Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jan 2014
Early neurologic improvement based on the National Institutes of Health Stroke Scale score predicts favorable outcome within 30 minutes after undergoing intravenous recombinant tissue plasminogen activator therapy.
The aim of the present study was to evaluate whether early neurologic improvement (within 30 minutes), as measured using the National Institutes of Health Stroke Scale (NIHSS) score, predicts favorable outcome at 90 days. ⋯ An improvement of at least 3 points in the NIHSS score at 15 minutes or of at least 5 points at 30 minutes appears to be a predictor of favorable outcome and helps to identify patients who will not respond to rt-PA therapy.
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J Stroke Cerebrovasc Dis · Jan 2014
Venous thromboembolism in the Get With The Guidelines-Stroke acute ischemic stroke population: incidence and patterns of prophylaxis.
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), represents a serious complication in hospitalized ischemic stroke patients. This study examines the incidence of VTE and the patterns of VTE prophylaxis in acute ischemic stroke patients deemed appropriate for VTE prophylaxis (nonambulatory) in the Get With The Guidelines-Stroke (GWTG-S) study. ⋯ Despite a high overall rate of VTE prophylaxis, VTE was found to occur in approximately 3% of GWTG-S patients. Reported rates of VTE prophylaxis differed among hospitals by region and hospital type, and among patients by age, race, and medical comorbidities.
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J Stroke Cerebrovasc Dis · Jan 2014
Comparative StudyRelative changes in transcranial Doppler velocities are inferior to absolute thresholds in prediction of symptomatic vasospasm after subarachnoid hemorrhage.
The absolute transcranial Doppler (TCD) velocity threshold has been validated as a screening tool for vasospasm after subarchnoid hemorrhage (SAH). We assessed whether relative changes in velocity were superior to absolute TCD thresholds in the detection of symptomatic vasospasm. We reviewed consecutive patients with aneurysmal SAH who underwent serial TCD monitoring and survived at least 7 days. ⋯ The best characteristics were observed for the combination of MFV >175 cm/s and/or maximal LR >6 (AUC 0.81). Our data suggest that absolute thresholds of TCD FVmean provide the most accurate prediction of symptomatic MCA vasospasm after SAH. Other thresholds, including relative change from baseline and day-to-day changes, are inferior to established absolute thresholds.
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J Stroke Cerebrovasc Dis · Jan 2014
Decompressive surgery for malignant cerebral venous sinus thrombosis: a retrospective case series from Pakistan and comparative literature review.
Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke in the West; however, it is prevalent in Asia and the Middle East. CVST is treated with dose-adjusted heparin or heparinoid followed by warfarin to facilitate recanalization of venous sinuses. For those with progressive malignant cerebral edema, the role of decompressive surgery has been reported from developed countries. We present data on decompressive craniectomy from a tertiary care stroke center in a developing country and compare our results and population with that described in the international literature. ⋯ Patients who received decompressive hemicraniectomy in Pakistan for CVST had excellent outcomes in all cases when intervention was performed with intact preoperative pupillary reflexes. Of the data reviewed, most reported (two-third) patients show the same prognosticators; however, one third show that even with nonreactive pupils complete recovery is possible.
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J Stroke Cerebrovasc Dis · Jan 2014
Observational StudyTissue plasminogen activator overdose in acute ischemic stroke patients linked to poorer functional outcomes.
The dose of intravenous tissue plasminogen activator (tPA) administered in acute ischemic stroke patients is calculated using the patient's weight (0.9 mg/kg). Patients are rarely weighed before treatment in actual practice, although overestimating patient weights leads to higher doses of tPA, which may adversely influence outcome. ⋯ Our findings provide support for the practice of accurately weighing all acute ischemic stroke patients before thrombolysis.