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Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.
Abstract An increased emphasis on stroke care has led to a proliferation of specialized stroke teams despite relatively few trials demonstrating their efficacy. Our academic stroke center incorporated a unique setup allowing for the comparison between stroke teams and emergency physicians. During weekday working hours, a stroke team would respond to the emergency department for stroke activations. During all other times, the emergency physician caring for the patient would make all treatment decisions. We sought to determine whether there was any difference in treatment and outcomes between these two groups. We co...
Source: Baylor University Medical Center Proceedings - September 30, 2019 Category: Universities & Medical Training Authors: Juergens AL, Barney J, Julakanti M, Allen L, Shaver C Tags: Proc (Bayl Univ Med Cent) Source Type: research

Pre-hospital Triage of Acute Ischemic Stroke Patients —Importance of Considering More Than Two Transport Options
Conclusion: Pre-hospital triage algorithms for AIS patients that only take into account the nearest CSC and the nearest PSC as transport destinations may be unable to identify the optimal transport destination for a significant proportion of patients. Introduction Background International guidelines recommend early administration of intravenous thrombolysis for eligible patients with acute ischemic stroke (AIS); in addition, patients with proximal large vessel occlusion (LVO) should receive mechanical thrombectomy (MT) as quickly as possible (1). As the clinical benefit of both thrombolysis (2–4) and MT (5&#...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Intravenous Thrombolysis in Posterior Circulation Stroke
Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset. Introduction History of Intravenous Thrombolysis—The Most Relevant Studies Intravenous...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis
Conclusion Our data suggest that women who suffer from IS present with a poorer functional outcome than men at 3-months, regardless of other preclinical and clinical factors during the acute phase. These relationships seem to be mediated by atrial dysfunction and inflammation. The inflammatory response is slightly higher in women; however, there are no sex differences in their functional behavior. There is a probable relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, and the connection seems to be more important in cardioembolic stroke patients. In patients wi...
Source: Frontiers in Neurology - April 16, 2019 Category: Neurology 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

Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Interventions for acute stroke management in Africa: a systematic review of the evidence
ConclusionEvidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients ’ outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake.Systematic review registrationPROSPEROCRD42016051566
Source: Systematic Reviews - October 24, 2017 Category: International Medicine & Public Health Source Type: research

Rapidly improving neurological deficit of stroke; case series in Academic institute, KAUH, Jeddah (P4.283)
Conclusions:Rapidly improving patient represent a challenge to whether tPA should be given. However, the good outcome with thrombolytic therapy observed in our study, will hopfuly support the decision to treat.Study Supported by: nonDisclosure: Dr. khoja has nothing to disclose. Dr. Alshaer has nothing to disclose. Dr. al-Turkistani has nothing to disclose. Dr. Al-Mekhalfi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: khoja, a., Al-Shaer, D., al-Turkistani, a., Al-Mekhalfi, M. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Resident door to needle Analysis: A retrospective Chart rEview (RACE) (P4.285)
Conclusions:Recognition and token awards for neurology residents can lead to shorter DTN times which could, in turn, improve outcomes in AIS. However, this approach requires a continued review of diagnostic accuracy and adverse events to ensure quality of care is not compromised for the sake of speed.Disclosure: Dr. Patel has nothing to disclose. Dr. Mehta has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Patel, N., Mehta, S. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Age, Gender and Racial Disparities in Acute Stroke Therapy in a Large Non-Academic Health System (P3.261)
Conclusions:We confirmed known disparities in ATT rates between PSC and AH. No disparity in age or gender were identified in this population. Racial disparity was problematic because of a small number of non-white patients and a number of patients with no racial data captured. Better racial data collection, analysis of access to care, and care process modeling might impact these findings.Disclosure: Dr. Taylor has nothing to disclose. Dr. Jones has received personal compensation for activities with Genentech as a speaker. Dr. Gosnell has nothing to disclose. Dr. Snyder has nothing to disclose. Dr. Schneider has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Taylor, R., Jones, R., Gosnell, J., Snyder, S., Schneider, A. Tags: Cerebrovascular Disease Epidemiology Source Type: research

