Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Comparative StudyIntravenous tissue plasminogen activator for patients with minor ischemic stroke.
Patients with minor ischemic stroke (MIS) are frequently excluded from thrombolytic therapy. Denial of therapy to these patients, however, remains controversial. We compared outcomes in patients with MIS who received intravenous (IV) tissue plasminogen activator (t-PA) with those who were not treated. ⋯ In our sample, patients with MIS treated with IV t-PA have similar outcomes as patients not receiving thrombolysis. A randomized trial or larger observational study is needed confirm or reject these findings.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsIntravenous thrombolysis in a stroke patient taking dabigatran.
We describe the use of intravenous thrombolysis with recombinant tissue plasminogen activator (IV-rtPA) in a patient with concomitant dabigatran use. A 64-year-old man with a history of coronary artery disease, pacemaker placement, and atrial fibrillation developed acute right arm/face weakness and dysarthria. He was unable to list his home medications. ⋯ We report a case of an acute stroke patient taking dabigatran who received IV-rtPA. In the acute stroke setting, clinicians should be aware of the increasing use of dabigatran in patients with atrial fibrillation when considering IV-rtPA. Although aPTT does not provide a linear response to dabigatran therapy, the presence of a completely normal PTT may exclude therapeutic dabigatran anticoagulation.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsAir tract in the thrombus: paradoxical cerebral air embolism through a residual catheter track.
We report a 49-year-old woman who sustained ischemic stroke after central venous catheter removal. Brain computed tomography (CT) scan revealed air bubbles in the subarachnoid vessels. ⋯ The patient was ultimately diagnosed with a paradoxical cerebral air embolism through the residual catheter track in the thrombus. Rapid recognition, response, and prompt diagnosis are the most important factors in the successful treatment of such an embolism.
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J Stroke Cerebrovasc Dis · Nov 2012
Multicenter StudyLow Alberta stroke program early computed tomography score within 3 hours of onset predicts subsequent symptomatic intracranial hemorrhage in patients treated with 0.6 mg/kg Alteplase.
The significance of early ischemic changes (EICs) on computed tomography (CT) in selecting candidates for thrombolysis remains controversial. The Alberta Stroke Program Early CT Score (ASPECTS) provides a semiquantitative scale that scores EICs within the middle cerebral artery territory using a 10-point grading system. We examined whether ASPECTS can predict the response to intravenous thrombolysis within 3 hours of stroke onset and incidence of secondary hemorrhage. ⋯ In J-ACT, patients with low ASPECTS values have an increased risk of thrombolysis-related sICH.
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J Stroke Cerebrovasc Dis · Nov 2012
Multicenter StudyComplications in acute stroke in India (CAST-I): a multicenter study.
The prognosis and final outcome in patients who sustain stroke are significantly affected by medical complications occurring during the acute phase of stroke. Only limited information is available from India and other developing countries regarding acute complications of stroke. This study examined the frequency of acute stroke and the factors associated with complications of stroke in India. ⋯ Our study shows high rates of complication in acute stroke. Limb weakness, stroke severity, length of hospital stay, and anemia were the factors associated with complications. Other complications, such as urinary tract infection, chest infection, bedsores, other pain, and depression, can lead to poor outcome.