Cerebrovascular diseases extra
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Cerebrovasc Dis Extra · Jan 2015
Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil.
The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. ⋯ This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.
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Cerebrovasc Dis Extra · May 2014
Gastrointestinal bleeding in acute ischemic stroke: recent trends from the fukuoka stroke registry.
Gastrointestinal (GI) hemorrhage is a potentially serious complication of acute stroke, but its incidence appears to be decreasing. The aim of this study was to elucidate the etiology of GI bleeding and its impact on clinical outcomes in patients with acute ischemic stroke in recent years. ⋯ GI bleeding infrequently occurred in patients with acute ischemic stroke, which was mostly due to etiologies other than peptic ulcer. GI bleeding was associated with poor clinical outcomes including neurologic deterioration, in-hospital mortality, and poor functional outcome.
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Cerebrovasc Dis Extra · May 2014
Is isolated aphasia associated with atrial fibrillation? A prospective study.
A cardioembolic source, usually atrial fibrillation (AF), is detected in 14-30% of strokes. If AF is found, anticoagulation therapy provides a substantial decrease of the risk of recurrent cerebrovascular ischemic events. AF is often paroxysmal, and extensive diagnostic procedures may be necessary to detect it in patients. Considering cost-effectiveness and patient burden, however, not every suspected patient can be thoroughly screened. Therefore, the identification of risk factors for AF may be helpful. Previous studies have identified isolated aphasia as a risk factor for AF as the cause of the stroke. These studies, however, were performed with small population samples, in a retrospective setting or focused on a specific subtype of aphasia. The aim of this observational study is to prospectively evaluate whether there is a relation between isolated aphasia and AF as the cause of cerebrovascular ischemia. ⋯ A statistically significant relation between isolated aphasia and AF could not be established in this study. However, our results showed a tendency towards significance. Further studies, in which rhythm is observed for a longer period of time, may be required to confirm this hypothesis.
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Cerebrovasc Dis Extra · Jan 2014
Measuring Quality Improvement in Acute Ischemic Stroke Care: Interrupted Time Series Analysis of Door-to-Needle Time.
In patients with acute ischemic stroke, early treatment with recombinant tissue plasminogen activator (rtPA) improves functional outcome by effectively reducing disability and dependency. Timely thrombolysis, within 1 h, is a vital aspect of acute stroke treatment, and is reflected in the widely used performance indicator 'door-to-needle time' (DNT). DNT measures the time from the moment the patient enters the emergency department until he/she receives intravenous rtPA. The purpose of the study was to measure quality improvement from the first implementation of thrombolysis in stroke patients in a university hospital in the Netherlands. We further aimed to identify specific interventions that affect DNT. ⋯ The DNT steadily improved from the first implementation of thrombolysis. Specific explanations for this improvement require further study, and may relate to the combined impact of a series of structural and logistic interventions. Our results support the use of performance measures for internal communication. Median DNT should be used on a monthly or quarterly basis to inform all professionals treating stroke patient of their achievements.
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Cerebrovasc Dis Extra · Jan 2014
Predictors of Outcome following Stroke due to Isolated M2 Occlusions.
Factors influencing outcome after cerebral artery occlusion are not completely understood. Although it is well accepted that the site of arterial occlusion critically influences outcome, the majority of studies investigating this issue has focused on proximal large artery occlusion. To gain a better understanding of factors influencing outcome after distal large artery occlusion, we sought to assess predictors of outcome following isolated M2 middle cerebral artery occlusion infarcts. ⋯ While the majority of patients with isolated M2 occlusion stroke has a good 90-day outcome, a substantial proportion of subjects dies by 90 days, as identified by a unique subset of predictors. The knowledge gained from our study may lead to an improvement in the prognostic accuracy, clinical management, and resource utilization in this patient population.