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National institute of health stroke scale

Na Xu, Zhouqing Chen, Chongshun Zhao, Tao Xue, Xin Wu, Xiaoou Sun, Zhong Wang
Background: Recent studies showed inconsistent results of tenecteplase vs alteplase for acute ischemic stroke (AIS) with safety and efficacy. Methods: A meta-analysis was performed to explore the value of tenecteplase and alteplase in AIS treatment. Medline, Embase, and Cochrane Library from January 2001 to April 2018 were searched for randomized controlled trials (RCTs) with tenecteplase vs alteplase for AIS. Results: The primary outcomes were early neurological improvement at 24 h and functional outcome at 3 months...
2018: Drug Design, Development and Therapy
Mersedeh Bahr Hosseini, Graham Woolf, Latisha K Sharma, Jason D Hinman, Neal M Rao, Bryan Yoo, Reza Jahan, Sidney Starkman, May Nour, Radoslav Raychev, David S Liebeskind, Jeffrey L Saver
BACKGROUND AND PURPOSE: Endovascular therapy (ET) has become the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, many LVO or medium vessel occlusion (MVO) patients are ineligible for ET, including some who harbor salvageable tissues. To develop complementary therapies for these patients, it is important to delineate their prevalence, clinical features, and outcomes. METHODS: In a prospectively maintained database, we reviewed consecutive AIS patients between December 2015 and September 2016...
July 16, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Cinzia Finocchi, Maurizio Balestrino, Laura Malfatto, Gianluigi Mancardi, Carlo Serrati, Carlo Gandolfo
BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is able to predict mortality and functional outcome in patients with ischemic stroke. Its role in primary intracerebral hemorrhage (ICH) is not clear. The objective of our study was to investigate whether NIHSS is a reliable instrument of clinical monitoring and correlates with mortality and functional outcome in ICH. METHODS: One hundred fifty-six consecutive subjects with primary ICH were included...
July 16, 2018: Neurological Sciences
Rupeng Mong, Ling Tiah, Michelle Wong, Camlyn Tan
INTRODUCTION: Telestroke allows for remote determination of suitability for treatment with thrombolysis in patients with acute ischaemic stroke. However, this approach is time-dependent and most centres have yet to achieve the recommended treatment times. We describe a quality improvement initiative aimed at improving the telestroke workflow and treatment times at our centre. METHODS: A multidisciplinary workgroup comprising clinicians, stroke case managers and radiology staff was formed to oversee the initiative...
July 16, 2018: Singapore Medical Journal
Abdelaziz Sagga, Faris Alebdi, Ibrahim Alnaami
OBJECTIVE: To compare the endovascular approaches and techniques used to treat tandem occlusions of anterior cerebral circulation. METHODS: A literature review was carried out using PubMed to review the studies that described endovascular therapies for patients with tandem cerebral occlusions. RESULTS: A total of 106 patients (median age: 64 years; range: 18-90 years) were identified. The median National Institutes of Health Stroke scale score at the time of admission for 104 patients was 16...
July 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Ji Man Hong, Mun Hee Choi, Sung-Il Sohn, Yang-Ha Hwang, Seong Hwan Ahn, Yeong-Bae Lee, Dong-Ick Shin, Ángel Chamorro, Dennis W Choi
BACKGROUND: The potential of neuroprotective agents should be revisited in the era of endovascular thrombectomy (EVT) for acute large-artery occlusion because their preclinical effects have been optimized for ischemia and reperfusion injury. Neu2000, a derivative of sulfasalazine, is a multi-target neuroprotectant. It selectively blocks N-methyl-D-aspartate receptors and scavenges for free radicals. This trial aimed to determine whether neuroprotectant administration before EVT is safe and leads to a more favorable outcome...
July 13, 2018: Trials
Jinju Guk, Dongwoo Chae, Hankil Son, Joonsang Yoo, Ji Hoe Heo, Kyungsoo Park
AIMS: Recombinant tissue plasminogen activator (rt-PA) is the only first-line agent approved by the Food and Drug Administration to treat acute ischaemic stroke. However, it often causes the serious adverse event (AE) of haemorrhagic transformation. This study developed a pharmacometric model for rt-PA treatment effect and AE and, using the developed model, proposed a benefit-to-risk ratio assessment scheme as a supportive tool to optimize treatment outcome. METHODS: Data of 336 acute ischaemic stroke patients were used...
