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Impact of CT scanner location on door to imaging time for emergency department stroke evaluation
Stroke is a potentially serious condition commonly diagnosed in the ED. Time to diagnosis can be crucial to maximizing outcome in a majority of ischemic stroke cases amenable to thrombolytic therapy.
Source: The American Journal of Emergency Medicine - August 13, 2019 Category: Emergency Medicine Authors: William Bonadio Source Type: research

Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke: Case report and review
The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Mild hypoesthesia was observed on his left limbs.
Source: The American Journal of Emergency Medicine - March 26, 2019 Category: Emergency Medicine Authors: Adam Tsou, Yu-Hsiu Juan, Tsu-Yi Chen, Shinn-Kuang Lin Source Type: research

Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke
The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Mild hypoesthesia was observed on his left limbs.
Source: The American Journal of Emergency Medicine - March 26, 2019 Category: Emergency Medicine Authors: Adam Tsou, Yu-Hsiu Juan, Tsu-Yi Chen, Shinn-Kuang Lin Tags: Case Report Source Type: research

Optimal treatment modality for coexisting acute myocardial infarction and ischemic stroke
We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy.
Source: The American Journal of Emergency Medicine - December 31, 2018 Category: Emergency Medicine Authors: Fatih Gungoren, Feyzullah Besli, Zulkif Tanriverdi, Ozcan Kocaturk 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

Is it dangerous to treat acute ischemic stroke by thrombolytic therapy in patients with comorbid intracranial aneurysms
The safety of cerebral ischemic stroke patients with comorbid intracranial aneurysms treated by thrombolysis is still an unsolved mystery. We aimed to perform a secondary analysis and review to provide evidence on whether stroke patients with intracranial aneurysms have worse outcomes following thrombolysis.
Source: The American Journal of Emergency Medicine - December 16, 2015 Category: Emergency Medicine Authors: Jiayue Ding, Jie Han, Zhe Jing, Yue Jiang Source Type: research

Stroke: prospective evaluation of a prehospital management process based on rescuers under medical direction
Abstract: Background: Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.Methods: This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after telephone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU); if symptom onset was more than 6 hours ago...
Source: The American Journal of Emergency Medicine - February 3, 2014 Category: Emergency Medicine Authors: Laure Alhanati, Stéphane Dubourdieu, Clément Hoffmann, Francis Béguec, Stéphane Travers, Hugues Lefort, Olga Maurin, Daniel Jost, Laurent Domanski, Jean-Pierre Tourtier Tags: Original Contributions Source Type: research

Tissue plasminogen activator for transient ischemic attack: the case for “off-label” use of thrombolytics
We describe an illustrative case of a patient with recurring middle cerebral artery (MCA) ischemia, where our risk benefit analysis led to the administration of thrombolytic therapy despite the patient’s score of 0 on the National Institute of Health Stroke Score (NIHSS).
Source: The American Journal of Emergency Medicine - November 6, 2013 Category: Emergency Medicine Authors: Richard M. Sobel, Daniel T. Wu, Kristina Hester, Kim Anda Tags: Correspondence Source Type: research

Predictive value of the Cincinnati Prehospital Stroke Scale for identifying thrombolytic candidates in acute ischemic stroke
Abstract: Background: Despite the usefulness of the Cincinnati Prehospital Stroke Scale (CPSS) for rapid recognition of acute stroke, its ability to assess stroke severity is unclear. We investigated the usefulness of CPSS for assessment of stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who were candidates for thrombolytic therapy at hospital admission within 6 hours of symptom onset.Methods: We conducted a retrospective analysis of a prospective registry database of consecutive patients included in the brain salvage through emergency stroke therapy program. In t...
Source: The American Journal of Emergency Medicine - September 23, 2013 Category: Emergency Medicine Authors: Je Sung You, Sung Phil Chung, Hyun Soo Chung, Hye Sun Lee, Jong Woo Park, Hyun Jong Kim, Shin Ho Lee, Incheol Park, Hahn Shick Lee Tags: Brief Reports Source Type: research

Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?
We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarc...
Source: The American Journal of Emergency Medicine - July 1, 2013 Category: Emergency Medicine Authors: Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi Tags: Correspondence Source Type: research

Rescue thrombolysis in the treatment of cardiac shock and acute stroke
The patients with ST-elevation myocardial infarction are primarily managed with percutaneous coronary intervention (PCI) or thrombolysis. It is well accepted that rescue PCI should be implemented in case of unsuccessful thrombolysis. However, the reverse, rescue thrombolysis, that is, administering of thrombolytic therapy in a patient in whom primary PCI fails, is not well defined. There are no available data about rescue thrombolysis so far. We represent a 43-year-old male patient with Buerger disease (thromboangiitis obliterans) who was admitted to our emergency department for cardiac shock related to inferior and right ...
Source: The American Journal of Emergency Medicine - April 19, 2013 Category: Emergency Medicine Authors: Sukru Akyuz, Mustafa Azmi Sungur, Cevdet Donmez, Aylin Sungur, Nese Cam Tags: Case Reports Source Type: research

Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke
We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Chen-Hsiung Huang, Hui-Chun Huang, Kang-Hsu Lin, Wei-Kung Chen, Chon-Haw Tsai Tags: Case Reports Source Type: research