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Chemotherapy induced stroke mimic: 5-Fluorouracil encephalopathy fulfilling criteria for tissue plasminogen activator therapy
Stroke mimics, especially those involving chemotherapy related neurotoxicity, can confound the clinical diagnosis of acute stroke. Here we describe the case of a 63year-old male with a recent history of stage IIIC colon cancer who presented with confusion on the second day of modified FOLFOX6 (5-fluorouracil/oxaliplatin) chemotherapy and subsequently received alteplase, tissue plasminogen activator therapy (tPA), for presumed ischemic stroke. Magnetic resonance imaging scans after tPA administration did not reveal evidence of an infarction and the patients' neurological symptoms resolved completely after discontinuation of...
Source: The American Journal of Emergency Medicine - July 6, 2017 Category: Emergency Medicine Authors: May Thuy Nguyen, Robyn Stoianovici, Luigi Brunetti Source Type: research

Investigation of UCH-L1 levels in ischemic stroke, intracranial hemorrhage and metabolic disorder induced impaired consciousness
We aimed to determine the levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons.
Source: The American Journal of Emergency Medicine - June 21, 2017 Category: Emergency Medicine Authors: Ihsan Yigit, Metin Atescelik, Mustafa Yilmaz, Mehmet Cagri Goktekin, Mehtap Gurger, Nevin Ilhan Source Type: research

Can we imagine a survival chain also for ischemic stroke?
I read with great interest the article about the University of Amiens experience in the management of acute stroke [1] and the concept of “door-to-needle” time, so similar to the best known “door-to-balloon” one. During my recent training period in an excellent Stroke Unit, I've directly experienced a quite brand new concept, brought by mechanical thrombectomy, the “door-to-reperfusion” time. We know from meta-analysis dat a that for every 9-minute delay in reperfusion, 1 of every 100 treated patients had a worse disability outcome (+1 point on MrS scale) [2].
Source: The American Journal of Emergency Medicine - May 29, 2017 Category: Emergency Medicine Authors: Aurora Vecchiato Source Type: research

Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups
ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed.
Source: The American Journal of Emergency Medicine - April 29, 2017 Category: Emergency Medicine Authors: Emre G ökcen, İbrahim Caltekin, Atakan Savrun, Hilal Korkmaz, Şeyda Tuba Savrun, Gökhan Yıldırım Source Type: research

Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke
The objective of the current study was to assess whether HbA1c-based adjusted glycemic variables were associated with unfavorable outcomes among patients admitted to the hospital for AIS.
Source: The American Journal of Emergency Medicine - March 21, 2017 Category: Emergency Medicine Authors: Chih-Jen Yang, Wen-I Liao, Jen-Chun Wang, Chia-Lin Tsai, Jiunn-Tay Lee, Giia-Sheun Peng, Chien-Hsing Lee, Chin-Wang Hsu, Shih-Hung Tsai Source Type: research

Thrombolytic therapy-associated acute myocardial infarction in patients with acute ischemic stroke: A treatment dilemma
Acute myocardial infarction (AMI) is uncommon in the acute phase of acute ischemic stroke (AIS) and occurs in approximately 1% of the population. Here, we report a paradoxical case of AMI during tissue plasminogen activator (t-PA) infusion for AIS. We review and analyze the previously reported cases. We found that only patients with AMI which occurred after thrombolytic therapy for AIS who received an adequate combination of anticoagulation plus percutaneous coronary intervention survived their events.
Source: The American Journal of Emergency Medicine - November 21, 2016 Category: Emergency Medicine Authors: Chih-Jen Yang, Po-Chuan Chen, Chin-Sheng Lin, Chia-Lin Tsai, Shih-Hung Tsai Source Type: research

Utility of point of care assessment of platelet reactivity (using the PFA-100 ®) to aid in diagnosis of stroke
Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS).The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic.
Source: The American Journal of Emergency Medicine - November 14, 2016 Category: Emergency Medicine Authors: Claire Pearson, Karin Przklenk, Valerie Mika, Syed Imran Ayaz, Morgan Ellis, Preet Varade, Rosa Tolomello, Robert D. Welch Source Type: research

Akinetic mutism revealing an ischemic stroke
We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.
Source: The American Journal of Emergency Medicine - November 3, 2016 Category: Emergency Medicine Authors: Zidouh Saad, Jidane Said, Belkouch Ahmed, Bakkali Hicham, Belyamani Lahcen Source Type: research

Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke: strength of association
We appreciate your insight and review of our manuscript in the American Journal of Emergency Medicine [1]. We acknowledge that measures such as odds ratio (OR) or relative risk may help the reader further understand the strength of association of our outcomes.
Source: The American Journal of Emergency Medicine - October 17, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall Tags: Correspondence Source Type: research

Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke
Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear.
Source: The American Journal of Emergency Medicine - September 16, 2016 Category: Emergency Medicine Authors: Jen Lin Chung, Tsung Yang Jen, Chu Huang Yen, Hsiung Tsai Yuan, Ming Hsueh Lee, Meng Lee, Ting Hsiao Cheng, Kuang Yu Hsiao, Leng Chieh Lin Tags: Brief Report Source Type: research

Favorable outcome of blood urea nitrogen/creatinine –based hydration therapy 3 months after acute ischemic stroke
Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear.
Source: The American Journal of Emergency Medicine - September 16, 2016 Category: Emergency Medicine Authors: Chung Jen Lin, Jen Tsung Yang, Yen Chu Huang, Yuan Hsiung Tsai, Ming Hsueh Lee, Meng Lee, Cheng Ting Hsiao, Kuang Yu Hsiao, Leng Chieh Lin Tags: Brief Report Source Type: research

Comprehensive interpretation of hyperglycemia and hyperosmolality on the clinical outcomes among ischemic stroke patients
Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients.
Source: The American Journal of Emergency Medicine - August 26, 2016 Category: Emergency Medicine Authors: Seunghun Ock, Sion Jo, Jae Baek Lee, Youngho Jin, Taeoh Jeong, Jaechol Yoon, Boyoung Park Source Type: research

Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke
The time to thrombolysis, commonly termed “door-to-needle” (DTN) is a measure of stroke center quality and effective patient care. The 2013 American Heart Association/American Stroke Association (AHA/ASA) Guidelines for the Early Management of Patients with Acute Ischemic Stroke recommend that hospitals administer thrombolytics to all eligible ischemic stroke patients in less than 60 minutes from arrival [1]. Time to initiation of thrombolytics in ischemic stroke patients has been associated with improved neurological outcomes, decreased adverse effects, and reduced mortality with early thrombolysis associated with the...
Source: The American Journal of Emergency Medicine - July 5, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall, Georgia Keriazes Source Type: research

Serum albumin level is associated with the recurrence of acute ischemic stroke
Previous studies have confirmed that low serum albumin levels in acute ischemic stroke patients increased the risk for poor outcome and death, demonstrating the neuroprotective role of albumin. However, there are few studies investigating the relationship between albumin levels and recurrence of stroke. The aim of this study was to evaluate the effect of serum albumin level on the risk of recurrence in patients with acute ischemic stroke.
Source: The American Journal of Emergency Medicine - June 12, 2016 Category: Emergency Medicine Authors: Qing Zhang, Yi-Xiong Lei, Qiang Wang, Yong-Ping Jin, Rong-Li Fu, He-Hong Geng, Ling-Ling Huang, Xiao-Xiao Wang, Pei-Xi Wang Tags: Original Contribution Source Type: research

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