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Introducción: El tiempo sigue siendo una variable determinante para los tratamientos de reper-fusión del ictus isquémico agudo. A pesar de las recomendaciones de las guías clínicas, soloalrededor de la tercera parte de los pacientes con ictus isquémico agudo son fibrinolizadosen = 60 min. El objetivo de este trabajo es describir nuestra experiencia implementando unprotocolo específico de atención del ictus isquémico agudo y evaluar su impacto en nuestrostiempos puerta-aguja. Métodos: A finales del 2015, se implantaron gradualmente unas medidas dise ~nadas para acortarlos tiempos de actuación y optimizar la atención del ictus isquémico agudo incluyendo unaguardia específica de Neurovascular. Se compararon los tiempos de actuación antes (2013-2015)y después (2017-2019) de la introducción de este protocolo. Resultados: Se incluyó a 182 pacientes antes y 249 después de la intervención. Cuando todas lasmedidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 45 min (previa74 min, 39% menos, p < 0, 001) con un 73, 5% de pacientes tratados en = 60 min (47% más quepreintervención, p < 0, 001). El tiempo global al tratamiento (inicio síntoma-aguja) se redujo en20 min de mediana (p < 0, 001). Conclusiones: Las medidas asociadas en nuestro protocolo han conseguido una disminución deltiempo puerta-aguja de forma significativa y sostenida, aunque todavía nos queda margen demejora, la dinámica establecida de control de resultados y mejora continua hará posible seguiravanzando en este sentido. Introduction: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60 minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. Methods: Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. Results: The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45 minutes (vs 74 minutes before, a 39% reduction; P

Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

Introduction The benefits of mechanical thrombectomy in the treatment of patients with acute stroke due to large vessel occlusions (LVOs) have been extensively demonstrated by randomized trials and registries in developed countries. However, data on thrombectomy outside controlled trials are scarce in developing countries. The aim of this study was to assess the safety and efficacy, and to investigate the predictors for good and poor outcomes of thrombectomy for treatment of AIS due to anterior circulation LVOs in Brazil. Materials and Methods This was a single center registry of thrombectomy in the treatment of stroke caused by anterior circulation LVOs. Between 2011 and 2019, a total of 565 patients were included. Results the mean baseline NIHSS score on admission was 17.2. The average baseline ASPECTS was 8, and 91.0% of patients scored ≥6. Half of the patients received intravenous thrombolysis. The mean time from symptom onset to arterial puncture was 296.4 minutes. The mean procedure time was 61.4 minutes. The rates of the main outcomes were recanalization (TICI 2b-3) 85.6%, symptomatic intracranial hemorrhage (sICH) 8,1%, good clinical outcome (mRS=0-2) 43,5%, and mortality 22.1% at three months. Conclusions This study demonstrates the efficacy and safety of mechanical thrombectomy for treatment of patients with AIS of the anterior circulation in real-life conditions under limited facilities and resources. The results of the present study were relatively similar to those of large trials and population registers of developed countries.

Background: Minorities constitute groups with higher risk of stroke and stroke severity. Disparities in stroke care may result from greater prevalence of risk factors, barriers to medical care, and lower utilization of preventive therapies. Insurance status may be one limiting factor in access to care and preventive measures. Purpose: We hypothesize that vascular risk factors differ between racial groups and that insurance status may affect stroke treatment, secondary prevention measures, stroke severity, and outcomes. Methods: We included 1061 consecutive patients with ischemic stroke (2005-2008) in our local Get-With-The-Guidelines (GWTG) database. Multivariate logistic regression analysis was used to evaluate the relation of race and insurance status to risk factors, intravenous thrombolytic therapy (IV-tPA) use, stroke severity (National Institute of Health Stroke Scale [NIHSS]), hospital complications, and ambulatory status at discharge. Results: Whites were older than Non-Whites (mean age 65 vs 62 years, p

