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Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota
I just got back from the North Dakota Mission: Lifeline STEMI and Acute Stroke Conference in Bismark, ND. I had a great time and I learned a lot. I often get asked to speak in various venues about acute STEMI and 12-lead ECG interpretation, but for this conference they wanted me to talk mostly about stroke. That turned out to be a good thing because it forced me to read the 2013 AHA / ASA Guildelines for the Early Management of Patients With Acute Ischemic Stroke to make sure I was asking intelligent questions during the panel discussion (which I moderated) and also giving accurate information for the class I taught about ...
Source: EMS 12-Lead - May 31, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics patient-management North Dakota Mission Lifeline Stroke Source Type: research

A rare cause of stroke in young: PHACE syndrome (P1.253)
Conclusions:Neurocutaneous syndromes are typically diagnosed in childhood and can be a rare cause of stroke in young. Our patient suffered an ischemic stroke secondary to sequelae of undiagnosed PHACE syndrome. Early identification of neurocutaneous syndromes allows for proper surveillance, evaluation, and preventative education for development of complications.Disclosure: Dr. Fitzgerald has nothing to disclose. Dr. Chandra has nothing to disclose. Dr. Dannenbaum has nothing to disclose. Dr. Sharrief has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Fitzgerald, K., Chandra, S., Dannenbaum, M., Sharrief, A. Tags: Genetic Stroke Syndromes, Biomarkers, and Translational/Basic Research Source Type: research

Frequency of Hemorrhage on Follow Up Imaging in Stroke Patients Treated With rt-PA Depending on Clinical Course
Conclusions: Frequency of hemorrhagic transformation in Routine follow-up brain imaging and consecutive changes in therapeutic management were different depending on clinical course measured by NHISS score. Introduction Brain imaging 24–36 h after systemic thrombolysis for acute ischemic stroke is recommended in American Stroke Association and European Stroke Organization guidelines (1, 2). Brain imaging is performed to detect secondary bleeding or hemorrhagic transformation in order to adapt medical stroke prevention if necessary. Guideline recommendations are based on the results of the first study on rt-PA...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Stroke system of care in Louisiana (P6.261)
Conclusions:After LERN’s recognition of stroke facility designations, implementation of education for stroke providers and quality improvement process, the proportion of patients treated with IV tPA has doubled in the state of Louisiana over a 5-year period. LERN’s Statewide stroke system of care has been instrumental in facilitating this progress.Disclosure: Dr. Navalkele has nothing to disclose. Dr. Hargrove has nothing to disclose. Dr. Chernyshev has nothing to disclose. Dr. Acosta has nothing to disclose. Dr. DeAlvare has nothing to disclose. Dr. Hidalgo has nothing to disclose. Dr. El Khoury has nothing to...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Navalkele, D., Hargrove, P., Chernyshev, O., Acosta, J., DeAlvare, L., Hidalgo, G., El Khoury, R., Martin-Schild, S. Tags: Cerebrovascular Disease Systems of Care and Health Policy Source Type: research

Lori’s Stroke Required Help From Doctors An Hour Away. Telemedicine Provided It.
Editor’s note: Our previous stories this American Stroke Month featured warning signs heeded and missed. Today we shift gears to showcase a textbook response to a stroke, including the crucial role of telestroke, a way for experts at another facility to help care for a patient via a webcam-type connection. The CHRONIC Care Act, which includes a provision to require Medicare to cover telestroke, will be discussed Tuesday during a hearing of the Senate Finance Committee. Lori Hoopingarner savored her occasional weekend getaway. Between running her financial advising company, raising a 10-year-old daughter and 6-year-old s...
Source: Healthy Living - The Huffington Post - May 15, 2017 Category: Consumer Health News Source Type: news

Wake-up Stroke and Onset-to-door Duration Delays: Potential Future Indications for Reperfusion Therapy.
Conclusion: The one- third proportion of wake-up stroke in this cohort and low prevalence of relative contraindications suggest this is a promising group for emerging thrombolysis indications. With the majority of patients presenting after 8 hours, widening of the therapeutic window with new potential reperfusion treatments would not appreciably increase treatment utilisation. This study reaffirms the urgent need for public education to improve stroke awareness in Singapore. PMID: 24557460 [PubMed - in process]
Source: Annals of the Academy of Medicine, Singapore - January 1, 2014 Category: Journals (General) Authors: Tan MSh, Ang ES, Ho SS, Ng SC, Talabucon L, Woon FP, De Silva DA Tags: Ann Acad Med Singapore Source Type: research

Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study
This study is registered with ClinicalTrials.gov, number NCT02358772. Findings Between Feb 5, 2011, and March 5, 2015, 427 patients were treated within the STEMO vehicle and their data were entered into a pre-hospital registry. 505 patients received conventional care and their data were entered into an in-hospital thrombolysis registry. Of these, 305 patients in the STEMO group and 353 in the conventional care group met inclusion criteria and were included in the analysis. 161 (53%) patients in the STEMO group versus 166 (47%) in the conventional care group had an mRS score of 1 or lower (p=0·14). Compared with conventio...
Source: The Lancet Neurology - July 15, 2016 Category: Neurology Source Type: research

Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
We report the effect of intravenous alteplase on long-term survival after ischaemic stroke of participants in the Third International Stroke Trial (IST-3). Methods In IST-3, done at 156 hospitals in 12 countries (Australia, Europe, and the UK), participants (aged >18 years) were randomly assigned with a telephone voice-activated or web-based system in a 1:1 ratio to treatment with intravenous 0·9 mg/kg alteplase plus standard care or standard care alone within 6 h of ischaemic stroke. We followed up participants in the UK and Scandinavia (Sweden and Norway) for survival up to 3 years after randomisation using data...
Source: The Lancet Neurology - July 19, 2016 Category: Neurology Source Type: research

Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa – A survey based approach
Publication date: August 2017 Source:Journal of Clinical Neuroscience, Volume 42 Author(s): Chen Lin, Ravi Vakani, Peter Kussin, Mary Guhwe, Alfredo E. Farjat, Kingshuk Choudhury, David Renner, Chrispine Oduor, Carmelo Graffagnino There is no published literature regarding sub-Saharan health-care providers’ understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administ...
Source: Journal of Clinical Neuroscience - June 29, 2017 Category: Neuroscience Source Type: research

Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Analysis of Thrombolysis Process for Acute Ischemic Stroke in Urban and Rural Hospitals in Nova Scotia Canada
Conclusions: Guidelines and clear protocols are critical in reducing treatment times and ensuring consistent access to treatment. The majority of treatment delays encountered are system delays, which can be appropriately planned for to reduce delays within the care pathway. There is a general consensus that there is an urban-rural treatment gap for acute ischemic stroke patients in Nova Scotia, and that continuing education is key in rural hospitals to improve Emergency Department (ED) physician comfort with treating patients with tPA.
Source: Frontiers in Neurology - March 15, 2021 Category: Neurology Source Type: research

Trends in Alteplase Utilization in Louisianas Level III Hospitals (P4.272)
Conclusions:The treatment rate is increasing in Level III hospitals in Louisiana and is higher than the latest national Primary Stroke Center rate. Half of registered patients presented within 4.5hrs of LSN. Documentation of the reason for not getting alteplase improved. The disability associated with perceived minimal deficits is a target for enhanced education in determining eligibility for alteplase.Disclosure: Dr. Navalkele has nothing to disclose. Dr. Hargrove has nothing to disclose. Dr. Chernyshev has nothing to disclose. Dr. Acosta has nothing to disclose. Dr. DeAlvare has nothing to disclose. Dr. Hidalgo has nothi...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Navalkele, D., Hargrove, P., Chernyshev, O., Acosta, J., DeAlvare, L., Hidalgo, G., El Khoury, R., Martin-Schild, S. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Review Streamlining of prehospital stroke management: the golden hour
Thrombolysis with alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment. We recommend that all links in the prehospital stroke rescue chain must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of s...
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Klaus Fassbender, Clotilde Balucani, Silke Walter, Steven R Levine, Anton Haass, James Grotta Tags: Review Source Type: research

Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke: A retrospective cohort study
This study was designed to investigate the factors affecting the in-hospital delay of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Two hundred and forty-eight consecutive AIS patients treated with intravenous administration of alteplase in Gansu Provincial Hospital from December 2014 to August 2018 were enrolled retrospectively in this study. According to door-to-needle (DTN) time, the patients were divided into either a delay group (DTN time> 60 minutes; n = 184) or a non-delay group (DTN time ≤60 minutes; n = 64). The baseline data, laboratory tests, onset-to-door (OTD) time, door-to-acc...
Source: Medicine - May 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature
ConclusionFurther integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
Source: Journal of Neurology - March 20, 2020 Category: Neurology Source Type: research