Entries Tagged as 'J Stroke Cerebrovasc Dis'
A comparison of characteristics and resource use between in-hospital and admitted patients with stroke.
J Stroke Cerebrovasc Dis. 2010 Sep-Oct;19(5):357-63
Authors: Bhalla A, Smeeton N, Rudd AG, Heuschmann P, Wolfe CD
Although in-hospital stroke is not a common occurrence, it is important to identify what components of stroke care these patients receive. The aims of this study were to estimate the clinical characteristics, process of stroke care, and mortality in patients admitted to hospital with stroke compared with patients with in-hospital strokes.
PMID: 20542447 [PubMed - indexed for MEDLINE]
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The use of diagnostic tests in patients with acute ischemic stroke.
J Stroke Cerebrovasc Dis. 2009 May-Jun;18(3):178-84
Authors: Yu EH, Lungu C, Kanner RM, Libman RB
BACKGROUND: Stroke is a leading cause of long-term disability in the United States. Inpatient hospital costs account for the majority of acute care costs of stroke with half the cost providing for room and board and 19% of total costs allocated to diagnostic testing. This study addresses the yield of common diagnostic tests in stroke and how frequently the results potentially impact early stroke management. METHODS: We conducted a retrospective chart review of patients with acute ischemic stroke over 3 years from a single-center community-based teaching hospital. Results of carotid Doppler (CD), transcranial Doppler, extracranial magnetic resonance (MR) angiography (EMRA), intracranial MR angiography, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and 24-hour Holter monitoring were reviewed. RESULTS: Extracranial carotid artery imaging with CD and EMRA showed symptomatic ipsilateral stenosis in 7.9% and 13% of patients with stroke. TTE alone showed intracardiac thrombus in 1.5% of patients whereas TEE had a yield of 3.8%. Patent foramen ovale was seen in 16% of TEE and none were detected on TTE. The 24-hour Holter monitoring revealed newly detected atrial fibrillation in 9.4% of patients with stroke. CONCLUSIONS: Standard diagnostic studies in acute stroke aimed at secondary stroke prevention are unlikely to yield results that warrant prolongation of hospitalization. Carotid endarterectomy is the only intervention with reasonable evidence suggesting benefit in the early period after stroke. Pursuing extracranial carotid artery imaging during initial hospitalization seems justifiable, especially given the high yield of CD and EMRA in the detection of treatable carotid artery stenosis.
PMID: 19426886 [PubMed - indexed for MEDLINE]
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A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke.
J Stroke Cerebrovasc Dis. 2008 Nov-Dec;17(6):331-3
Authors: Cucchiara B, Tanne D, Levine SR, Demchuk AM, Kasner S
BACKGROUND: Ability to predict risk of postthrombolysis intracerebral hemorrhage (ICH) is currently limited. METHODS: Using data from the Multicenter Recombinant Tissue Plasminogen Activator Stroke Survey Group, we developed a score to predict this risk. One point was assigned for the presence of each of 4 variables: age older than 60 years, baseline National Institutes of Health Stroke Scale score greater than 10, glucose greater than 8.325 mmol/L, and platelet count less than 150,000/mm(3). RESULTS: Rate of any ICH increased with higher scores: 0 points, 2.6%; 1 point, 9.7%; 2 points, 15.1%; and greater than or equal to 3 points, 37.9%. The model had reasonable discriminatory capability (C-statistic 0.69). A similar pattern was seen with symptomatic and asymptomatic ICH separately, and with radiographically defined parenchymal hemorrhage. CONCLUSION: A simple risk score may be useful for predicting postthrombolysis ICH.
PMID: 18984422 [PubMed - indexed for MEDLINE]
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Vascular risks and complications in diabetes mellitus: the role of helicobacter pylori infection.
J Stroke Cerebrovasc Dis. 2008 Mar-Apr;17(2):86-94
Authors: Hamed SA, Amine NF, Galal GM, Helal SR, Tag El-Din LM, Shawky OA, Ahmed EA, Abdel Rahman MS
Patients with diabetes mellitus (DM) are at risk for Helicobacter pylori infection. This infection has been linked to atherosclerosis and its vascular complications. The aim of this study was to evaluate the: (1) prevalence of H pylori infection in patients with DM; (2) association between diabetic vascular complications and H pylori infection; and (3) influence of H pylori infection on atherosclerosis and inflammatory biomarkers. In this study, we evaluated 80 patients with DM for atherosclerosis; cardiac, cerebral, and peripheral vascular diseases; retinopathy; neuropathy; and nephropathy. We estimated the blood levels of glucose, glycosylated hemoglobin, complete blood cell count, erythrocytic sedimentation rate, lipid profile, tumor necrosis factor-alpha, interleukin (IL)-6, and anti-H pylori IgG antibodies. H pylori infection was detected in 85% of patients versus 76.7% for control subjects. Carotid artery intima-media thickness was significant in H pylori-infected patients. IL-6 and tumor necrosis factor-alpha were significantly associated with H pylori infection. In multivariate analysis, blood glucose, triglycerides, erythrocytic sedimentation rate, IL-6, and tumor necrosis factor-alpha increased the odds for atherothrombotic cause of cerebral ischemia in H pylori infection. We concluded that H pylori infection is common in DM and seems to be linked to the presence of atherosclerosis and ischemic cerebrovascular stroke. This effect could be mediated by increasing cytokine levels.
PMID: 18346651 [PubMed - indexed for MEDLINE]
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