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Medical records of 455 acute stroke patients admitted to six community hospitals between October and April, 1969 through 1970 and 1971 through 1972, were surveyed. Data were obtained for: demography, diagnosis and management, complications, patient status and outcome variables (discharge status, disposition, length of stay, mortality and survival time), for one year before and after establishment of acute neurovascular care units (NCUs) in three of the hospitals. Patient status on admission based on a self-care scale was the most accurate measure used in predicting outcome (except when secondary complications occurred). There was a significant decline in mortality for nonhemorrhagic strokes for all patients, due to reduction in complication-related deaths among younger and less impaired persons. Forty-one percent of complication-related deaths for both surveys occurred during the first nine hospital days. Complications significantly lengthened hospitalization, increased the risk of late complication-related deaths, and decreased home discharges. Complication-related deaths were reduced in the second survey. Hospitals with NCUs showed a 50% reduction in secondary complications; hospitals without NCUs showed no reduction. Frequency of complications is an excellent measure of the quality of care. The acute NCU appears to be a practical method for achieving such quality.

One hundred consecutive cases with an admitting diagnosis of cerebrovascular disease treated in a four-bed Stroke Intensive Care Unit were reviewed in regard to final diagnosis and outcome. Eleven had final diagnoses other than cerebrovascular disease. Eighty-one had specific diagnoses as to major type of cerebrovascular disease present. The outcome in these cases was compared with that of 81 control cases matched for diagnosis only and blindly selected from concurrent admissions to an adjacent neurological ward. No significant differences in overall mortality (33% versus 27%) or in mortality by diagnostic category were found. This was true even if deaths in the first 48 hours were omitted from both groups to compensate for the selective admission of more seriously ill patients to the Stroke Intensive Care Unit. These results are compared to those reported by others. We concluded that specialized stroke intensive care units modeled on coronary care units do not have a significant impact on acute stroke mortality.

A battery of blood coagulation tests were performed on 14 acute stroke patients. Various abnormalities were found, notably elevation of blood fibrinogen, factor VIII, prothrombin, platelet factor 3, and a shortened P.T.T. The significance of these findings is discussed and they are considered to be of no importance since similar changes were noted in the blood of healthy subjects of the same age range.

Background & objective: Stroke is a dreadful health hazard all over the world as well as in our country and one of the leading causes of mortality & morbidity. The relationship between serum C-reactive protein (CRP) level and post stroke outcome is not well studied especially in Bangladesh. We were interested to study this relationship in our country. Materials & methods: A cross sectional prospective study was performed on 50-stroke patients. Serum CRP & Lipid profile was determined. Post stroke outcome was measured by modified ranking scale (good outcome, score within 0 – 2 & bad outcome, score within 3 – 6). The subjects were divided in two groups, CRP level above or below 10 mg/L. Statistical analysis was performed by using SPSS software. Chi-square test & Spearman’s rho correlation test was done to see the level of significance. Results: Mean serum CRP level was 9.69 mg/L that was higher than normal subjects. Correlation analysis between serums CRP level of stroke patients with post stroke outcome was found to be positively correlated (r = 0.598/p

Acute stroke is a heterogeneous condition and the risk of death can be gauged by various factors. This study sought to evaluate GCS score on admission as a prognostic tool of outcome among stroke patients, by observing the GCS score following acute stroke and in-hospital outcome at a tertiary level hospital in Bangladesh. Stroke is a major health problem in developed countries as well as developing countries like Bangladesh. This observational study was conducted among 122 consecutive patients, fulfilling the WHO stroke defining criteria, from 1st January 2007 to 30th June 2007. Mean age was 59.28 ± 14.89(SD) years and male female ratio was 2.39: 1. Cerebral infarct was 49.13%. Intracerebral hemorrhage and subarachnoid hemorrhage was 31.89% and 18.96% respectively. Overall in-hospital mortality was 15.57% though mortality in patients with cerebral infarcts was nil. Patients presenting with GCS between 3 and 8 caused 12.07% fatality, whereas, none died with GCS score 13-15.Here GCS score showed an inverse relationship with outcome that varied with type of stroke. We can conclude that GCS score on admission might be incorporated as an valuable prognostic parameter in stroke outcome measurement scale.  doi:10.3329/jom.v10i3.2009  J Medicine 2009; 10 (Supplement 1): 11-14

Background: Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients.Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. Materials & Methods: This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours.Results: Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh.Conclusion: Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention. DOI: 10.3329/bmrcb.v36i3.7286Bangladesh Med Res Counc Bull 2010; 36: 78-81

The cerebral mode transit time of hippuran 131I was measured in 30 patients suffering from hemispheric ischemic stroke. The average mode transit time of each hemisphere was calculated from the curve obtained by an arbitrary and by an averaging statistical smoothing. The statistical analysis of the results was based on the comparison of the right-left hemisphere difference of mode transit time between the control and stroke patients. The average mode transit time in patients and controls obtained by statistical averaging showed slightly different values in the stroke patients as compared to those obtained by the arbitrary visual smoothing of the curve. However, the right-left hemisphere differences were the same whether arbitrary smoothing or statistical averaging were used. This study confirms previous observations that the circulation time is significantly prolonged in the involved hemisphere in patients with acute ischemic stroke.

