Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2011
Cerebrospinal fluid ferritin level, a sensitive diagnostic test in late-presenting subarachnoid hemorrhage.
The workup of patients with suspected subarachnoid hemorrhage (SAH) presenting late is complicated by a loss of diagnostic sensitivity of computed tomography (CT) brain imaging and cerebrospinal fluid (CSF) bilirubin levels. In this prospective longitudinal study of CSF ferritin levels in SAH, serial CSF samples from 14 patients with aneurysmal SAH requiring extraventricular drainage (EVD) were collected. The control group comprised 44 patients presenting with headache suspicious of SAH. ⋯ CSF ferritin levels increased after SAH, from an average of 65 ng/mL on day 1 to 1750 ng/mL on day 11 (P < .01). Both the Fisher and Columbia CT scores were significantly correlated with CSF ferritin level. The increase in CSF ferritin level after SAH and possibly may provide additional diagnostic information in patients with suspected SAH who present late to the clinic.
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J Stroke Cerebrovasc Dis · Nov 2011
Multicenter Study Clinical TrialFactors predicting outcome in stroke patients treated with 0.6 mg/kg alteplase: evidence from the Japan Alteplase Clinical Trial (J-ACT).
The aim of the present study was to identify factors associated with functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH) in patients from the Japan Alteplase Clinical Trial (J-ACT) data set with ischemic stroke treated with intravenous (IV) 0.6 mg/kg alteplase within 3 hours after onset. The patient sample comprised 103 patients from the J-ACT, a multicenter, single-dose, open-label cohort study conducted to verify the efficacy and safety of IV 0.6 mg/kg alteplase in treating acute hemispheric stroke. The effects of 21 patient baseline characteristics on a favorable outcome (as evaluated by modified Rankin scale [mRS] score of 0-1 after 3 months), death within 3 months, and incidence of sICH within 36 hours after the start of treatment were examined by univariate analysis and stepwise logistic regression analysis. ⋯ No factors significantly predicted sICH. Age and baseline NIHSS score were independent predictors for both favorable outcome and death. Although these factors are consistent with those found to be predictors in studies on IV 0.9 mg/kg alteplase, there were no factors predicting outcomes specific for IV 0.6 mg/kg alteplase.
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J Stroke Cerebrovasc Dis · Nov 2011
Cognitive functioning in the acute phase poststroke: a predictor of discharge destination?
Cognitive dysfunction occurs in more than half of stroke survivors and can have far-reaching consequences for functioning in daily life. Assessment of cognitive function can play a major role in determining the appropriate discharge destination after a hospital stay. The present study aimed to determine the feasibility of cognitive screening in the acute phase poststroke and to investigate whether this cognitive screening can accurately predict discharge destination to either a dependent or an independent living situation. ⋯ Cognitive screening in the acute phase poststroke appeared to be feasible and capable of supporting the decision of whether to discharge a patient to home or to a dependent living situation. Functional status improved the predictive value of the model; the MMSE was not suitable for prediction. A comprehensive set of various predictors, including cognition, is recommended to support discharge planning.
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J Stroke Cerebrovasc Dis · Nov 2011
Presenting symptoms and onset-to-arrival time in patients with acute stroke and transient ischemic attack.
Delayed arrival to the emergency department (ED) precludes most stroke patients from receiving thrombolytic treatment. Our objective in this study was to examine the association between presenting symptoms and onset-to-arrival time (ie, time between onset of symptoms to arrival at the ED) in a statewide stroke registry. Demographics, clinical data, and presenting symptoms were collected for patients with acute stroke or symptomatic transient ischemic attack (TIA) admitted to 15 Michigan hospitals (n = 1922). ⋯ Difficulty with walking, balance, or dizziness (12%), confusion (9%), loss of consciousness (6.7%) and falls (3.4%) were associated with lower likelihood of arriving within 2 hours (walking: aOR, 0.7; 95% CI, 0.4-1.0; confusion: aOR, 0.5; 95% CI, 0.3-0.8; consciousness: aOR, 0.5; 95% CI, 0.1-0.9; falls: aOR, 0.4; 95% CI, 0.3-0.9). Presenting symptoms were strongly associated with time of arrival; patients with unilateral symptoms and speech difficulties were more likely to seek care early. Future studies should consider including more specific patient-level data to identify psychosocial and behavioral aspects of recognition and action to stroke symptoms.
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J Stroke Cerebrovasc Dis · Nov 2011
Case ReportsIntravenous thrombolysis in an elderly patient with acute ischemic stroke masking aortic dissection.
Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. ⋯ Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered.