Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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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.
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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.
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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.
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J Stroke Cerebrovasc Dis · Nov 2013
Body mass index and stroke: overweight and obesity less often associated with stroke recurrence.
Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke). ⋯ The obesity paradox in stroke can be extended to include also stroke recurrence. Obese and overweight stroke patients had experienced less previous strokes than normal weight stroke patients.
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J Stroke Cerebrovasc Dis · Nov 2013
Randomized Controlled TrialThe effect of Ginkgo biloba on functional outcome of patients with acute ischemic stroke: a double-blind, placebo-controlled, randomized clinical trial.
Acute ischemic stroke is a major cerebrovascular disease with potential morbidity and mortality. Despite the availability of thrombolytic therapy in some centers, risk factor modification and rehabilitation therapy are the mainstays of stroke management. There is supporting evidence that Ginkgo biloba may afford neuroprotection and improve the outcomes of patients with acute ischemic stroke. ⋯ Our data suggest that G biloba may have protective effects in ischemic stroke. Therefore, the administration of G biloba is recommended after acute ischemic stroke.