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Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis Clinical Sciences
Background and Purpose—Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes.Methods—We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke–International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months.Results—In hospita...
Source: Stroke - June 25, 2018 Category: Neurology Authors: Michael V. Mazya, Niaz Ahmed, Elsa Azevedo, Antoni Davalos, Laura Dorado, Michal Karlinski, Svetlana Lorenzano, Jiři Neumann, Danilo Toni, Tiago P. Moreira Tags: Ultrasound, Health Services, Ischemic Stroke Original Contributions Source Type: research

Evolution of a US County System for Acute Comprehensive Stroke Care Clinical Sciences
We examined relationships between stroke details, reperfusion therapies, hospital transfers, and their change over time.Methods—All patients from January 1, 2013, to December 31, 2015, for whom 911 was called within 7 hours of onset in whom Emergency Medical Services personnel suspected acute stroke were evaluated.Results—Among 6132 patients, 3924 (64%) had confirmed diagnosis of stroke (74% ischemic/26% hemorrhagic), yielding diagnostic precision of 64% in the field. Of the 2892 patients with acute ischemic stroke, acute reperfusion therapy was given to 29.2% (21.7% intravenous tPA [tissue-type plasminogen activator] ...
Source: Stroke - April 23, 2018 Category: Neurology Authors: Radoslav I. Raychev, Dana Stradling, Nirav Patel, Joey R. Gee, David A. Lombardi, Johnson L. Moon, David M. Brown, Mayank Pathak, Wengui Yu, Samuel J. Stratton, Steven C. Cramer Tags: Cerebrovascular Disease/Stroke, Cerebrovascular Procedures, Ischemic Stroke Original Contributions Source Type: research

Effects of Prehospital Thrombolysis in Stroke Patients With Prestroke Dependency Clinical Sciences
Background and Purpose—Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily –independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency.Methods—This observational, retrospective analysis included all patients with acute ischemic str...
Source: Stroke - February 26, 2018 Category: Neurology Authors: Christian H. Nolte, Martin Ebinger, Jan F. Scheitz, Alexander Kunz, Hebun Erdur, Frederik Geisler, Tim-Bastian Braemswig, Michal Rozanski, Joachim E. Weber, Matthias Wendt, Katja Zieschang, Jochen B. Fiebach, Kersten Villringer, Ulrike Grittner, Sabina Ka Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Correction to: Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS Swiss Study on Aneurysmal Subarachnoid Hemorrhage) Correction
Source: Stroke - February 26, 2018 Category: Neurology Tags: Corrections Source Type: research

Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage Clinical Sciences
Background and Purpose—To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact.Methods—Retrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009–2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate ...
Source: Stroke - January 22, 2018 Category: Neurology Authors: Martin Nikolaus Stienen, Menno Germans, Jan–Karl Burkhardt, Marian C. Neidert, Christian Fung, David Bervini, Daniel Zumofen, Michel Rothlisberger, Serge Marbacher, Rodolfo Maduri, Thomas Robert, Martin A. Seule, Philippe Biȷlenga, Karl Schal Tags: Mortality/Survival, Cerebral Aneurysm, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage Original Contributions Source Type: research

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System Clinical Sciences
This study included 310 patients treated with alteplase in the pre–EXpediting the PRrocess of Evaluating and Stopping Stroke period and 557 patients treated with alteplase in the EXpediting the PRrocess of Evaluating and Stopping Stroke period. After implementation, alteplase administrations increased to 62/mo from 34/mo at baseline (P
Source: Stroke - December 22, 2017 Category: Neurology Authors: Mai N. Nguyen-Huynh, Jeffrey G. Klingman, Andrew L. Avins, Vivek A. Rao, Abigail Eaton, Sunil Bhopale, Anne C. Kim, John W. Morehouse, Alexander C. Flint Tags: Treatment, Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Risk Factors of Sudden Death From Subarachnoid Hemorrhage Clinical Sciences
Background and Purpose—One in every 4 subarachnoid hemorrhage (SAH) patients dies suddenly outside hospital, but most SAH risk factor studies focus on hospitalized patients. We studied the differences in risk factors between hospitalized SAH and sudden-death SAH patients.Methods—The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.52 million person-years. The Cox proportional hazards model calculated hazard ratios (HRs), with all analyses adjusted for known SAH risk factors, marital status, and socioeconomic status. A competing risks model analyzed differences in risk factors between ...
Source: Stroke - August 28, 2017 Category: Neurology Authors: Joni Valdemar Lindbohm, Jaakko Kaprio, Pekka Jousilahti, Veikko Salomaa, Miikka Korja Tags: Epidemiology, Risk Factors, Intracranial Hemorrhage, Aneurysm Original Contributions Source Type: research

