Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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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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Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates. ⋯ IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsRotational vertigo associated with putaminal infarction.
A 57-year-old man was admitted because of left hemiparesis. A magnetic resonance imaging scan of the brain revealed a recent infarct from the dorsal side of the right putamen to the corona radiata. ⋯ Repeat magnetic resonance imaging scans on days 2 and 11 revealed no additional lesions. The present case indicates that rotational vertigo might result from a small, supratentorial, subcortical lesion.
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J Stroke Cerebrovasc Dis · Nov 2012
Type of preadmission antidiabetic treatment and outcome among patients with ischemic stroke: a nationwide follow-up study.
We examined whether the preadmission use of sulfonylureas is associated with improved clinical outcome compared with other antidiabetic treatments after hospitalization with ischemic stroke. ⋯ Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsThree cases of middle cerebral artery occlusion emergently revascularized with a balloon-expandable coronary bare stent after intravenous tissue plasminogen activator.
Revascularization with emergency stent placement in patients with acute middle cerebral artery occlusion is still controversial in Japan. ⋯ Revascularization with emergency stent placement seems likely to be successful in patients with acute middle cerebral artery occlusion, but clinical symptoms do not always improve in some cases and care is needed in selecting patients for the procedure.