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Health Stroke Scale (health + stroke_scale)
Terms modified by Health Stroke Scale Selected AbstractsThe response to IV rt-PA in very old stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2008M. Gómez-Choco The use of rtPA in stroke patients aged >80 years remains controversial and it is debated whether there are sex-based differences in the response to rtPA. We assessed the clinical value of thrombolytic therapy in patients aged >80 years (elderly group) in comparison with a non-elderly group, and evaluated the existence of sex differences in the response to rtPA. All consecutive patients (n = 157) treated with rtPA were prospectively assessed since July 2001, including 49 elderly patients who fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) criteria. Changes of the National Institute of Health Stroke Scale (NIHSS) score at 1 h, 24 h, and 7 days after rtPA administration, favourable outcome at day 90 [(modified Rankin Scale) mRS 0,1, or 2 if mRS = 2 before the stroke], symptomatic bleedings, and death rates were compared between elderly and non-elderly patients. Using logistic regression, baseline NIHSS score [odds ratio (OR) 0.59, 95% confidence interval (CI) 0.41,0.84] was an independent predictor of favourable outcome, but not sex (OR 0.72, 95% CI 0.33,1.56), or age >80 years (OR 0.74, 95% CI 0.32,1.70). The rates of clinical improvement, mortality, or symptomatic CNS bleeding were also unrelated to age and sex. In conclusion, the response to IV rtPA is not impaired in elderly stroke patients and male and female are equally responsive. [source] A pilot study on systemic thrombolysis followed by low molecular weight heparin in ischemic strokeEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2006R. Mikulík Low molecular weight heparin (LMWH) administered immediately after intravenous thrombolysis (IT) may reduce the risk of arterial re-occlusion. Its benefit, however, may not outweigh the risk of intracranial hemorrhage (ICH). We sought preliminary data regarding safety of this combined therapy in an open-label, non-randomized study. The patients received either a standard anticoagulation (AC) starting 24 h after IT (the standard AC group) or AC with 2850 IU of nadroparin, given every 12 h immediately after IT (the early AC group). Sixty patients received IT treatment: 25 in the standard AC group [mean age 66, median National Institutes of Health Stroke Scale (NIHSS) 13, 64% men] and 35 in the early AC group (mean age 68, median NIHSS 13, 69% men). Symptomatic ICH occurred in one patient (4%) in the standard AC group and three patients (8.6%) in the early AC group [odds ratio (OR) 1.8; 95%CI 0.2,12.8]. At 3 months, nine patients in the standard AC group (36%) and 16 patients in the early AC group (45.7%) achieved a modified Rankin scale 0 or 1 (OR 1.2; 95%CI 0.5,3.2). Our study suggests that treatment with LMWH could be associated with higher odds of ICH, although it may not necessarily lead to a worse outcome. This justifies larger clinical trials. [source] Postprocedure Intravenous Eptifibatide Following Intra-Arterial Reteplase in Patients with Acute Ischemic StrokeJOURNAL OF NEUROIMAGING, Issue 1 2008Adnan I. Qureshi MD ABSTRACT BACKGROUND AND PURPOSE Early use of intravenous platelet glycoprotein IIB/IIIA antagonists after intra-arterial (IA) thrombolysis may reduce the risk of reocclusion and microvascular compromise. METHODS We performed a retrospective study to determine the in-hospital outcomes using serial neurological evaluations and imaging among patients treated with intravenous eptifibatide administered as a 135 microg/kg single-dose bolus, followed by 0.5 microg/kg/min infusions for 20 to 24 hours following treatment with IA reteplase. RESULTS Twenty patients were treated (mean age ± standard deviation, 68.4 ± 14.5 years; median National Institutes of Health Stroke Scale [NIHSS] score was 17). The dose of reteplase ranged from 0.5 to 4 units. Eleven patients demonstrated early neurological improvement, defined as a decline of ,4 points on the 24 hours NIHSS score compared with initial NIHSS score; neurological deterioration, defined as an increase of ,4 points on the 24 hours