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https://www.readbyqxmd.com/read/28812226/in-light-of-recently-published-clinical-trials-and-their-implication-for-clinical-practice-does-a-large-catchment-area-acute-hospital-require-24%C3%A2-hour-ct-neck-and-head-angiography-and-or-neuro-interventional-services-in-the-setting-of-acute-ischaemic-stroke
#1
REVIEW
J Halpin, C Peters, J O'Brien, T Scanlon, M Shelly, N Cunningham, L Hickey
BACKGROUND: Recently published clinical trials have resulted in a significant change in the guidelines used to manage patients suffering an acute ischaemic stroke. New neuro-interventional techniques have revolutionised stroke outcomes. Currently, such services are only available in two specialist centres. AIMS: We attempted to evaluate the need for the provision of routine computed tomography (CT) angiography and neuro-interventional services at a university teaching hospital in Limerick...
August 15, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28811092/direct-oral-anticoagulants-in-patients-with-hypertrophic-cardiomyopathy-and-atrial-fibrillation
#2
Fernando Dominguez, Vicente Climent, Esther Zorio, Tomás Ripoll-Vera, Joel Salazar-Mendiguchía, Jose Manuel García-Pinilla, Jose Angel Urbano-Moral, Xusto Fernández-Fernández, David Lopez-Cuenca, Raquel Ajo-Ferrer, Jorge Sanz-Sanchez, Yolanda Gomez-Perez, Miguel A López-Garrido, Roberto Barriales-Villa, Juan Ramón Gimeno, Pablo Garcia-Pavia
BACKGROUND: Chronic anticoagulation with vitamin K antagonists (VKAs) is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Direct oral anticoagulants (NOACs) are an alternative to VKAs but there are limited data to support their use in HCM. We sought to describe the pattern of use, thromboembolic events, bleeding and quality of life in patients with HCM and AF treated with NOACs. METHODS: Data from patients treated with NOACs (n=99) and VKA (n=433) at 9 inherited cardiac diseases units were retrospectively collected...
August 7, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28810239/the-prevalence-of-and-factors-related-to-vascular-hyperintensity-on-t1-weighted-imaging-in-acute-ischemic-stroke
#3
Yuki Sakamoto, Seiji Okubo, Chikako Nito, Satoshi Suda, Noriko Matsumoto, Arata Abe, Junya Aoki, Takashi Shimoyama, Kanako Muraga, Takuya Kanamaru, Kentaro Suzuki, Yuki Go, Masahiro Mishina, Kazumi Kimura
BACKGROUND: Thrombus visualization in patients with acute ischemic stroke has been detected and reported using various imaging modalities. T1-weighted imaging (T1-WI) can depict thrombi as hyperintense signals within vessels. Moreover, in addition to thrombi, T1-WI hyperintensities in arteries may suggest arterial dissection. However, the frequency of and factors related to the T1-hyperintense vessel sign (T1-HVS) are not fully known. The aim of this study was to clarify the prevalence of and related factors for the T1-HVS in patients with acute ischemic stroke...
August 16, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28808783/post-stroke-seizures-are-clinically-underestimated
#4
Carla Bentes, Hugo Martins, Ana Rita Peralta, Carlos Casimiro, Carlos Morgado, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho E Melo, Teresa Paiva, José M Ferro
Cerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment...
August 14, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28803784/race-ethnic-disparities-in-cardiometabolic-risk-profiles-among-stroke-survivors-with-undiagnosed-diabetes-and-prediabetes-in-the-united-states
#5
Okkyung Kim, Bruce Ovbiagele, Natalie Valle, Daniela Markovic, Amytis Towfighi
BACKGROUND AND PURPOSE: Up to 25% of the U.S. population has undiagnosed diabetes. Diabetes and stroke both disproportionately afflict race/ethnic minorities. We assessed race/ethnic differences in the prevalence of undiagnosed diabetes, prediabetes, and cardiometabolic risk profiles among stroke survivors in the United States. METHODS: The prevalence of diabetes and prediabetes among adults (≥20 years) with a self-reported history of stroke was assessed using the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2010...