July 13, 2018: British Journal of Clinical Pharmacology
Yuan Shao, Weiwei Heng, Shanshan Li, Yun Xu, Gang Hu
BACKGROUND: Glycemic control is essential for managing acute stroke. This study evaluated the impact of a diabetes-specific formula (DSF) on glycemic control in severe acute ischemic stroke patients. METHODS: A randomized, prospective controlled trial was conducted in Nanjing Drum Tower Hospital. Acute ischemic stroke patients who scored > 10 on the National Institutes of Health Stroke Scale as well as had swallowing problems were randomized to group A, which received a diabetes-specific enteral formula, and group B, which received a standard formula...
July 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Pooja Khatri, Dawn O Kleindorfer, Thomas Devlin, Robert N Sawyer, Matthew Starr, Jennifer Mejilla, Joseph Broderick, Anjan Chatterjee, Edward C Jauch, Steven R Levine, Jose G Romano, Jeffrey L Saver, Achala Vagal, Barbara Purdon, Jenny Devenport, Andrey Pavlov, Sharon D Yeatts
Importance: More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled. Objective: To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling. Design, Setting, and Participants: The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States...
July 10, 2018: JAMA: the Journal of the American Medical Association
Zhicai Chen, Ruiting Zhang, Feizhou Xu, Xiaoxian Gong, Feina Shi, Meixia Zhang, Min Lou
Background : Identifying large vessel occlusion (LVO) patients in the prehospital triage stage to avoid unnecessary and costly delays is important but still challenging. We aim to develop an artificial neural network (ANN) algorithm to predict LVO using prehospital accessible data including demographics, National Institutes of Health Stroke Scale (NIHSS) items and vascular risk factors. Methods : Consecutive acute ischemic stroke patients who underwent CT angiography (CTA) or time of flight MR angiography (TOF-MRA) and received reperfusion therapy within 8 h from symptom onset were included...
2018: Frontiers in Aging Neuroscience
Alessandra Danese, Manuel Cappellari, Elia Pancheri, Giacomo Mugnai, Nicola Micheletti, Giampaolo Tomelleri, Monica Carletti, Giulia Turri, Vincenzo Marafioti, Salvatore Monaco, Bruno Bonetti, Paolo Bovi
BACKGROUND: Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event...
July 2018: Journal of Electrocardiology
Osian Llwyd, Angela S M Salinet, Ronney B Panerai, Man Y Lam, Nazia P Saeed, Fiona Brodie, Edson Bor-Seng-Shu, Thompson G Robinson, Ricardo C Nogueira
BACKGROUND: Acute ischaemic stroke (AIS) patients often show impaired cerebral autoregulation (CA). We tested the hypothesis that CA impairment and other alterations in cerebral haemodynamics are associated with stroke subtype and severity. METHODS: AIS patients (n = 143) were amalgamated from similar studies. Data from baseline (< 48 h stroke onset) physiological recordings (beat-to-beat blood pressure [BP], cerebral blood flow velocity (CBFV) from bilateral insonation of the middle cerebral arteries) were calculated for mean values and autoregulation index (ARI)...
July 11, 2018: Cerebrovascular Diseases Extra
Jaechun Hwang, Mi Ji Lee, Jong-Won Chung, Oh Young Bang, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee
Background and purpose The status of collateral vessels has important clinical implications in acute ischemic stroke. To evaluate which components of ischemic symptoms were predictive of pretreatment collateral status, we tested the hypothesis that sub-item scores from the National Institutes of Health Stroke Scale (NIHSS) are associated with leptomeningeal collateral status in acute ischemic stroke with middle cerebral artery (MCA) occlusion. Methods This study included consecutive patients with acute M1 occlusion who underwent revascularization treatment for acute MCA infarction...
January 1, 2018: Interventional Neuroradiology
San-Shuai Chang, Jia-Hui Wu, Yi Liu, Ting Zhang, Xin Du, Jian-Zeng Dong, Gregory Y H Lip, Chang-Sheng Ma
Objective: Limited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these patients, compare the costs at different scenarios, and identify independent factors that may predict the costs...
June 2018: Chronic Diseases and Translational Medicine
Yuichi Okano, Kazuaki Ishimatsu, Yoichi Kato, Junichi Yamaga, Ken Kuwahara, Katsuki Okumoto, Kuniyasu Wada
Aim: To clarify the features of stroke mimics. Methods: We retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue-type plasminogen activator treatment time window. Results: Of 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20...
