Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jun 2015
Circulatory and Respiratory Parameters during Acute Endovascular Stroke Therapy in Conscious Sedation or General Anesthesia.
Whether patients suffering from acute ischemic stroke and undergoing endovascular recanalization should be treated under general anesthesia (GA) or conscious sedation (CS) is a matter of debate. According to retrospective studies, GA appears to be associated with a worse outcome than CS. The underlying mechanisms are unknown, but hypotension and hypocapnia during GA have been suggested. There are no prospective data on this question. ⋯ In this small prospective study, patients under CS required less vasopressor medication and had a higher mean blood pressure than those under GA, but they also showed signs of hyperventilation. The impact of these physiological differences on outcome needs to be studied in randomized trials.
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J Stroke Cerebrovasc Dis · Jun 2015
Inter-rater Reliability and Misclassification of the ABCD(2) Score after Transient Ischemic Attack.
The ABCD(2) score was initially developed as a simple tool to help first-line clinicians identify patients at highest short-term risk for stroke after transient ischemic attack (TIA). The score is increasingly used for risk stratification of TIA patients, but little is known about its inter-rater reliability. The aim of the present study was to prospectively assess the inter-rater reliability of the ABCD(2) score in patients with TIA, including a comparison among raters of different specialties. ⋯ The inter-rater reliability of the ABCD(2) score is only fair, with rater disagreement of ABCD(2) risk category in nearly one third of patients.
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J Stroke Cerebrovasc Dis · Jun 2015
Susceptibility Vessel Sign for Intra-arterial Thrombus in Acute Posterior Cerebral Artery Infarction.
Susceptibility vessel sign (SVS) on susceptibility-weighted imaging (SWI) has a high sensitivity and specificity to detect the intra-arterial thrombus in anterior circulation stroke. However, SVS has not been evaluated in posterior circulation stroke. ⋯ SWI is more sensitive than MRA for the detection of intraluminal thrombus, especially peripheral one, in patients with acute ischemic stroke of the PCA territory. In addition, irrespective of thrombus location, SWI is significantly superior to CT in detecting thrombus in acute PCA infarction.
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J Stroke Cerebrovasc Dis · Jun 2015
Clot characteristics on computed tomography and response to thrombolysis in acute middle cerebral artery stroke.
Clinical and computer tomography angiography (CTA) correlates of hyperdense middle cerebral artery sign (HMCAS) and dot sign were revisited in patients treated for acute MCA stroke. Temporal evolution of these signs over 24 hours was assessed quantitatively by density (Hounsfield unit [HU]) measurements. ⋯ CTA provides dependable (high sensitivity and specificity) information regarding clot size and location, whereas hyperdense artery signs have low sensitivity and just acceptable specificity levels in this regard. However, the prognostic and diagnostic information generated by the presence of hyperdense artery signs and temporal change in attenuation can be useful in acute stroke settings where CTA is not readily available. Quantitative measures, rather than qualitative evaluation have a higher yield in determination of temporal change of the hyperdensity signs and its possible clinical correlates.
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J Stroke Cerebrovasc Dis · Jun 2015
Stroke awareness and knowledge in an urban New Zealand population.
Stroke is the third most common cause of death and a major cause of chronic disability in New Zealand. Linked to risk factors that develop across the life-course, stroke is considered to be largely preventable. This study assessed the awareness of stroke risk, symptoms, detection, and prevention behaviors in an urban New Zealand population. ⋯ The variability in stroke awareness and knowledge may suggest the need to enhance stroke-related health literacy that facilitates understanding of risk and of factors that reduce morbidity and mortality after stroke in people of Māori and Pacific Island descent and in those with lower educational attainment or socioeconomic status. It is therefore important that stroke awareness campaigns include tailored components for target audiences.