International journal of stroke : official journal of the International Stroke Society
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Randomized Controlled Trial
The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke.
Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during acute stroke is feasible and can be accomplished safely but has not been fully assessed for efficacy. ⋯ This trial will provide important novel information about preferred management of acute ischemic stroke patients with hyperglycemia. It will determine the potential benefits and risks of intensive glucose control during acute stroke.
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A large diffusion-weighted imaging lesion ≤six-hours of symptom onset was found to predict the development of 'malignant' middle cerebral artery infarction with high specificity, positive predictive value, and negative predictive value, but sensitivity was low. ⋯ Clinical follow-up examination after 24 h helps identify patients at risk of 'malignant' middle cerebral artery infarction that are missed by predictive algorithms based on early diffusion-weighted imaging lesion volume alone.
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The cause of perimesencephalic hemorrhage is unknown, but a venous source is suggested. If perimesencephalic hemorrhage is of venous origin, less elevation of the intracranial pressure and less perfusion deficits are expected than after aneurysmal subarachnoid hemorrhage. ⋯ Perimesencephalic hemorrhage patients have a higher cerebral blood flow than aneurysmal subarachnoid hemorrhage patients. The findings of this study further support a venous origin of bleeding in perimesencephalic hemorrhage patients. Future studies should further elaborate on cerebral blood flow in posterior circulation aneurysms.
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Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. ⋯ This research will provide evidence for an effective telestroke program for use in regional Australian hospitals.