July 2018: Acute Medicine & Surgery
Paola Caruso, Marcello Naccarato, Giovanni Furlanis, Miloš Ajčević, Lara Stragapede, Mariana Ridolfi, Paola Polverino, Maja Ukmar, Paolo Manganotti
OBJECTIVE: Ischemic stroke is a neuroemergency condition highly treatable with thrombolysis and thrombectomy. Recently, observational studies have brought insights into clinical and imaging characteristics of wake-up stroke, which interested up to 25% of ischemic stroke patients. In clinical practice, wake-up strokes are usually not considered for reperfusion therapy. The aim of this study was to investigate the use CT perfusion imaging in patients with wake-up stroke and to assess the effect of neuroimaging information provided by CT perfusion maps on the efficacy and safety of thrombolysis and thrombectomy...
July 10, 2018: Neurological Sciences
Dong-Hun Kang, Cheolkyu Jung, Woong Yoon, Seul Kee Kim, Byung Hyun Baek, Joon-Tae Kim, Man Seok Park, Yong Won Kim, Yang Ha Hwang, Yong-Sun Kim, Beom Joon Kim, Moon-Ku Han, Hee-Joon Bae
BACKGROUND: Despite the recent acceptance of thrombectomy as the standard of care in patients with acute anterior circulation stroke, the benefits of thrombectomy remain uncertain for patients with acute basilar artery occlusion (BAO). This study aimed to evaluate the effectiveness and safety of thrombectomy and to identify predictors of outcomes in a large cohort of patients with acute BAO. METHODS AND RESULTS: This study included 212 consecutive patients with acute BAO who underwent either stent-retriever or contact aspiration thrombectomy as the first-line approach between January 2011 and August 2017 at 3 stroke centers...
July 7, 2018: Journal of the American Heart Association
Hiroyuki Naito, Tomohisa Nezu, Naohisa Hosomi, Shiro Aoki, Naoto Kinoshita, Junichiro Kuga, Ryo Shimomura, Mutsuko Araki, Hiroki Ueno, Kazuhide Ochi, Hirofumi Maruyama
BACKGROUND: Malnutrition is an independent risk factor for poor outcomes in patients with acute ischemic stroke. However, the indicator of malnutrition has not yet been established. We investigated the relationship between the Controlling Nutritional Status score, a useful prognostic measure of malnutrition in patients with cardiovascular diseases and malignant tumors, and functional outcomes in patients with acute ischemic stroke. METHODS: Patients with acute ischemic stroke (n = 264, 71 ± 12 y old) were consecutively evaluated within 7 d of stroke onset...
March 28, 2018: Nutrition
Urai Kummarg, Siriorn Sindhu, Sombat Muengtaweepongsa
Background: Intravenous recombinant tissue plasminogen activator (i.v. rt-PA) is the milestone treatment for patients with acute ischemic stroke. Stroke Fast Track (SFT) facilitates time reduction, guarantees safety, and promotes good clinical outcomes in i.v. rt-PA treatment. Nursing case management is a healthcare service providing clinical benefits in many specific diseases. The knowledge about the efficacy of a nurse case management for Stroke Fast Track is limited. We aim to study the effect of nurse case management on clinical outcomes in patients with acute ischemic stroke involving intravenous recombinant tissue plasminogen activator (i...
2018: Neurology Research International
Steven R Levine, Sarah Z Weingast, Jeremy Weedon, Dimitre G Stefanov, Patricia Katz, Dana Hurley, Scott E Kasner, Pooja Khatri, Joseph P Broderick, James C Grotta, Edward Feldmann, Peter D Panagos, Jose G Romano, Riccardo Bianchi, Brett C Meyer, Phillip A Scott, Doojin Kim, Clotilde Balucani
BACKGROUND AND PURPOSE: The 2015 updated US Food and Drug Administration alteplase package insert altered several contraindications. We thus explored clinical factors influencing alteplase treatment decisions for patients with minor stroke. METHODS: An expert panel selected 7 factors to build a series of survey vignettes: National Institutes of Health Stroke Scale (NIHSS), NIHSS area of primary deficit, baseline functional status, previous ischemic stroke, previous intracerebral hemorrhage, recent anticoagulation, and temporal pattern of symptoms in first hour of care...
July 5, 2018: Stroke; a Journal of Cerebral Circulation
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