Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · Nov 2012
Barriers to the use of intravenous tissue plasminogen activator for in-hospital strokes.
Patients who have ischemic strokes (ISs) while hospitalized for other conditions may be less likely to receive intravenous tissue plasminogen activator (IV tPA) when compared to patients who have strokes in the community. This study explored possible barriers to IV tPA use in these patients. ⋯ Seventy percent of in-hospital IS cases in our single hospital retrospective study were postoperative, clinically subtle, or had contraindications to IV tPA, preventing its use. Of the remaining untreated patients, the biggest barrier to IV tPA administration was delay in stroke discovery, which was largely dependent on observation by hospital staff or family rather than patient report.
-
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.
-
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.
-
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.
-
J Stroke Cerebrovasc Dis · Nov 2012
Does inpatient quality of care differ by age among US veterans with ischemic stroke?
Some studies have found that older individuals are not as likely as their younger counterparts to be treated with some guideline-based stroke therapies. We examined whether age-related differences in inpatient quality of care exist among US veterans with ischemic stroke. ⋯ Risk-adjusted inpatient stroke care quality varies little with age for veterans admitted to a Veterans Affairs medical center for acute ischemic stroke.