Objective: Variable treatment strategies and protocols have been applied to reduce time durations in the process of acute stroke management. The aim of this study is to investigate the effectiveness of our intra-arterial thrombectomy (IAT) protocol for decreasing door-to-recanalization time duration and improve successful recanalization.Methods: A systemic and endovascular protocol included door-to-image, image-to-puncture and puncture-to-recanalization. We retrospectively analyzed the patients of pre- (Sep 2012–Apr 2014) and post-IAT protocol (May 2014–Jul 2018). Univariate analysis was used for the statistical significance according to variable factors (age, gender, the location of occluded vessel, successful recanalization TICI 2b-3). Independent t-test was used to compare the time duration.Results: Among all 267 patients with acute stroke of anterior circulation, there were 50 and 217 patients with pre- and post-IAT protocol. Age, gender, and the location of occluded vessel have no statistical significance (p＞0.05). In pre- and post-IAT group, successful recanalization was 39 of 50 (78.0%) and 185/217 (85.3%), respectively (p＜0.05). Post-IAT (48.8%, 106/217) group had a higher tendency of good outcome than pre-IAT group (36.0%, 18/50) (p＞0.05). Pre- and post-IAT group showed 61.7±21.4 vs. 25±16.0 (p＜0.05), 102.0±29.8 vs. 82.7±30.4 (min) (p＜0.05), and 79.1±47.5 vs. 58.4±75.3 (p＜0.05) in three steps, respectively.Conclusions: We suggest that the application of systemic and endovascular IAT protocols showed a significant time reduction for faster recanalization in patients with LVO. To build-up the well-designed IAT protocol through puncture-to-recanalization can be needed to decrease time duration and improve clinical outcome in recanalization therapy in acute stroke patients.

Resumen Introduccion El uso de activador tisular del plasminogeno (rt-PA) a dosis bajas fue propuesto inicialmente en paises asiaticos en atencion a particularidades raciales relacionadas con la funcionalidad del fibrinogeno y factores de coagulacion que contribuyen al riesgo de hemorragias intracerebrales, asi como a la intencion de ahorrar costos. Ante la controversia sobre el uso de rt-PA por debajo de la dosis estandar, realizamos una revision de la literatura sobre los estudios que motivaron su uso y aquellos dirigidos a comparar diferentes dosis de rt-PA. Desarrollo Se revisaron 198 resumenes relacionados con los terminos de busqueda. Se revisaron 52 publicaciones de texto completo de los ultimos 30 anos. Se incluyeron 13 ensayos clinicos aleatorizados dirigidos a determinar la eficacia y seguridad del uso de rt-PA a diferentes dosis en el ictus agudo, 14 estudios de cohorte observacionales, 5 metaanalisis y 3 revisiones sistematicas. Conclusiones No se cuenta con evidencia suficiente para catalogar la dosis baja de alteplase como superior o al menos no inferior que el tratamiento estandar en el manejo del ictus agudo en poblacion occidental. Se requieren mas ensayos clinicos para determinar, si el uso de dosis bajas es beneficioso en pacientes con contraindicaciones relativas de terapia trombolitica u otras circunstancias particulares que eleven el riesgo de hemorragias intracerebrales.

This article focuses on the inpatient evaluation and management of ischemic stroke and transient ischemic attack (TIA). We describe foundational principles including quality metrics, TIA, and stroke as emergencies, TIA/minor stroke management, and standard assessments before discussing tailored evaluation and management strategies by stroke type.

У статті поданий огляд публікацій, присвячених проблемі лихоманки у хворих на гострий інсульт (ГІ). Наголошується, що висока температура тіла значно корелює з вихідною тяжкістю інсульту, розміром ураження, смертністю й неврологічними наслідками. У хворих на ГІ для диференціальної діагностики лихоманки мають значення час її появи, особливості клінічної картини та рівень С-реактивного білка. Підвищена температура тіла при ГІ повинна бути обов’язково знижена й має підтримуватися в безпечному нормотермічному діапазоні принаймні перші кілька днів після початку ГІ. Ацетамінофен (парацетамол) у дозах, рекомендованих для лікування лихоманки, має обмежену ефективність у хворих на ГІ. Для запобігання побічним ефектам добова доза ацетамінофену не повинна перевищувати 3 г/день. Необхідні додаткові дослідження для того, щоб з’ясувати, чи лихоманка є одним із патогенетичних механізмів, чи тільки маркером несприятливого результату, а також щоб визначити оптимальну програму лікування.