NIHSS score as compared with initial NIHSS score, was observed in one patient. Two asymptomatic intracerebral hemorrhages were observed while no symptomatic hemorrhages were observed on serial computed tomographic scans. CONCLUSIONS The use of intravenous eptifibatide within 24 hours in selected patients after IA thrombolysis is feasible and safe. Further studies are required to determine the benefit of early use of intravenous eptifibatide following thrombolysis. [source] MRI Assessment Followed by Successful Mechanical Recanalization of a Complete Tandem (Internal Carotid/Middle Cerebral Artery) Occlusion and Reversal of a 10-Hour Fixed DeficitJOURNAL OF NEUROIMAGING, Issue 1 2008Catalina C. Ionita MD ABSTRACT BACKGROUND Mechanical clot extraction up to 8 hours after stroke onset is an alternative strategy for opening large vessels, especially for patients ineligible for intravenous thrombolysis. Safety beyond this therapeutic window is untested. METHODS An 81-year-old woman presented 8 hours after she developed left-sided weakness and dysarthria with a National Institutes of Health Stroke Scale (NIHSS) score fluctuating between 6 and 13. Neuroimaging revealed a large perfusion deficit with no diffusion abnormalities. An emergent cerebral angiogram revealed a complete internal carotid artery terminus occlusion. RESULTS Successful mechanical thrombectomy was performed without complication and resulted in almost complete reversal of the patient's deficit to an NIHSS score of 1, 10 hours after stroke onset. CONCLUSION Patients with large hypoperfused areas and minimal diffusion abnormalities on the MRI may benefit from mechanical thrombectomy beyond an 8-hour window. [source] Copeptin: A novel, independent prognostic marker in patients with ischemic stroke,ANNALS OF NEUROLOGY, Issue 6 2009Mira Katan MD Objective Early prediction of outcome in patients with ischemic stroke is important. Vasopressin is a stress hormone. Its production rate is mirrored in circulating levels of copeptin, a fragment of provasopressin. We evaluated the prognostic value of copeptin in acute stroke patients. Methods In a prospective observational study, copeptin was measured using a new sandwich immunoassay on admission in plasma of 362 consecutive patients with an acute ischemic stroke. The prognostic value of copeptin to predict the functional outcome (defined as a modified Rankin Scale score of ,2 or ,3), mortality within 90 days, was compared with the National Institutes of Health Stroke Scale score and with other known outcome predictors. Results Patients with an unfavorable outcomes and nonsurvivors had significantly increased copeptin levels on admission (p <0.0001 and p <0.0001). Receiver operating characteristics to predict functional outcome and mortality demonstrated areas under the curve of copeptin of 0.73 (95% confidence interval [CI], 0.67,0.78) and 0.82 (95% CI, 0.76,0.89), which was comparable with the National Institutes of Health Stroke Scale score but superior to C-reactive protein and glucose (p <0.01). In multivariate logistic regression analysis, copeptin was an independent predictor of functional outcome and mortality, and improved the prognostic accuracy of the National Institutes of Health Stroke Scale to predict functional outcome (combined areas under the curve, 0.79; 95% CI, 0.74,0.84; p <0.01) and mortality (combined areas under the curve, 0.89; 95% CI, 0.84,0.94; p <0.01). Interpretation Copeptin is a novel, independent prognostic marker improving currently used risk stratification of stroke patients. Ann Neurol 2009;66:799,808 [source] Circulating endothelial microparticles as a marker of cerebrovascular disease,ANNALS OF NEUROLOGY, Issue 2 2009Keun-Hwa Jung MD Objective Circulating endothelial microparticles (EMPs) have been reported to reflect vascular damage. Detailed profiling of these blood endothelial markers may adumbrate the pathogenesis of stroke or enable determination of the risk for stroke. We investigated EMP profiles in patients at risk for cerebrovascular disease. Methods We prospectively examined 348 consecutive patients: 73 patients with acute stroke and 275 patients with vascular risk factors but no stroke events. We quantified various