Journal of the neurological sciences
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Up to 15-25% of patients with ischemic stroke wake up with their deficits. Because of the uncertainty about the time of onset, these patients are generally not offered thrombolytic therapy. Some of these wake-up stroke patients may be eligible for acute endovascular stroke therapy based on hyperacute CT or MR imaging independent of the time window. ⋯ Some patients who present with stroke on awakening may be candidates for thrombolytic therapy or recanalization techniques irrespective of mode of therapy (intravenous, intravenous+intra-arterial or intra-arterial tPA alone). Further randomized, controlled studies are warranted to safely identify those candidates who would benefit from thrombolysis and endovascular interventions in ischemic wake-up strokes.
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The purpose of this study was to assess outcomes in Thai patients after treatment with intravenous recombinant tissue plasminogen activator (rtPA) and to determine the factors associated with good outcome and death. ⋯ Standard-dose intravenous rtPA in a cohort of Thai patients led to better clinical outcomes and comparable death rates when compared to other Asian cohorts receiving intravenous rtPA. Several factors were independently associated with patient outcomes at 3 months.
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Degos' disease or malignant atrophic papulosis is a rare disseminated occlusive vasculopathy affecting the skin, gastrointestinal tract, central nervous system, and less often other organ systems. The exact etiology of this vasculopathy has not been established. ⋯ Here, we report the clinical, radiological and histopathologic features of Degos' disease in a 41-year-old man following streptococcal throat infection. Prior postulated hypothesis as post-infectious immunologic mechanism may be further supported by this case.