Stroke; a journal of cerebral circulation
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Randomized Controlled Trial Multicenter Study
Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial.
Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic abnormalities are independently associated with adverse neurological outcomes. ⋯ Bradycardia, relative tachycardia, and nonspecific ST- and T-wave abnormalities are strongly and independently associated with 3-month mortality after subarachnoid hemorrhage. Further research should be performed to determine whether there is a causal relationship between cardiac dysfunction and neurological outcome after subarachnoid hemorrhage.
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Multicenter Study
Optimal Tmax threshold for predicting penumbral tissue in acute stroke.
We sought to assess whether the volume of the ischemic penumbra can be estimated more accurately by altering the threshold selected for defining perfusion-weighting imaging (PWI) lesions. ⋯ Defining PWI lesions based on a stricter Tmax threshold than the standard >2 seconds delay appears to provide more a reliable estimate of the volume of the ischemic penumbra in stroke patients imaged between 3 and 6 hours after symptom onset. A threshold between 4 and 6 seconds appears optimal for early identification of critically hypoperfused tissue.
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Previous reports have shown higher in-hospital mortality for patients with acute stroke who arrived on weekends compared with regular workdays. We analyzed the effect of presenting during off-hours, defined as weekends and weeknights (versus weekdays), on in-hospital mortality and on quality of care in the Get With The Guidelines (GWTG)-Stroke program. ⋯ Off-hour presentation was associated with an increased risk of dying in-hospital, although the absolute effect was small for ischemic stroke admissions (0.6% difference; number needed to harm=166) and moderate for hemorrhagic stroke (3.1% difference; number needed to harm=32). Reducing the disparity in hospital-based outcomes for admissions that present during off-hours represents a potential target for quality improvement efforts, although evidence of differences in the quality of care by time of presentation was lacking.
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MRI biomarkers play an important role in the diagnostic work-up of dementia, but their prognostic value is less well-understood. We investigated if simple MRI rating scales predict mortality in a memory clinic population. ⋯ Simple MRI biomarkers, in addition to their diagnostic use, have a prognostic value with respect to mortality in a memory clinic population. Microbleeds were the strongest predictor of mortality.
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Enrollment in acute stroke trials at a stroke center with multiple study protocols may delay the initiation of intravenous thrombolytics in patients who present within 3 hours of symptom onset. ⋯ We found that trials requiring prethrombolytic randomization can lead to a delay in the initiation of treatment. Future studies are needed to determine if such a delay is clinically significant and can be shortened by improved enrollment strategies.