Stroke; a journal of cerebral circulation
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Antifibrinolytic treatment for 4 weeks after a subarachnoid hemorrhage has been shown to have no effect on outcome since a reduction in the rate of rebleeding was offset by an increase in ischemic events. To determine if a shorter course (4 days) of antifibrinolytic treatment before the expected onset of ischemic complications might reduce the rate of rebleeding yet avoid ischemic complications, we prospectively studied a series of 119 patients with subarachnoid hemorrhage; 479 patients with subarachnoid hemorrhage from our previous randomized double-blind study (238 treated with placebo, 241 with long-term tranexamic acid) served as historical control groups. ⋯ In contrast, the rate of cerebral infarction (33 of 119, 28%) was almost identical to that after long-term tranexamic acid (59 of 241, 24%), although mortality from cerebral infarction was reduced. Compared with historical control groups, treatment with tranexamic acid for 4 days fails to reduce the incidence of rebleeding but still increases the rate of cerebral infarction.
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Dysphagia is a well-recognized complication of stroke. We report two cases of dysphagia in stroke patients caused by the pharyngeal impaction of dental prostheses. Radiologic identification of such impaction is unreliable due to the increasing use of radiolucent material in dental prostheses. We recommend direct or indirect laryngoscopy to exclude foreign body impaction in all patients complaining of dysphagia.