In the article, the authors present an analysis of published data on international scientific community thought about the issue of care for acute stroke and the need for stroke centers, suggest an approximate description of stroke centers that are recommended for introduction in Kyiv and Ukraine. Description consists of the general provisions, the main tasks of the center, functions, center management, recommendations for specialized centers for the treatment of stroke (emergency diagnostics, general examination and treatment of complications of a stroke).

Актуальність. Однією з основних причин і важливим фактором ризику виникнення гострого інсульту (ГІ) є цукровий діабет (ЦД), який погіршує перебіг інсульту, збільшує ризик розвитку ускладнень і смертельного наслідку. Для зменшення неврологічного дефіциту та поліпшення результатів лікування ГІ у даний час широко використовують нейропротектори, зокрема цитиколін і препарати магнію. Мета. Дослідження ефективності застосування комбінації цитиколіну та магнію сульфату як нейропротекторної терапії у хворих на ГІ на тлі супутнього ЦД. Матеріали та методи. Було проведено комплексне клініко-неврологічне та лабораторне обстеження 346 хворих (165 жінок та 181 чоловік), які перенесли гострий ішемічний інсульт. Цим хворим призначали цитиколін 1000 мг 1 раз на добу та розчин магнію сульфату 25% 30 мл на добу у 2–3 введення. В групі контролю (46 хворих — 25 жінок та 21 чоловік) використовували різні препарати із заявленою нейропротективною дією (крім цитиколіну та магнію сульфату). Результати. В групах, де використовувалися для нейропротекції цитиколін і магнію сульфат, починаючи з 5-ї доби, рівень свідомості відновлювався більш швидко, ніж у групі традиційного лікування. Згідно з аналізом за шкалою FOUR, на 10-й день лікування різниця між 1-ю, 2-ю групами та контролем стає відчутною і досягає рівня вірогідності (p < 0,05). На 3-тю добу лікування у хворих усіх груп рівень нейронспецифічної енолази (NSE) перевищував нормальні показники, причому найбільшою мірою — у хворих контрольної групи, в яких рівень NSE зріс у 10 разів (з 9,2 до 96,4 нг/мл). У подальшому спостерігалося швидке зниження рівня NSE, який в основних групах хворих на 10-ту добу лікування досягнув нормальних показників. У контрольній групі динаміка зниження NSE не була такою вираженою і на 10-й день лікування рівень NSE не досяг референтних значень. У хворих контрольної групи спостерігалося різке зниження rSO2 (особливо на 3-тю — 4-ту добу) з подальшим тривалим і повільним його підвищенням. Висновки. Комбінація цитиколіну з магнію сульфатом була вірогідно ефективною під час лікування хворих на ГІ на тлі супутнього ЦД. У хворих зі станами предіабету та у хворих без ЦД і з транзиторними гіперглікеміями спостерігалася менша ефективність цієї комбінації, а у групі хворих, які отримували традиційне лікування, вірогідних відмінностей у динаміці клініко-лабораторних показників виявлено не було. Таким чином, у хворих на ГІ на тлі супутнього ЦД комбінація цитиколіну та магнію сульфату є однією з можливих перспективних комбінацій препаратів, що мають нейропротекторні властивості.

