Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2007
Comparative StudyImproved time intervals by implementation of computerized physician order entry-based stroke team approach.
The need for rapid evaluation and treatment of acute stroke patients has been well documented. A computerized physician order entry (CPOE) system can improve communication and provide immediate access to information, which may be useful for an effective team approach program targeted to reduce in-hospital time delays. ⋯ Implementation of the CPOE-based team approach program significantly reduced time from emergency department arrival to evaluations and treatment.
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Cerebrovascular diseases · Jan 2007
Fibromuscular dysplasia may herald symptomatic recurrence of cervical artery dissection.
The prevalence of fibromuscular dysplasia (FMD) in patients with cervical artery dissection (CAD) is unknown. Our objectives were to assess the risk of CAD recurring as a stroke or a transient ischemic attack and the association of these events with FMD. ⋯ The rate of symptomatic CAD recurrence was 1% per year and was often related to FMD.
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Cerebrovascular diseases · Jan 2007
ReviewSymptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: a review of the risk factors.
Symptomatic intracerebral hemorrhage (SICH) following thrombolytic therapy for acute ischemic stroke is associated with a high rate of morbidity and mortality. Knowledge of the risk factors associated with SICH following thrombolyitc therapy may provide insight into the pathophysiological mechanisms underlying the development of SICH, lead to the development of treatments that reduce the risk of SICH and have implications for the design of future stroke trials. ⋯ Twelve studies met inclusion criteria for the systematic review. Extent of hypoattenuated brain parenchyma on pretreatment CT and elevated serum glucose or history of diabetes were independent risk factors for thrombolysis-associated SICH in six of the twelve studies. Symptom severity was an independent risk factor in three of the studies and advanced age, increased time to treatment, high systolic blood pressure, low platelets, history of congestive heart failure and low plasminogen activator inhibitor levels were found to be independent risk factors for SICH in a single study. Although these data should not alter the current guidelines for the use of rt-PA in acute stroke, they may help develop future strategies aimed at reducing the rate of thrombolysis-associated SICH.
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Ischemia-modified albumin (IMA)is a new biological marker of ischemia. Previous studies have found increased serum IMA levels after myocardial ischemia, but no study has investigated the possibility that stroke modifies IMA blood levels. ⋯ IMA blood levels may be a biomarker for early identification of acute stroke. Further studies are required to investigate the role of IMA in the early detection of acute stroke.
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Cerebrovascular diseases · Jan 2007
Comparative StudyDevelopment of a conversion factor to facilitate comparison of National Institute of Health Stroke Scale scores with Scandinavian Stroke Scale scores.
The National Institute of Health Stroke Scale (NIHSS) and the Scandinavian Stroke Scale (SSS) are commonly used in clinical stroke trials. Use of different scales in trials makes comparison of outcomes difficult. ⋯ A total of 144 patients were included (46% males, mean age = 73 years). At presentation the median SSS score was 38 (2-58), and a week later 40 (4-58), the median NIHSS score at presentation was 5 (0-29) and a week later 3 (0-27). Changes in both scales were strongly correlated, r = 0.76, p < 0.001. Both were good predictors of mortality. Linear regression analysis produced an equation relating the two: SSS = 50 - 2 x NIHSS.