Palliative Care for Hospitalized Patients With Stroke Clinical Sciences
This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States.Methods—Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by International Classification of Diseases-Ninth Revision codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the International Classification of Diseases-Ninth Revision code V66....
Source: Stroke - August 28, 2017 Category: Neurology Authors: Tarvinder Singh, Steven R. Peters, David L. Tirschwell, Claire J. Creutzfeldt Tags: Race and Ethnicity, Quality and Outcomes, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

Simultaneous Multiple Intracerebral Hemorrhages (SMICH) Clinical Sciences
Background and Purpose—Simultaneous multiple intracerebral hemorrhages (SMICHs) are uncommon. Few single-center studies have analyzed characteristics and outcome of SMICH. We analyzed clinical characteristics and outcome of SMICH patients from 2 comprehensive stroke centers.Methods—Baseline imaging from consecutive intracerebral hemorrhage (ICH) patients (n=1552) from Helsinki ICH study and Royal Melbourne Hospital ICH study was screened for SMICH. ICH pathogenesis was classified according to the structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined classification system ...
Source: Stroke - February 26, 2017 Category: Neurology Authors: Teddy Y. Wu, Nawaf Yassi, Darshan G. Shah, Minmin Ma, Gagan Sharma, Jukka Putaala, Daniel Strbian, Bruce C.V. Campbell, Bernard Yan, Turgut Tatlisumak, Patricia M. Desmond, Stephen M. Davis, Atte Meretoja Tags: Intracranial Hemorrhage Original Contributions Source Type: research

Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage Clinical Sciences
Background and Purpose—Several studies have reported a better functional outcome in lobar intracerebral hemorrhage (ICH) compared with deep location. However, among lobar ICH, a correlation of hemorrhage site—involving the specific lobes—with functional outcome has not been established.Methods—Conservatively treated patients with supratentorial ICH, admitted to our hospital over a 5-year period (2008–2012), were retrospectively analyzed. Lobar patients were classified as isolated or overlapping ICH according to affected lobes. Demographic, clinical, and radiological characteristics were recorded and compared amon...
Source: Stroke - February 26, 2017 Category: Neurology Authors: Stefan T. Gerner, Joȷi B. Kuramatsu, Sebastian Moeller, Angelika Huber, Hannes Lucking, Stephan P. Kloska, Dominik Madžar, Jochen A. Sembill, Stefan Schwab, Hagen B. Huttner Tags: Imaging, Prognosis, Quality and Outcomes, Intracranial Hemorrhage Original Contributions Source Type: research

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage Clinical Sciences
Background and Purpose—We aimed to develop and validate a grading scale for predicting 30-day mortality and 90-day functional outcome in patients with primary pontine hemorrhage (PPH).Methods—We retrospectively reviewed records of consecutive patients with first-ever pontine hemorrhage from 3 teaching hospitals between 2005 and 2012. Independent factors associated with 30-day mortality were identified by logistic regression to establish a risk stratification scale, named the new PPH score. For validation of the new PPH score, we prospectively recruited subjects from 10 units between December 2014 and November 2015. The...
Source: Stroke - December 22, 2016 Category: Neurology Authors: Kaibin Huang, Zhong Ji, Lihua Sun, Xiaoya Gao, Shaopeng Lin, Tao Liu, Shanfang Xie, Qishan Zhang, Wenchuan Xian, Saijun Zhou, Youquan Gu, Yongming Wu, Shengnan Wang, Zhenzhou Lin, Suyue Pan Tags: Clinical Studies, Prognosis, Quality and Outcomes, Intracranial Hemorrhage Original Contributions Source Type: research

Rheumatic Mitral Valve Disease Is Associated With Worse Outcomes in Stroke Clinical Sciences
We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes.Resultsâ...
Source: Stroke - October 23, 2016 Category: Neurology Authors: Wood, A. D., Mannu, G. S., Clark, A. B., Tiamkao, S., Kongbunkiat, K., Bettencourt-Silva, J. H., Sawanyawisuth, K., Kasemsap, N., Barlas, R. S., Mamas, M., Myint, P. K. Tags: Rheumatic Heart Disease, Valvular Heart Disease, Complications, Mortality/Survival, Cerebrovascular Disease/Stroke Original Contributions Source Type: research

Prehospital Reversal of Warfarin-Related Coagulopathy in Intracerebral Hemorrhage in a Mobile Stroke Treatment Unit Clinical and Research Innovations
Source: Stroke - April 27, 2015 Category: Neurology Authors: Gomes, J. A., Ahrens, C. L., Hussain, M. S., Winners, S., Rasmussen, P. A., Uchino, K., on behalf of the Cleveland Pre-Hospital Acute Stroke Treatment Study Group Tags: Coumarins, Anticoagulants Clinical and Research Innovations Source Type: research