Неврологічне обстеження хворих із гострим інсультом є обов’язковим компонентом діагностики інсульту. Для ґрунтовного з’ясування впливу ізоосмолярного розчину 0,9% NaCl та гіперосмолярного розчину маніту на перебіг гострого порушення мозкового кровообігу за ішемічним типом становило інтерес дослідження впливу курсової терапії цими розчинами на перебіг неврологічного дефіциту за допомогою різних неврологічних шкал. Досліджувані розчини вводили в умовно ефективній дозі (визначеній в експерименті) одразу при підтвердженні діагнозу і далі щодоби кожні 12 год впродовж 7 діб. Контроль результатів терапії в дослідженні проводився щодня за допомогою шкали коми Глазго, шкали FOUR та NIHSS. Застосування 0,9% NаСl та маніту не мало вірогідного впливу на динаміку неврологічного дефіциту за показниками шкал коми Глазго, FOUR та NIHSS упродовж 7 діб спостереження (р > 0,05). Міжгруповий аналіз неврологічного дефіциту показав вірогідно гірший результат у групі маніту порівняно з 0,9% NaCl за показниками шкали FOUR (р = 0,02).

Background Functional neurological disorder is defined by symptoms not explained by the current model of disease and its pathophysiology. It is found in 8.4% of patients presenting as acute stroke. Treatment is difficult and recurrence rates are high. We introduced hypnotherapy as a therapeutic option in addition to standard stroke unit care. Methods This is an observational study of successive patients with functional neurological disorder presenting as acute stroke treated with hypnotherapy between 1 April 2014 and 1 February 2018. The diagnosis of functional neurological disorder was confirmed by clinical examination and computed tomography/magnetic resonance imaging. Hypnosis was delivered by a hypnotherapy trained stroke physician using imagery for induction. A positive response was defined as a National Institutes of Health Stroke score reduction to 0 or by ≥4 points posthypnotherapy. Costs were calculated as therapist time and benefits as reduction in disability/bed days. Results Sixty-eight patients (mean age 36.4 years, 52 (76%) females, mean baseline National Institutes of Health Stroke 5.0 (range 1–9)) were included. Two patients (3%) could not be hypnotized. Fifty-eight 58 (85%) responded, 47 (81%) required one treatment session, while 19% needed up to three sessions for symptomatic improvement. No adverse events were observed. Disability (modified Rankin Scale) reduced from a mean of 2.3 to 0.5 resulting in an average cost saving of £1,658 per patient. Most (n = 50, 86%) remained well without recurrence at six-month follow-up. Conclusions In this case series, hypnotherapy was associated with rapid and sustained recovery of symptoms. A prospective randomized controlled study is required to confirm the findings and establish generalizability of the results.

Introduction Patients hospitalized for acute ischemic stroke have an increased risk of venous thromboembolism (VTE) that may persist beyond the currently recommended period of 6 to 14 days of thromboprophylaxis. This systematic review evaluated the efficacy and safety of extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke. Materials and methods MEDLINE, EMBASE and Clinicaltrials.gov were searched up to December 2020 for randomized controlled trials comparing extended versus standard venous thromboprophylaxis in patients hospitalized for acute ischemic stroke. The efficacy outcome was a composite of asymptomatic or symptomatic deep vein thrombosis, symptomatic pulmonary embolism, and VTE-related death. The safety outcome was major bleeding. Summary risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Results Four randomized controlled trials enrolling 33718 patients were included. Of 4330 (12.8%) patients hospitalized for acute ischemic stroke, 2152 (49.7%) received extended thromboprophylaxis for four to five weeks with betrixaban (n = 405, 18.8%), enoxaparin (n = 198, 9.2%), or rivaroxaban (n = 1549, 72.0%), and 2178 (50.3%) received standard venous thromboprophylaxis with enoxaparin. VTE risk was lower in acute ischemic stroke patients receiving extended thromboprophylaxis (RR 0.67; 95% CI, 0.43 to 1.04; 13 fewer per 1000), whereas the increase in major bleeding seemed trivial when compared with standard prophylaxis (RR 1.10; 95% CI, 0.31 to 3.95; 1 more per 1000). Conclusion In patients hospitalized for acute ischemic stroke, the net clinical benefit may favor extended venous thromboprophylaxis for four to five weeks over standard thromboprophylaxis.

