registry 2008–2012
ConclusionsIn this study of acute ischemic stroke patients, older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of atrial fibrillation were associated with increased in‐hospital death among patients receiving intravenous tissue plasminogen activator. Among patients treated with intravenous tissue plasminogen activator, in‐hospital mortality and symptomatic intracerebral hemorrhage rates were similar between those treated within three‐hours of time last known to be well and those treated between three and 4·5 hours after this time.
Source: International Journal of Stroke - September 12, 2013 Category: Neurology Authors: Xin Tong, Mary G. George, Quanhe Yang, Cathleen Gillespie Tags: Research Source Type: research

Processes of early stroke care and hospital costs
ConclusionsEarly care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.
Source: International Journal of Stroke - December 19, 2013 Category: Neurology Authors: Marie Louise Svendsen, Lars H. Ehlers, Heidi H. Hundborg, Annette Ingeman, Søren P. Johnsen Tags: Research Source Type: research

Should minor stroke patients be thrombolyzed? A focused review and future directions
Stroke is a leading cause of morbidity and mortality worldwide. Up to 80% of ischemic stroke patients may initially present with minor symptoms. Minor stroke and transient ischemic attack patients are typically treated conservatively with antiplatelet agents and general vascular prevention strategies. Yet a high proportion develop recurrent stroke or progression of stroke and up to one in four of these patients are disabled or dead at follow‐up. Minor or rapidly improving symptoms are the top reasons for withholding thrombolytic therapy to time‐eligible stroke patients as they are believed to be ‘too good to treat’...
Source: International Journal of Stroke - December 25, 2014 Category: Neurology Authors: Amy Y. X. Yu, Michael D. Hill, Shelagh B. Coutts Tags: Review (invited) Source Type: research

Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke
ConclusionsThese results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.
Source: International Journal of Stroke - October 22, 2013 Category: Neurology Authors: Nishant K. Mishra, Pitchaiah Mandava, Christopher Chen, James Grotta, Kennedy R. Lees, Thomas A. Kent, Tags: Research Source Type: research

Burden of stroke in Italy: An economic model highlights savings arising from reduced disability following thrombolysis
ConclusionOur study reveals that performing thrombolytic therapy in eligible patients improves economic outcomes compared with patients receiving standard care. This model is useful for decision makers, both within and outside of the Italian national context, as a tool to assess the cost‐effectiveness of thrombolysis in both short‐ and long‐term period.
Source: International Journal of Stroke - April 8, 2015 Category: Neurology Authors: M. Chiumente, M. M. Gianino, D. Minniti, T. J. Mattei, B. Spass, K. M. Kamal, D. E. Zimmerman, A. Muca, E. Luda Tags: Research Source Type: research

Combined lysis of thrombus with ultrasound and systemic tissue plasminogen activator for emergent revascularization in acute ischemic stroke (CLOTBUST‐ER): design and methodology of a multinational phase 3 trial
ConclusionsSince intravenous recombinant tissue‐plasminogen‐activator remains the only medical therapy to reverse ischemic stroke applicable in the emergency department, our trial will determine if the additional use of transcranial ultrasound improves functional outcomes in patients with severe acute ischemic stroke (NCT#01098981).
Source: International Journal of Stroke - June 29, 2015 Category: Neurology Authors: Peter D. Schellinger, Andrei V. Alexandrov, Andrew D. Barreto, Andrew M. Demchuk, Georgios Tsivgoulis, Martin Kohrmann, John Alleman, Virginia Howard, George Howard, Anne W. Alexandrov, Gordon Brandt, Carlos A. Molina, Tags: Protocol Source Type: research

Intra‐arterial thrombolysis vs. standard treatment or intravenous thrombolysis in adults with acute ischemic stroke: a systematic review and meta‐analysis
Conclusions This analysis finds a modest benefit of intra‐arterial thrombolysis over standard treatment, although it does not find a clear benefit of intra‐arterial thrombolysis over intravenous thrombolysis in acute ischemic stroke patients. However, few trials, small sample sizes, and indirectness limit the strength of evidence.
Source: International Journal of Stroke - January 7, 2013 Category: Neurology Authors: Julian Nam, He Jing, Daria O'Reilly Tags: Systematic Review Source Type: research

Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke
ConclusionsThese results suggest that the larger proportion of patients arriving within 4·5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates.
Source: International Journal of Stroke - December 23, 2013 Category: Neurology Authors: Maarten M. H. Lahr, Patrick C. A. J. Vroomen, Gert‐Jan Luijckx, Durk‐Jouke Zee, Ronald Vos, Erik Buskens Tags: Research Source Type: research

High levels of von Willebrand factor and low levels of its cleaving protease, ADAMTS13, are associated with stroke in young HIV‐infected patients
ConclusionsStroke in human immunodeficiency virus infection is associated with a prothrombotic state, characterized by elevated von Willebrand factor and low ADAMTS13 levels.
Source: International Journal of Stroke - June 29, 2015 Category: Neurology Authors: Sameera Allie, Alan Stanley, Alan Bryer, Muriel Meiring, Marc I. Combrinck Tags: Research Source Type: research

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