Stroke; a journal of cerebral circulation
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Multicenter Study
Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study.
Dizziness, vertigo, and imbalance are common presenting symptoms in the emergency department. Stroke is a leading concern even when these symptoms occur in isolation. The objective of the present study was to determine the "real-world" proportion of stroke among patients presenting to the emergency department with these dizziness symptoms (DS). ⋯ The proportion of cerebrovascular events in patients presenting with dizziness, vertigo, or imbalance is very low. Isolated dizziness, vertigo, or imbalance strongly predicts a noncerebrovascular cause. The symptom of imbalance is a predictor of stroke/TIA.
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Biochemical markers of acute neuronal injury may aid in the diagnosis and management of acute ischemic stroke. Serum samples from the National Institute for Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen activator Stroke Study were analyzed for the presence of 4 biochemical markers of neuronal, glial, and endothelial cell injury. These biochemical markers, myelin basic protein (MBP), neuron-specific enolase (NSE), S100beta, and soluble thrombomodulin, were studied for an association with initial stroke severity, infarct volume, and functional outcome. ⋯ This study corroborates previous work demonstrating correlations of MBP, NSE, and S100beta with clinical and radiographic features in acute stroke. Despite significantly better outcomes in the tissue plasminogen activator-treated group, we found no difference in the early release of the 4 biomarkers between treatment groups. Further study will define the role of biomarkers in acute stroke management and prognostication.
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Multicenter Study
Should spectrophotometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage?
The absence of xanthochromia in the cerebrospinal fluid (CSF) is often used to exclude subarachnoid hemorrhage (SAH). Authorities advocate spectrophotometry to measure xanthochromia, but most North American hospitals use visual inspection. We studied the diagnostic accuracy of spectrophotometry for SAH, and its potential impact on current practice. ⋯ Spectrophotometric definitions of xanthochromia have only moderate to low specificity for SAH. Using spectrophotometry could increase angiography rates, thereby identifying more incidental aneurysms, increasing patient anxiety and exposing patients to unnecessary surgical or investigational complications without benefit.
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Comparative Study
Frequency and determinants of nonpublication of research in the stroke literature.
Selective nonpublication will yield publication bias and a published literature imperfectly representative of the full range of scientific findings. We evaluated the proportion of research abstracts presented at the leading United States research meeting in stroke, the International Stroke Conference (ISC), which were subsequently published as full-length articles and investigated the factors associated with full manuscript publication. ⋯ Approximately 1 of every 3 abstracts presented at an international stroke meeting was not published as a full manuscript within 5 years. Poster abstracts were less likely to be published in full manuscript form than oral presentations.
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Exogenous delivery of vascular endothelial growth factor gene (VEGF) may provide a useful approach to the treatment of brain ischemia. We investigated the use of a hypoxia-responsive element to control VEGF expression given for neuroprotection. ⋯ Exogenous expression of VEGF through AAVH9-VEGF gene transfer 5 days before the onset of ischemia provides neuroprotection. Hypoxia-responsive element is a viable strategy of restricting VEGF expression to areas of ischemia to minimize adverse effects of therapy on adjacent normal parenchyma.