Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2013
Comparative StudyDecompressive hemicraniectomy for malignant hemispheric stroke in the elderly: comparison of outcomes between individuals 61-70 and >70 years of age.
Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients>60 years of age has rarely been investigated. ⋯ We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.
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J Stroke Cerebrovasc Dis · Nov 2013
Antihypertensives are administered selectively in emergency department patients with subarachnoid hemorrhage.
Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP)≥160 mmHg is associated with increased risk of rebleeding and neurologic decline. In a population-based study, we determined the frequency of antihypertensive therapy in emergency department (ED) patients with SAH and the proportion of those patients with SBP≥160 mmHg who received this therapy. ⋯ Age, sex, Glascow Coma Scale score, and National Institutes of Health Stroke Scale score were similar between treated and untreated patients. In the absence of definitive evidence, current blood pressure management in local EDs appears reasonable. Further studies of blood pressure management in acute SAH are warranted.
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J Stroke Cerebrovasc Dis · Nov 2013
Risk factors for poor outcome and mortality at 3 months after the ischemic stroke in patients with atrial fibrillation.
It has been shown that patients with atrial fibrillation have a poor prognosis in the early recovery phase after ischemic stroke (IS) or transient ischemic attack (TIA). The purpose of this study was to identify the risk factors associated with poor outcome, including mortality, 3 months after the onset of IS in patients with atrial fibrillation. ⋯ Age, gender, and NIHSS score were independently associated with poor outcome for IS or TIA patients with nonvalvular atrial fibrillation in the early recovery stage.
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J Stroke Cerebrovasc Dis · Nov 2013
National survey of thrombolytic therapy for acute ischemic stroke in Taiwan 2003-2010.
Data on thrombolytic therapy at the national level is scarce in Asia. Understanding current practice pattern is important for a policy maker in decision making. This cross-sectional study analyzed the utilization pattern of thrombolytic therapy for acute ischemic stroke (AIS) in Taiwan from 2003 through 2010 and identified factors associated with post-therapy intracerebral hemorrhage (ICH) and mortality. ⋯ Patients given thrombolytic therapy in hospitals with thrombolysis cases more than the 5.5/year had a lower risk of ICH (odds ratio: .53; 95% confidence interval: .31-.88). Compared with most developed countries, there is indeed much unmet need for stroke thrombolysis in Taiwan. Effective mechanism should be implemented to increase the thrombolysis rate safely and improve outcome for patients with AIS.
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J Stroke Cerebrovasc Dis · Nov 2013
The emergence of endovascular treatment-only centers for treatment of intracranial aneurysms in the United States.
Because of the availability of new technology, the spectrum of endovascular treatment for intracranial aneurysms has expanded widely. Some centers have started offering only endovascular treatment to patients with intracranial aneurysms (endovascular treatment-only centers [ETOCs]). Our objective was to identify the proportion and outcome of patients treated at ETOCs in the United States. ⋯ The recent emergence of ETOCs and provision of treatment with comparable outcomes and shorter length of stay at these hospitals may change the pattern of intracranial aneurysm treatment in the United States.