Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · May 2013
Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005-2009.
The aim of the study is to evaluate recent trends in mortality, length of stay, costs, and charges for patients admitted to the US hospitals with the principal diagnosis of stroke. ⋯ Between 2005 and 2009, in-hospital mortality for patients hospitalized with stroke improved despite increasing severity of illness. At the same time, the average charge for hospitalization increased by 28% despite unchanged cost of treatment and shorter length of stay.
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J Stroke Cerebrovasc Dis · May 2013
Preclusion of ischemic stroke patients from intravenous tissue plasminogen activator treatment for mild symptoms should not be based on low National Institutes of Health Stroke Scale Scores.
Intravenous tissue plasminogen activator (IV tPA) improves neurologic outcome after stroke, but is not recommended for patients with minor neurologic deficits commonly classified by a lower cutoff on the National Institutes of Health Stroke Scale (NIHSS). Because not all stroke signs are captured on the NIHSS, the use of a strict cutoff may exclude functionally impaired stroke patients from IV tPA treatment. ⋯ Language impairment, distal (hand) paresis, and gait disorder are common disabling deficits in patients with low NIHSS scores. Judgment of whether a stroke is disabling should not be based on the NIHSS score but on the assessment of the individual neurologic deficits and their impact on functional impairment.
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J Stroke Cerebrovasc Dis · May 2013
Randomized Controlled Trial Comparative StudyComparison of the effects of high- and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke.
Recently, high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and low-frequency rTMS (LF-rTMS) are reported to improve motor function significantly in chronic hemiparetic stroke patients. However, few studies have investigated the safety and efficacy of these rTMS modalities introduced during the early phase of stroke. The purpose of this study was to clarify the rTMS modality that is more beneficial for upper limb hemiparesis in the early phase of stroke using a randomized controlled trial. ⋯ HF-rTMS applied to the lesional hemisphere in the early phase of stroke was more beneficial for motor improvement of the affected upper limb than LF-rTMS.
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J Stroke Cerebrovasc Dis · May 2013
Multicenter StudyHyperacute-phase computed tomography-diffusion-weighted imaging discrepancy and response to thrombolysis.
This study investigated the incidence and clinical features of reversed discrepancy (RD) in patients with hyperacute ischemic stroke. Sixty-two patients with anterior circulation ischemic stroke were enrolled. All patients underwent computed tomography (CT) and magnetic resonance imaging within 3 hours and received therapy with intravenous tissue plasminogen activator. ⋯ In contrast, all 4 patients with bRD but without DWI-W (the bRD+W- group) had no basal ganglia infarction. Dramatic improvement after intravenous tissue plasminogen activator therapy was significantly less common in the bRD+W+ group (0 of 4 patients) than in the bRD+W- group (3 of 4 patients; P = .0285). Our findings suggest that the presence of both bRD and a DWI-W lesion can be used to predict whether dramatic improvement will occur and whether the basal ganglia will progress to infarction.
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J Stroke Cerebrovasc Dis · May 2013
Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?
The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. ⋯ Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.