Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · Nov 2013
Hospital discharges and mortality registries: 2 complementary databases for the epidemiological surveillance of stroke.
Stroke is a public health concern and the availability of a stroke registry would provide valuable information. Administrative hospital data and mortality registries have been previously suggested as suitable sources of information. The aim of this study was to evaluate the utility of merging data from a hospital discharge database and the mortality registry (MR) to estimate the incidence of stroke in La Rioja, Spain. ⋯ Considering both the Minimum Basic Data Set and the MR as data sources appears advisable to build a stroke registry to evaluate the incidence and to perform epidemiological surveillance of stroke.
-
J Stroke Cerebrovasc Dis · Nov 2013
Balloon test occlusion of the internal carotid artery with stump pressure ratio and venous phase delay technique.
Balloon test occlusion (BTO) is crucial before sacrificing parent arteries. We proposed a simple paradigm combining clinical tolerance with venous phase technique and stump pressure ratio as a criterion for sufficient collateral flow. Internal carotid artery (ICA) occlusion was considered safe for asymptomatic patients who exhibited less than 2 seconds of venous phase delay or had a stump pressure ratio greater than 60%. ⋯ Only 1 patient developed delayed vasospasm and brain infarction. Adequate collateral flow may be indicated by a stump ratio of 60% or greater with or without a high-flow bypass. Combined with clinical assessment and venous phase technique, ICA occlusion may be a safe option that does not result in delayed ischemic complications.
-
J Stroke Cerebrovasc Dis · Nov 2013
Early access to a neurologist reduces the rate of missed diagnosis in young strokes.
We hypothesized that the presence of an in-house neurologist or a neurology or emergency medicine (EM) residency is associated with a lower rate of missed stroke diagnosis and a greater use of thrombolytic therapy. ⋯ Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.
-
J Stroke Cerebrovasc Dis · Nov 2013
Relationship between diffusion tensor fractional anisotropy and motor outcome in patients with hemiparesis after corona radiata infarct.
This study examined the relationship between fractional anisotropy (FA) values of magnetic resonance-diffusion tensor imaging (DTI) and motor outcome (1 month after onset) in 15 patients with hemiparesis after ischemic stroke of corona radiata lesions. DTI data were obtained on days 14-18. FA values within the cerebral peduncle were analyzed using a computer-automated method. ⋯ Analysis revealed statistically significant relationships between rFA and upper extremity functions (correlation coefficient=.679 for shoulder/elbow/forearm and .706 for wrist/hand). Although slightly less evident, the relationship between rFA and lower extremity function was also statistically significant (correlation coefficient=.641). FA values within the cerebral peduncle are moderately associated with the outcome of both upper and lower extremity functions, suggesting that DTI may be applicable for outcome prediction in stroke patients with corona radiata infarct.
-
J Stroke Cerebrovasc Dis · Nov 2013
Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from Get with the Guidelines--Stroke.
National guidelines recommend dysphagia screening (DS) before oral intake in stroke patients to reduce hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP after ischemic stroke. ⋯ HAP occurs in 1 of 17 hospitalized stroke patients and is associated with a greater than 5-fold increase in mortality. DS did not occur in 31.1% of eligible patients, with increased screening among those with more severe strokes and those who developed HAP. The attenuation of the relationship between DS and HAP risk when controlling for NIHSS score suggests the association between screening and pneumonia is confounded by severity. Controlled trials are needed to determine DS effectiveness.