Stroke; a journal of cerebral circulation
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Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. ⋯ We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.
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The purpose of this study was to determine the accuracy and optimal timing of physician prognostication in patients with subarachnoid hemorrhage, a prototypical neurological disease characterized by variable outcomes and frequent disability. ⋯ Neurologists were generally but not perfectly accurate in their prognostications of functional outcomes. The accuracy of prognoses did not correlate with the hospital day on which they were made but was affected by clinical factors that can cloud the neurological examination.
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Comparative Study
Does helicopter emergency medical service transfer offer benefit to patients with stroke?
Helicopter transportation of patients with acute stroke who have received recombinant tissue-type plasminogen activator is commonly considered the best option. We evaluated if transportation by helicopter can reduce complications and improve clinical outcomes in patients with acute stroke. ⋯ Air transfer of patients with acute ischemic stroke treated with thrombolysis does not seem to impart any benefit to patient outcomes when compared with ground transport. Therefore, ground transport should be considered for these patients unless they are being considered for emergency endovascular rescue therapy.
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Review Meta Analysis
Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence.
Patients discovered to have a patent foramen ovale in the setting of a cryptogenic stroke may be treated with percutaneous closure, antiplatelet therapy, or anticoagulants. A recent randomized trial (CLOSURE I) did not detect any benefit of closure over medical treatment alone; the optimal medical therapy is also unknown. We synthesized the available evidence on secondary stroke prevention in patients with patent foramen ovale and cryptogenic stroke. ⋯ Although further randomized trial data are needed to precisely determine the effects of closure on stroke recurrence, the results of CLOSURE I challenge the credibility of a substantial body of observational evidence strongly favoring mechanical closure over medical therapy.