types of EMPs by flow cytometry using CD31, CD42b, annexin V (AV), and CD62E antibodies in the peripheral blood of patients. This method allowed fractionation of CD31+/CD42b,, CD31+/AV+, and CD62E+ EMPs. Clinical and laboratory factors associated with EMPs were assessed. Results Recent ischemic episodes were found to be more strongly associated with greater CD62E+ EMP levels than with levels of other phenotypes. Increased National Institutes of Health Stroke Scale scores and infarct volumes in acute stroke patients were significantly associated with greater CD62E+ EMP levels. In the risk factor group, patients with extracranial arterial stenosis had greater CD62E+ EMP levels, whereas those with intracranial arterial stenosis had greater CD31+/CD42b, and CD31+/AV+ EMP levels. The ratio of CD62E+ to CD31+/CD42b, or CD31+/AV+ EMP level significantly discriminated extracranial and intracranial arterial stenosis. Interpretation Circulating EMP phenotypic profiles reflect distinct phenotypes of cerebrovascular disease and are markers of vascular pathology and an increased risk for ischemic stroke. Ann Neurol 2009;66:191,199 [source] Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflowACTA NEUROLOGICA SCANDINAVICA, Issue 2 2010K. Abul-Kasim Abul-Kasim K, Brizzi M, Petersson J. Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow. Acta Neurol Scand: DOI: 2010: 122: 132,139. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives,,, To evaluate the association between the hyperdense middle cerebral artery sign (HMCAS) and the functional outcome on one hand, and different predictors such as the National Institutes of Health Stroke Scale (NIHSS), infarct size, ASPECTS Score, intracerebral hemorrhage, and mortality on the other hand. Material and methods,,, Retrospective analysis of 120 patients with MCA-stroke treated with intravenous thrombolysis. We tested the association between HMCAS and NIHSS, infarct volume, ASPECTS, outcome, level of consciousness, different recorded time intervals, and the day/time of admission. Results,,, Seventy-four percentage of patients treated with thrombolysis developed cerebral infarction. All patients with HMCAS (n = 39) sustained infarction and only 31% showed favorable outcome compared with 62% and 60%, respectively among patients without HMCAS (P < 0.001 and P = 0.002). There was statistically significant association between functional outcome and HMCAS (P = 0.002), infarct volume, NIHSS, and ASPECTS (P < 0.001). The time to treatment was 12 min shorter in patients who developed infarction (P = 0.037). Independent predictors for outcome were NIHSS and the occurrence of cerebral infarction on computed tomography for the whole study population, and infarct volume for patients who sustained cerebral infarction. Conclusions,,, Despite optimal workflow, patients with HMCAS showed poor outcome after intravenous thrombolysis. The results emphasize the urgent need for more effective revascularization therapies and neuroprotective treatment in this subgroup of stroke patients. [source] Mechanical embolectomy for large vessel ischemic strokes: A cardiologist's experience,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2010Dr. Mark Abelson FCP (Cardiology) Abstract Introduction: Large vessel acute ischemic stroke has a poor outcome. Intravenous (IV) thrombolysis is often contra-indicated and if given, usually ineffective. Mechanical embolectomy is an option in these patients and may be performed by an interventional cardiologist experienced in carotid interventions. Method: Consecutive stroke patients were assessed by the stroke physician and, if eligible, referred for possible mechanical embolectomy using the Merci retriever. All procedures were done by a single cardiologist. Patient information, procedural characteristics and clinical outcomes at 90 days were collected by retrospective chart review. Results: A total of 22 patients were referred for emergency cerebral angiography with 17 undergoing mechanical embolectomy. The mean National Institute of Health Stroke Scale (NIHSS) score was 20.1 and the mean stroke duration was 284 min. Recanalization was successful in 15 (88%) patients. Ten patients (59%) had a good outcome (modified Rankin Score ,2 at 90 days) and four died (mortality 23%). Three patients had significant intra-cerebral hemorrhage. There were no other major adverse events. Conclusions: For patients with large vessel occlusion strokes where IV thrombolysis was either contra-indicated or had failed, mechanical embolectomy performed by an interventional cardiologist had a high recanalization rate with an acceptable clinical outcome and safety profile. © 2010 Wiley-Liss, Inc. [source] Sequential Analysis of Pretreatment Delays In Stroke ThrombolysisACADEMIC EMERGENCY MEDICINE, Issue 9 2010Tuukka Puolakka BM ACADEMIC EMERGENCY MEDICINE 2010; 17:965,969 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The aim was to determine if an intensive restructuring of the approach to acute stroke improved time to thrombolysis over a 3-year study period and to determine whether delay modifications correlated with increased thrombolytic intervention or functional outcome. Methods:, The study examined the pretreatment process to define specific time intervals (delays) of interest in the acute management of 289 consecutive ischemic stroke patients who were transported by the emergency medical services (EMS) and received intravenous (IV) thrombolytic therapy in the emergency department (ED) of Helsinki University Central Hospital. Time interval changes of the 3-year period and use of thrombolytics was measured. Functional outcome, measured with the modified Rankin Scale (mRS) at 3 months, was assessed with multivariable statistical analysis. Results:, During implementation of the restructuring program from 2003 to 2005, the median total time delay from symptom onset to drug administration dropped from 149 to 112 minutes (p < 0.0001). Prehospital delays did not change significantly during the study period. The median delay in calling an ambulance remained at 13 minutes, and the total median prehospital delay stayed at 71 minutes. In-hospital delays decreased from 67 to 34 minutes (p < 0.0001). The median call delay was 25 minutes in patients with mild symptoms (National Institute of Health Stroke Scale [NIHSS] score < 7) and 8 minutes with severe symptoms (NIHSS > 15). In the multivariate model, stroke severity (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.78 to 0.88, p < 0.0001), age (OR = 0.57, 95% CI = 0.42 to 0.77, p < 0.0001), and in-hospital delay (OR = 0.47, 95% CI = 0.22 to 0.97, p = 0.04) were suggesting a good outcome. Conclusions:, Restructuring of the teamwork between the EMS personnel and the reorganized ED significantly reduced in-hospital, but not prehospital, delays. The present data suggest that a decreased in-hospital delay improves the accessibility of the benefits of thrombolysis. [source] Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarctionACTA NEUROLOGICA SCANDINAVICA, Issue 5 2008T. S. Skoglund Objectives,,, To study the long-term outcome in patients with malignant middle cerebral artery (MCA) infarction treated with decompressive craniectomy. The outcome is described in terms of survival, impairment, disabilities and life satisfaction. Materials and methods,,, Patients were examined at a minimum of 1 year (mean 2.9, range 1,6) after the surgery and classified according to the Glasgow Outcome Scale (GOS), the National Institutes of Health Stroke scale (NIHSS), the Barthel Index (BI), the short-form health survey (SF-36) and the life satisfaction checklist (LiSat-11). Results,,, Eighteen patients were included. The long-term survival was 78%. The mean NIHSS score was 13.8 (range 6,20). No patient was left in a vegetative state. The mean BI was 63.9 (5-100). The SF-36 scores showed that the patients' view of their health was significantly lower in most items compared with that of a reference group. According to the LiSat checklist, 83% found their life satisfying/rather satisfying and 17% found their life rather dissatisfying/dissatisfying. Conclusion,,, We conclude that the patients remained in an impaired neurological condition, but had fairly good insight into their limitations. Although their life satisfaction was lower compared with that of the controls, the majority felt that life in general could still be satisfying. [source] | ||||||||||