This work presents a novel and promising approach to the clinical management of acute stroke. Using machine learning techniques, our research has succeeded in developing accurate diagnosis and prediction real-time models from hemodynamic data. These models are able to diagnose stroke subtype with 30 min of monitoring, to predict the exitus during the first 3 h of monitoring, and to predict the stroke recurrence in just 15 min of monitoring. Patients with difficult access to a CT scan and all patients that arrive at the stroke unit of a specialized hospital will benefit from these positive results. The results obtained from the real-time developed models are the following: stroke diagnosis around 98% precision (97.8% sensitivity, 99.5% specificity), exitus prediction with 99.8% precision (99.8% Sens., 99.9% Spec.), and 98% precision predicting stroke recurrence (98% Sens., 99% Spec.). Graphical abstract depicting the complete process since a patient is monitored until the data collected is used to generate models.

BACKGROUND: Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse post-stroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. OBJECTIVES: To determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels. METHODS: We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7-day and 30-day all-cause readmissions for Black and White ischemic stroke patients. RESULTS: Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30-day and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (< 3 patients per nurse), Black and White stroke patients’ disparities were no longer significant. DISCUSSION: Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.

BackgroundIn patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.MethodsFrom April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).ResultsOf the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).ConclusionSystematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

Background and Purpose: The aim of this study was to examine whether sphingosine-1-phosphate (S1P) levels in patients with acute stroke are associated with stroke severity and outcome. Methods: In a prospective stroke cohort (MARK-STROKE), 374 patients with acute ischemic stroke or transient ischemic attack were enrolled (mean age: 67.9±13.0 years, sex: 64.7% male), and serum-S1P at admission was analyzed with tandem mass spectrometry. In addition to cross-sectional analyses, 79 adverse events (death, stroke, myocardial infarction, rehospitalization) were recorded in 270 patients during follow-up. Regression analyses were adjusted for age, sex, low-density lipoprotein cholesterol, and vascular risk factors. Results were validated in an independent stroke cohort with 219 patients with acute ischemic stroke (CIRCULAS). Results: Low serum-S1P was associated with higher National Institutes of Health Stroke Scale score at admission and with anterior circulation nonlacunar infarcts determined by multivariate regression analyses. During a follow-up of 294±170 days, patients with S1P in the lowest tertile (P =0.048 for trend). In adjusted Cox regression analysis, the lowest S1P tertile was associated with a worse outcome after stroke (hazard ratio, HR 0.51 [95% confidence interval 0.28–0.92]). Results were confirmed in an independent cohort, ie, low S1P levels were associated with higher National Institutes of Health Stroke Scale, larger infarct volumes and worse outcome after 90 days (β-coefficient: –0.03, P =0.026; β-coefficient: −0.099, P =0.009 and odds ratio 0.52 [0.28–0.96], respectively). Conclusions: Our findings imply a detrimental role of low S1P levels in acute stroke and therefore underpin the therapeutic potential of S1P-mimics.

Background. There are currently conflicting results regarding the link between vitamin D deficiency and the increased risk for stroke and its poor prognosis. The present study aimed to assess the relationship between vitamin D deficiency and prognosis of acute stroke. Methods. This bi-center cross-sectional study was performed on 140 consecutive patients who referred to two general hospitals in Iran with the diagnosis of acute stroke. The levels of 25-hydroxy vitamin D were evaluated by Electrochemiluminescence (ECL) technique. Clinical severity of stroke on admission as well as on discharge time were evaluated using the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin (mRS) tools. Results. Mean serum level of vitamin D was 25.51 ± 18.87 ng/mL, ranging from 3.0 to 98.6 ng/ml. There was a significant difference between the two groups (with and without vitamin D deficiency) in terms of stroke severity and disability, as reflected by mRS (P=0.003) and NIHSS evaluation (14.24 ± 9.23 versus 9.73 ± 7.36, P=0.003). Also, regarding patients’ clinical condition, the mean NIHSS score in those with deficient and normal levels of vitamin D was 14.24 ± 9.23 and 9.73 ± 7.36, respectively with NIHSS score > 5 in 76.1% and 61.5%, respectively (P = 0.003). Conclusion. According to the results of study, vitamin D status can be related to the severity of stroke. However, considering the cross-sectional design of our study, it could not point out the causality between vitamin D deficiency and acute stroke and further studies are warranted. It is not possible to draw any conclusions in terms of causality. Further studies are required in order to assess the relationship between the serum vitamin D levels and stroke severity.

