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Introduction: The optimal timing for decompressive hemicraniectomy (DHC) after intravenous thrombolysis (IVT) remains unclear. This study in patients with acute ischemic stroke treated with IVT aimed to assess the safety of DHC and patient outcome., Methods: Data was extracted from the Tabriz stroke registry from June 2011 up to September 2020. In all, 881 patients were treated with IVT. Among these, 23 patients underwent DH. Six patients were excluded due to symptomatic intracranial hemorrhage (parenchymal hematoma type 2 based on SITS-MOST definition) after IVT, but other types of bleeding after venous thrombolysis, including HI1, HI2, and PH1 were not excluded; so the remaining 17 patients were enrolled in the study. Functional Outcome was defined as the proportion of patients who achieved mRS score of 2-3 (moderate disability), 4-5 (severe disability), or 6 (mortality) at 90 days after stroke. mRSwas assess by trained neurologist at the hospital clinic with direct interview Safety outcome was assessed by comparison of two scans just prior to and after craniectomy. Any new hemorrhage or worsening of previous hemorrhage was reported. Parenchymal hematoma type 2, based on ECASS II definition, was considered as major surgical complication. This study was approved by the local ethics committee of the Tabriz University of Medical Sciences (Ethics Code: IR.TBZMED.REC.1398.420)., Results: At the three-month mRS follow up, six patients (35%) had moderate and five (29%) had severe disability. The outcome of death was observed in six patients (35%).Nine of 15 patients (60%) underwent surgery in the first 48 hours after onset of symptoms. No patient over 60 years of age survived to the three-month follow up; 67% of those who were under60 years and underwent DH in the first 48 hours had favorable outcome. Hemorrhagic complication was seen in 64% of patients but none was major., Conclusion: Results of this study showed that the rate of major bleeding and outcome of acute ischemic stroke patients who underwent DHC after IVT is comparable with the reported data in the literature and intentionally waiting for the fibrinolytic effects of IVT to disappear may not outweigh the benefits of DHC. Although the findings of the study should be interpreted with caution and larger studies are needed to confirm the results., (© 2023. The Author(s).)

Objectives: In the present study, we sought to investigate the association between red cell distribution width (RDW) and stroke severity and outcome in patients who underwent anti-thrombolytic therapy with tissue plasminogen activator (tPA)., Results: In this prospective study, 282 stroke patients who underwent tPA injection were included. The categorization of RDW to < 12.9% and > 13% values revealed insignificant difference in stroke severity score, accounting for the mean 36-h NIHSS of 8.19 ± 8.2 in normal RDW values and 9.94 ± 8.28in higher RDW group (p = 0.64). In seventh day, NIHSS was 6.46 ± 7.28 in normal RDW group and was 8.52 ± 8.35 in increased RDW group (p = 0.058). Neither the 36-h, nor the seventh day and 3-month mRS demonstrated significant difference between those with normal and higher RDW values.

Background: Early recognition of stroke symptoms results in a lower time period after stroke onset to treatment with a better outcome. This depends on the awareness of patients, family members, and the general public., Objective: The aim of this study was to evaluate public awareness about stroke risk factors, warning symptoms, and treatments., Methods: This cross-sectional study was conducted as a hospital-based survey on 2712 people who visited clinics or emergency department of Imam Reza hospital for any reason, from March 2015 to February 2016. All subjects were interviewed face-to-face by four trained physicians and a structured, pre-tested questionnaire was filled., Results: The mean age of participants was 41.0 ± 12.1 years old. Considering Cincinnati prehospital stroke scale (CPSS) as the main diagnostic system, the percentage of participants that mentioned face asymmetry, speech disturbances, and arm paralysis as a symptom of stroke was 7, 1.5, and 7.9%, respectively. Meanwhile, 71.2% of participants could not mention any of the stroke symptoms. Among participants, 20.2% did not know any of stroke risk factors although 35.1, 27.8, and 17.3% could name one, two and three or more risk factors, respectively. Among participants, only 1.1% were aware of thrombolytic therapy (t-PA) as a first-line drug for stroke treatment., Conclusion: In this study, public knowledge regarding stroke symptoms, risk factors, and therapy approaches was low. Taken together, public education is necessary to reduce the time for recognition of stroke symptoms and subsequently prompt and proper proceeding seems to be necessary for the community.