Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Mar 2010
Timing of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage: the effect of treatment modality and clinical implications.
A better prediction of the time course of symptomatic vasospasm (SVSP) might have a significant impact on the management and prevention of delayed neurologic ischemic deficit (DIND). We studied the influence of the treatment for ruptured aneurysm on SVSP timing. We retrospectively analyzed data of consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH) admitted in our center between 1999 and 2005, treated within 72 hours of the rupture by surgical clipping or endovascular coiling and in accordance with our neuroscience unit protocol. ⋯ The median time from the procedure to clinical vasospasm was 4 days in the coiled patients and 7 days in the clipped patients. In a proportional hazards model regression analysis including age, sex, Fisher and Hunt-Hess grades, time between onset to procedure, and intervention type, only intervention type emerged as a significant predictor of time to SVSP after intervention (likelihood ratio chi2 = 16.8; P < .00). Treatment modality of ruptured intracranial aneurysm may influence the timing of SVSP occurrence.
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J Stroke Cerebrovasc Dis · Mar 2010
Does mild deficit for patients with stroke justify the use of intravenous tissue plasminogen activator?
Intravenous (IV) tissue plasminogen activator (t-PA) is an effective medication currently used to treat acute ischemic stroke within 3 hours of symptom onset in patients with an identifiable clinical deficit measured using the National Institutes of Health Stroke Scale (NIHSS). Some reports suggest that patients with milder acute ischemic stroke may improve spontaneously and may not benefit additionally from IV thrombolysis. The objective of this retrospective study was to assess the outcomes of patients at our stroke center who received IV t-PA treatment for acute ischemic stroke, within 3 hours of symptom onset, outside the setting of a clinical trial and had a NIHSS score of less than or equal to 10 compared with historic control subjects. ⋯ The mean age was 65 +/- 13 years, the mean NIHSS score was 7 +/- 2, and the mean mRS score was 2.5 +/- 1.7. Assuming equal variances, the mRS score at discharge, for the IV t-PA-treated group, demonstrated a better clinical outcome that was statistically significant (P < .009). This retrospective study demonstrates that administering IV t-PA to patients with a mild stroke, measuring 10 or less by the NIHSS, can lead to improved clinical outcome when compared with patients with similar NIHSS score who have not received similar treatment.