Stroke Code Simulation Lab; Save Time Save Brain! (P2.375)
CONCLUSIONS: The stroke code simulation lab met its objectives of improving the neurology residents’ knowledge and experience managing stroke codes. It was perceived as a valuable exercise. Further data will determine if the stroke code simulation lab improves patient care.Disclosure: Dr. Mao has nothing to disclose. Dr. Zidan has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Cherukuri has nothing to disclose. Dr. Qadeer has nothing to disclose. Dr. Bradshaw has received research support from Cytokinetcs.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Mao, Y., Zidan, A., Afzal, U., Cherukuri, R., Qadeer, U., Bradshaw, D. Tags: Research Methodology and Education: Patient Safety and Quality Source Type: research

Are all stroke patients eligible for fast alteplase treatment? An analysis of unavoidable delays
ConclusionsUp to 31% of patients have delays due to medical or eligibility‐related causes that may be legitimate reasons for providing alteplase later than the benchmark time of 60 minutes.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - January 29, 2016 Category: Emergency Medicine Authors: Philip M C Choi, Jamsheed A Desai, Devika Kashyap, Caroline Stephenson, Noreen Kamal, Sheldon Vogt, Victoria Bohm, Michael Suddes, Erin Bugbee, Michael D Hill, Andrew M Demchuk, Eric E Smith Tags: Original Contribution Source Type: research

Balancing Autonomy and Beneficence in Acute Stroke Therapy: Neurologist Attitudes Toward Delaying Thrombolysis in Order to Obtain Informed Consent (P7.332)
CONCLUSIONS: Vascular neurologists indicate they emphasize beneficence over autonomy in deciding when to forego further attempts to reach consent providers to proceed with thrombolytic therapy under the doctrine of presumed consent. Their preference for rapid intervention is magnified when decisions are framed in person failure to benefit and neuron loss, compared with simple chronologic time.Disclosure: Dr. Kaplan has nothing to disclose. Dr. Cranston has nothing to disclose. Dr. Saver has received personal compensation for activities with the University of California, BrainsGate, CoAxia, eV3, Talecris Biotherapeutics Inc...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Kaplan, B., Cranston, J., Saver, J. Tags: Practice, Policy, and Ethics Source Type: research

Reducing Time to Treatment - The Role of Stroke Neurologist as First Responder (S5.006)
CONCLUSIONS: The use of a stroke-trained attending neurologist as a first responder and stroke team leader resulted in rapid patient evaluation and faster decision regarding thrombolytic therapy, improving time to treatment and time to CT.Disclosure: Dr. Ozark has nothing to disclose. Dr. Sabatino has nothing to disclose. Dr. Holmstedt has nothing to disclose. Dr. Turan has received personal compensation for activities with Gore Laboratories Inc., and Boehringer Ingelheim Pharmaceuticals Inc. Dr. Turan has received research support from Stryker Co., the National Institutes of Health, and AstraZeneca.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Ozark, S., Sabatino, P., Holmstedt, C., Turan, T. Tags: Cerebrovascular Disease and Interventional Neurology: Pre-hospital, Telemedicine, and Related Topics Source Type: research

Decompressive Hemicraniectomy for Malignant Hemispheric Stroke in the Elderly: Comparison of Outcomes between Individuals 61-70 and >70 Years of Age
Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.
Source: Journal of Stroke and Cerebrovascular Diseases - March 13, 2013 Category: Neurology Authors: Joji Inamasu, Takafumi Kaito, Takeya Watabe, Tsukasa Ganaha, Yasuhiro Yamada, Teppei Tanaka, Shuei Imizu, Takuro Hayashi, Motoharu Hayakawa, Yoko Kato, Yuichi Hirose Tags: Original Articles Source Type: research

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