August 10, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28803441/thermoregulation-disorders-of-central-origin-how-to-diagnose-and-treat
#6
Marta Zawadzka, Marta Szmuda, Maria Mazurkiewicz-Bełdzińska
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28800866/five-year-trends-of-critical-care-practice-and-outcomes
#7
Craig M Lilly, Sunil Swami, Xinggang Liu, Richard R Riker, Omar Badawi
BACKGROUND: Longitudinal analyses of large detailed adult critical care datasets provide insights into practice trends and generate useful outcome and process benchmarks. METHODS: Data representing 991,571 consecutive critical care visits to160 United States adult ICUs during 2009 to 2013 from the eICU Research Institute clinical practice database were used to quantitate patient characteristics, APACHE IV based acuity predictions, treatments, and outcomes. Analyses for changes over time were performed for patient characteristics, entry and discharge locations, primary admission diagnosis, treatments, adherence to consensus ICU best practices, length of stay (LOS), and inpatient mortality...
August 8, 2017: Chest
https://www.readbyqxmd.com/read/28800728/feasibility-and-diagnostic-accuracy-of-point-of-care-handheld-echocardiography-in-acute-ischemic-stroke-patients-a-pilot-study
#8
Peter Kraft, Anna Fleischer, Silke Wiedmann, Viktoria Rücker, Daniel Mackenrodt, Caroline Morbach, Uwe Malzahn, Christoph Kleinschnitz, Stefan Störk, Peter U Heuschmann
BACKGROUND: Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting. METHODS: IS patients were recruited on the SU of the University Hospital Würzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF)...
August 11, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28799870/vitamin-d-status-and-3-month-glasgow-outcome-scale-scores-in-patients-in-neurocritical-care-prospective-analysis-of-497-patients
#9
Jian Guan, Michael Karsy, Andrea A Brock, Ilyas M Eli, Gabrielle M Manton, Holly K Ledyard, Gregory W J Hawryluk, Min S Park
OBJECTIVE Vitamin D deficiency has been associated with a variety of negative outcomes in critically ill patients, but little focused study on the effects of hypovitaminosis D has been performed in the neurocritical care population. In this study, the authors examined the effect of vitamin D deficiency on 3-month outcomes after discharge from a neurocritical care unit (NCCU). METHODS The authors prospectively analyzed 25-hydroxy vitamin D levels in patients admitted to the NCCU of a quaternary care center over a 6-month period...
August 11, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28794256/trends-in-stroke-incidence-in-the-united-states-will-women-overtake-men
#10
EDITORIAL
Silvia Koton, Kathryn M Rexrode
No abstract text is available yet for this article.
August 9, 2017: Neurology
https://www.readbyqxmd.com/read/28794252/white-matter-hyperintensity-reduction-and-outcomes-after-minor-stroke
#11
Joanna M Wardlaw, Francesca M Chappell, Maria Del Carmen Valdés Hernández, Stephen D J Makin, Julie Staals, Kirsten Shuler, Michael J Thrippleton, Paul A Armitage, Susana Muñoz-Maniega, Anna K Heye, Eleni Sakka, Martin S Dennis
OBJECTIVE: To assess factors associated with white matter hyperintensity (WMH) change in a large cohort after observing obvious WMH shrinkage 1 year after minor stroke in several participants in a longitudinal study. METHODS: We recruited participants with minor ischemic stroke and performed clinical assessments and brain MRI. At 1 year, we assessed recurrent cerebrovascular events and dependency and repeated the MRI. We assessed change in WMH volume from baseline to 1 year (normalized to percent intracranial volume [ICV]) and associations with baseline variables, clinical outcomes, and imaging parameters using multivariable analysis of covariance, model of changes, and multinomial logistic regression...
August 9, 2017: Neurology
https://www.readbyqxmd.com/read/28790536/comparison-of-results-classical-and-eversion-carotid-endarterectomy
#12
Muhamed Djedovic, Emir Mujanovic, Amel Hadzimehmedagic, Dragan Totic, Haris Vukas, Haris Vranic
INTRODUCTION: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications...
April 2017: Medical Archives
https://www.readbyqxmd.com/read/28782109/low-vs-high-haemoglobin-trigger-for-transfusion-in-vascular-surgery-protocol-for-a-randomised-trial
#13
A Møller, H B Nielsen, J Wetterslev, O B Pedersen, D Hellemann, S Shahidi
BACKGROUND: In patients with cardiovascular disease, guidelines for administration of red blood cells (RBC) are mainly based on studies outside the vascular surgical setting with the recommendation to use a haemoglobin (hb) trigger-level lower than by guidelines from The European Society for Vascular Surgery. Restricting RBC transfusion may affect blood O2 transport with a risk for development of tissue ischaemia and postoperative complications. METHODS: In a single-centre, open-label, assessor blinded trial, 58 vascular surgical patients (> 40 years of age) awaiting open surgery of the infrarenal aorta or infrainguinal arterial bypass surgery undergo a web-based randomisation to one of two groups: perioperative RBC transfusion triggered by hb < 8 g/dl or hb < 9...