Although cerebrovascular disease is the third most common cause of death in the United States, there is little information about the actual mechanism of death in patients with an acute, terminal stroke. We have investigated the records of 200 patients who were admitted to the Evanston Hospital with the diagnosis of stroke, died, and had autopsies. Our data show that patients who died within a week after onset presented important differences in the probable causes of death from those who died later. In the latter group, death appeared much more frequently to be due to nonneurologic diseases such as pneumonia, pulmonary embolism, and urinary tract infections.

The various measures available for the therapy of a patient with a stroke have been discussed. The value of vigorous conservative therapy has been emphasized. The role of anticoagulant drugs has been detailed. This mode of therapy seems most efficacious in treatment of recurrent transient ischemic attacks and the slowly progressive stroke. The value of anticoagulants in the acute phase of cerebral thrombosis and in long-term postinfarction therapy is not clear as yet. The role of anticoagulant drugs in treatment of cerebral embolism seems well established. It may be wise to delay institution of these drugs for 24 to 36 hours after the acute stroke. Surgical procedures give promise of value in certain well-defined syndromes. The patient with cerebral hemorrhage remains a formidable therapeutic problem.

In a random manner, 100 patients with acute cerebral infarction due to thromboembolism were assigned to two groups. The patients in one group received continuous intravenous therapy with dextran 40 for three days; the others received an equivalent volume of fluid without the dextran 40. In the treated group, levels of dextran 40 remained greater than 1% for three to five days after the infusion was stopped. The group treated with dextran 40 showed lower mortality and better quality of survival in terms of the neurological status. The improvement in the treated group was significantly better than in the untreated group ( P

Excerpt A double-blind study of the effect of dexamethasone on acute stroke was conducted at the Neurological Institute of New York, N. Y. At the end of the study it was found that 17 patients had ...

Eighteen of twenty patients with subclavian or innominate artery obstruction experienced episodes of transient cerebral arterial insufficiency; one patient suffered acute stroke and coma; all patients had angiographic evidence of subclavian or innominate artery obstruction; and most were shown to have retrograde flow in a vertebral artery. Two clinical patterns were apparent by arteriographic studies. Six patients had single lesions of a subclavian artery resulting in centrifugal cerebral ischemia. A second group of 14 patients had other significant lesions of either the carotid or vertebral-basilar arterial systems. Carotid-subclavian bypass or aorto-subclavian bypass are the preferred methods of reconstruction of subclavian obstructions. Of these two approaches, the extrathoracic procedure is preferable.

A patient with an acute stroke had Gerstmann's syndrome. Cerebral angiography disclosed occlusion of the posterior parietal branch of the middle cerebral artery. The patient has remained physically well over a three-year period with only slight residual impairment in the intellectual spheres. Intracranial occlusions of smaller arterial branches can be diagnosed by cerebral angiography and occlusions of isolated branches give rise to characteristic clinical findings.

A double blind study of the effects of dexamethasone on acute stroke was conducted at the Neurological Institute of New York. At the end of the study, it was found that 17 patients had been treated with placebo and 14 patients had been treated with dexamethasone. The dose of steroid was 16 mg daily for 10 days followed by tapering doses from 12 mg to zero over the ensuing 7 days.

SURGERY IS NOW being widely employed for correction of stenosis or occlusion of extracranial vessels caused by thrombosis, degenerative disease, or mechanical disorders. Although elongation and kinking of the carotid arteries from degenerative vascular disease has been reported as being an etiological agent in the development of intermittent attacks of cerebral vascular insufficiency, 1 (particularly when the head is turned), kinking caused by a congenital disturbance has not, to our knowledge, been commented upon. The neurological arteriographic operation and postoperative findings are reported for a 78-year-old man who experienced an acute episode of cerebral vascular insufficiency and was found to have kinking of the right internal carotid artery by a dense fibrous band of connective tissue and complete congenital absence of the right external carotid artery. Report of a Case A 78-year-old, white, male retired office worker was admitted to the emergency room of the Washington Hospital Center at 2:40

SUMMARYWe have reported a case of anaphylactic reaction to low molecular weight dextran (dextran 40) which resulted in an acute stroke in a patient with previous transient ischemic episodes. This is the first such reaction, known to us, resulting from low molecular weight dextran and is reported as a warning to users of this drug.