Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2016
Prescribing Aerobic Exercise Intensity without a Cardiopulmonary Exercise Test Post Stroke: Utility of the Six-Minute Walk Test.
The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments. ⋯ The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.
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J Stroke Cerebrovasc Dis · Sep 2016
Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary Approach.
The mainstay of acute management of intracerebral hemorrhage (ICH) is blood pressure reduction. Intravenous (IV) nicardipine is an effective but costly intervention for blood pressure reduction in the intensive care unit (ICU). Earlier transition to oral (PO) antihypertensive agents may reduce ICU length of stay (LOS) and associated costs. We sought to study the effectiveness of an interdisciplinary intervention to start earlier transition to PO antihypertensives. ⋯ A physician and pharmacist-led project to initiate oral antihyperintensive medications earlier was successful in reducing the duration of IV nicardipine treatment in patients with ICH while leading to substantial cost savings.
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J Stroke Cerebrovasc Dis · Sep 2016
Observational StudySevere Hemorrhagic Transformation after Thrombolysis for Acute Ischemic Stroke Prevents Early Neurological Improvement.
Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis. ⋯ The PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
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J Stroke Cerebrovasc Dis · Aug 2016
Case ReportsSpontaneous Bilateral Cervical Internal Carotid and Vertebral Artery Dissection in a Japanese Patient without Collagen Vascular Disease with Special Reference to Single-Nucleotide Polymorphisms.
Spontaneous cervical artery dissection (sCAD) is a major cause of ischemic stroke in young adults. Frequently, sCAD involves multiple neck arteries, accounting for 13%-28% of the total sCAD cases. However, little is known about factors related to multiple sCAD. ⋯ The patient did not fulfill any major criteria of collagen vascular disease such as Ehlers-Danlos syndrome type IV or Loeys-Dietz syndrome. The data in our patient are quite similar to those reported in patients with single-nucleotide polymorphism (SNP) of PHACTR1. Obtaining the patient's informed consent, we analyzed a common SNP variation in the rs9349379[G] allele (PHACTR1), which has been reported to be associated with a lower risk of sCAD.
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J Stroke Cerebrovasc Dis · Aug 2016
The Combination of Clinical Features, Transcranial Doppler, and Alberta Stroke Program Early Computed Tomography Score (Computed Tomography Angiography) in Predicting Outcome in Intravenous Recombinant Tissue Plasminogen Activator-Treated Patients.
Little data exist on using combined baseline clinical neuroimaging and transcranial Doppler (TCD) information in predicting clinical outcome in stroke patients treated with intravenous (IV) thrombolysis. ⋯ A multimodal grading system is useful in predicting outcome in patients treated with IV rt-PA. Those withhigher scores might be candidates for interventional therapy.