September 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28780554/early-prediction-of-physical-activity-level-1-year-after-stroke-a-longitudinal-cohort-study
#14
Ola A Olsson, Hanna C Persson, Margit Alt Murphy, Katharina S Sunnerhagen
OBJECTIVE: To investigate which variables present prior and early after stroke may have an impact on the level of physical activity (PA) 1 year poststroke. DESIGN: Prospective longitudinal cohort and logistic regression analysis. SETTING: Stroke Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS: 117 individuals as part of the Stroke Arm Longitudinal Study (SALGOT) admitted to the stroke unit during a period of 18 months were consecutively recruited...
August 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28780236/tenecteplase-versus-alteplase-for-management-of-acute-ischaemic-stroke-nor-test-a-phase-3-randomised-open-label-blinded-endpoint-trial
#15
Nicola Logallo, Vojtech Novotny, Jörg Assmus, Christopher E Kvistad, Lars Alteheld, Ole Morten Rønning, Bente Thommessen, Karl-Friedrich Amthor, Hege Ihle-Hansen, Martin Kurz, Håkon Tobro, Kamaljit Kaur, Magdalena Stankiewicz, Maria Carlsson, Åse Morsund, Titto Idicula, Anne Hege Aamodt, Christian Lund, Halvor Næss, Ulrike Waje-Andreassen, Lars Thomassen
BACKGROUND: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. METHODS: This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway...
August 2, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28777903/hypertension-screening-of-commercial-divers-from-an-occupational-medicine-perspective
#16
Alejandro Garbino, Robert W Sanders, Charles H Mathers
Hypertension is one of the most common chronic diseases in the world: in the United States, it affects one-third of the adult population. Most cases are primary hypertension - with no identified cause - and significantly increase risk for cardiovascular disease and stroke. At NASA's Neutral Buoyancy Laboratory (NBL), there is a cadre of professional divers who provide underwater support during extravehicular activity training (EVAs, commonly referred to as "spacewalks") for astronauts. The NBL occupational health program requires regular "work-site" physical exams, including blood pressure checks, on at least a weekly basis...
March 2017: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/28776182/progressive-deficit-in-isolated-pontine-infarction-the-association-with-etiological-subtype-lesion-topography-and-outcome
#17
Elif Gökçal, Elvin Niftaliyev, Gözde Baran, Çiğdem Deniz, Talip Asil
It is important to predict progressive deficit (PD) in isolated pontine infarction, a relatively common problem of clinical stroke practice. Traditionally, lacunar infarctions are known with their progressive course. However, few studies have analyzed the branch atheromatous disease subtype as a subtype of lacunar infarction, separately. There are also conflicting results regarding the relationship with the topography of lesion and PD. In this study, we classified etiological subtypes and lesion topography in isolated pontine infarction and aimed to investigate the association of etiological subtypes, lesion topography and clinical outcome with PD...
August 3, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28771893/mri-interscanner-agreement-of-the-association-between-the-susceptibility-vessel-sign-and-histologic-composition-of-thrombi
#18
Romain Bourcier, Lili Détraz, Jean Michel Serfaty, Beatrice Guyomarch Delasalle, Mahmood Mirza, Imad Derraz, Frédérique Toulgoat, Olivier Naggara, Claire Toquet, Hubert Desal
BACKGROUND AND PURPOSE: The susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) is related to thrombus location, composition, and size in acute stroke. No previous study has determined its inter-MRI scanner variability. We aimed to compare the diagnostic accuracy in-vitro of four different MRI scanners for the characterization of histologic thrombus composition. METHODS: Thirty-five manufactured thrombi analogs of different composition that were histologically categorized as fibrin-dominant, mixed, or red blood cell (RBC)-dominant were scanned on four different MRI units with T2* sequence...
August 3, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28767503/neuroendovascular-surgery-for-the-treatment-of-ischemic-stroke
#19
Arthur Wang, Meic H Schmidt
This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Advanced perfusion imaging helps identify patients with a low ratio of ischemic core to salvageable penumbra...
June 22, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28766306/interpretation-of-brain-ct-scans-in-the-field-by-critical-care-physicians-in-a-mobile-stroke-unit
#20
Maren Ranhoff Hov, Erik Zakariassen, Thomas Lindner, Terje Nome, Kristi G Bache, Jo Røislien, Jostein Gleditsch, Volker Solyga, David Russell, Christian G Lund
BACKGROUND AND PURPOSE: In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU)...
July 27, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
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