Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Feb 2014
An emergency department intervention to increase warfarin use for atrial fibrillation.
Emergency department (ED) encounters represent lost opportunities to facilitate anticoagulation for stroke prevention in atrial fibrillation (AF). However, screening of warfarin eligibility in the ED may not be feasible. We evaluated whether a practical quality improvement initiative increased postdischarge warfarin use in ED patients with AF. ⋯ This practical stroke prevention quality improvement initiative was not associated with an increase in warfarin use among ED patients with AF.
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J Stroke Cerebrovasc Dis · Feb 2014
Prognostic value of high-sensitivity cardiac troponin T in acute ischemic stroke.
Cardiac troponins have been investigated as prognostic markers in the setting of ischemic stroke with diverging results. A new generation of highly sensitive troponin assays have recently been developed that allow for the detection of concentrations 5 to 10 times lower than those measureable with conventional assays. The aim of this study was to determine the association between high-sensitivity cardiac troponin T (hs-cTnT) elevation on admission and mortality after acute ischemic stroke. ⋯ Circulating hs-cTnT levels are closely associated with the risk of death in patients with acute ischemic stroke, and even levels below the upper reference limit appear to have prognostic value.
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J Stroke Cerebrovasc Dis · Feb 2014
Transient ischameic attack/stroke electronic decision support: a 14-month safety audit.
To assess the safety of a Transient Ischameic Attack (TIA)/Stroke Electronic Decision Support (EDS) tool in the primary care setting intended to aid general practitioners in the timely management of transient ischemic attacks (TIAs). ⋯ Results suggest that TIA/Stroke EDS use is not associated with major morbidity or mortality. Larger studies are needed to draw more definite conclusions regarding the utility of this TIA/Stroke EDS in preventing strokes.
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J Stroke Cerebrovasc Dis · Feb 2014
Case Reports Comparative StudyCerebral blood flow and oxygen metabolism measurements using positron emission tomography on the first day after carotid artery stenting.
The aim of the present study is the characterization of hemodynamics to predict hyperperfusion syndrome (HPS) after carotid artery stenting (CAS) with positron emission tomography (PET) obtained before and on the first day after the treatment. ⋯ CAS increases cerebral perfusion and improves hemodynamic compromise in patients with symptomatic ICA stenosis. Although we could not clarify the usefulness of PET before and on the first day after CAS in predicting HPS, a high preoperative OEF is related to postoperative marked CBF increase and might be used as a predictor of HPS. Patients with greater hemodynamic compromise with a high preoperative OEF should be managed carefully to prevent HPS, but they have a greater chance of CBF increase after CAS.
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J Stroke Cerebrovasc Dis · Feb 2014
Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder.
Receiving information that one has a dissected cervical artery, which can cause a stroke at any time, is obviously traumatic, but details about the psychiatric and psychosocial sequelae are not known. We investigated the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in patients with spontaneous cervical artery dissection (CD) and the impact of PTSD on their psychosocial functioning. ⋯ PTSD seems to occur frequently in patients with CD and is associated with reduced mental HRQoL. Because the presence of a maladaptive coping style is correlated with PTSD, teaching patients better coping skills might be helpful.