Stroke; a journal of cerebral circulation
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Comparative Study Observational Study
Comparing National Institutes of Health Stroke Scale among a stroke team and helicopter emergency medical service providers.
The use of tissue-type plasminogen activator is limited to a maximum of 4.5 hours after symptom-onset. Endovascular recanalization may improve outcomes for large-vessel occlusions (LVO), but efficacy decreases with time from symptom-onset. A National Institutes of Health Stroke Scale (NIHSS) score ≥12 is predictive of LVOs and could be used to triage patients if appropriately used by prehospital providers. The NIHSS has been considered too complex and has not been validated in the prehospital setting. ⋯ HEMS providers can administer NIHSS with moderate to good agreement with the receiving stroke team. The use of the NIHSS in HEMS may identify patients with LVO and inform triage decisions for patients ineligible for tissue-type plasminogen activator.
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Prophylactic anticoagulation for deep venous thrombosis prevention after intracerebral hemorrhage (ICH) is safe. Current guidelines recommend prophylactic anticoagulation after cessation of hematoma growth. We aimed to evaluate nationwide trends in deep venous thrombosis prophylaxis after ICH. ⋯ Less than 20% of patients with ICH receive anticoagulation for deep venous thrombosis in the United States. When used, the time to initiation is <2 days in less than half of the patients. Further study should focus on understanding variations in practice and emphasize guideline-driven care.
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Norrin and its receptor Frizzled-4 have important roles in the blood-brain barrier development. This study is to investigate a potential role and mechanism of Norrin/Frizzled-4 on protecting blood-brain barrier integrity after subarachnoid hemorrhage (SAH). ⋯ Norrin protected blood-brain barrier integrity and improved neurological outcome after SAH, and the action of Norrin appeared mediated by Frizzled-4 receptor activation, which promoted β-catenin nuclear translocation, which then enhanced Occludin, VE-Cadherin, and ZO-1 expression. Norrin might have potential to protect blood-brain barrier after SAH.
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Electroencephalographic recovery is predictive of outcome after perinatal hypoxia-ischemia, but it is unknown whether early changes in electroencephalographic can predict the response to therapeutic hypothermia in the preterm brain. ⋯ Recovery of higher electroencephalographic frequencies may be a biomarker of effective hypothermic neuroprotection in the preterm-equivalent brain.