Stroke; a journal of cerebral circulation
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Vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains a leading cause of death and disability after aneurysm rupture. Decreased availability of nitric oxide (NO) may be crucial in its pathogenesis. We hypothesized that endothelial NO synthase (eNOS) polymorphisms may determine susceptibility to vasospasm in SAH patients. ⋯ These findings suggest that genetic variation influencing NO regulation contributes to the risk of angiographic vasospasm in patients with SAH. The specific role of the promoter SNP (-786T-->C) may determine the effect of NO regulated by this pathway, distinct from other known eNOS polymorphisms.
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In 1998, 2947 patients in metropolitan Phoenix were hospitalized for acute cerebral infarction. Only 2 of the 26 regional hospitals satisfied criteria for primary stroke center (PSC) designation. Fewer than 1% of patients with ischemic stroke received tissue plasminogen activator for thrombolysis. We sought to develop and evaluate the effectiveness of a metropolitan prehospital emergency medical system for effectively identifying and transporting patients with acute stroke to a matrix of predesignated PSCs and increasing to 20% the proportion of all such patients receiving tissue plasminogen activator. ⋯ It is feasible to develop and operationalize a successful metropolitan-wide matrix of PSCs to accommodate emergency medical system-identified and transported patients with acute stroke in a 9000-square-mile region with a population of 3.5 million people.
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A new Glasgow Coma Scale-based scale has been developed to predict patient outcome in subarachnoid hemorrhage by calculating cut-off points by which 2 consecutive categories corresponded to a statistically significant different outcome. We assessed the external validity of this Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) scale and compared it to the commonly used World Federation of Neurological Surgeons scale. ⋯ Both PAASH and WFNS scales have a good discriminatory ability for patient prognosis. Because the OR of the PAASH increase more gradually, it is slightly preferable to the WFNS scale.