Introduction: Stroke is the second leading underlying cause of death globally and the leading cause of disability in adults. Stroke diagnosis should be performed quickly and efficiently to eliminate other potential causes of neurological deficits and to assess the time since the onset of clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential methods of detecting and evaluating stroke type and treatmentoptions. Diffusion and perfusion MR imaging is recommended for early stroke diagnosis, as well as for the selection of patients for recanalization therapy, and is considered effective in assessing treatment outcomes. The objectives of this study were to demonstrate the diagnostic value of diffusion and perfusion imaging in the diagnosis of acute ischemic stroke, analyze the role of magnetic resonance imaging in the selection of patients with acute stroke for recanalization therapy, and assess the effect of acute stroke complicity.Material and methods: The research is designed as a systematic review of the primary scientific research literature, which was published in English in relevant scientific databases (PubMed, Google Scholar, Medline) from 2014 to 2021.Results: 14 scientific research papers were singled out and the general characteristics of the study were analyzed (country, authors, year of publication, title of the study, type of study, study objectives, research methods, results and conclusion). A quality assessment of the included studies with cohort design and randomized controlled studies was performed, and most belong to the category of high-quality studies with a smaller number of medium-quality studies. The overall percentage of detected AIS cases in isolated studies using the DWI and/or PWI sequence was 90.8%. At the same time, the outcome of recanalization therapy was assessed using MRI studies (the number of patients who developed adverse events with functional data outcome 30 or 90 days after the procedure was observed). Comparison of MRI and CT imaging protocols provided data on the total percentage of detected acute stroke cases using CT imaging protocols (68.9%) and MRI imaging protocols (88.5%), which is why MRI is considered a superior method.Conclusion: Although CT is a suitable method for visualizing bleeding and also for early differentiation of hemorrhagic from ischemic stroke, if MRI imaging is available, it is recommended to use DWI, PWI, MRA sequences for a more accurate diagnosis of stroke in the acute phase.

PURPOSE OF REVIEW Blood pressure management in acute stroke has long been a matter of debate. Epidemiological data show that high blood pressure is associated with death, disability and early stroke recurrence, whereas the pathophysiological rationale for ensuring elevated blood pressure in order maintain adequate cerebral perfusion remains a pertinent argument, especially in ischaemic stroke. RECENT FINDINGS The European Stroke Organisation Guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage provide recommendations for the appropriate management of blood pressure in various clinical acute stroke settings. SUMMARY In this narrative review, we provide specific updates on blood pressure management in ICH, blood pressure management in the setting of reperfusion therapies for ischaemic stroke, and the evidence for the use of induced hypertension in patients with acute ischaemic stroke in the light of the recent guidelines.

The World Health Organization defines a stroke as ‘rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin’. If the symptoms last less than 24 hours, typically less than 2 hours, then this is classified as a transient ischaemic attack. ‘Brain attack’ is a term that is increasingly used, as the rapid nature of treatment means the differentiating criterion of symptoms lasting at least 24 hours, is often not met before initiation of treatment.

PURPOSE OF REVIEW The earlier the treatment, the better the outcomes after acute ischemic stroke. Optimizing prehospital care bears potential to shorten treatment times. We here review the recent literature on mothership vs. drip-and-ship as well as mobile stroke unit concepts. RECENT FINDINGS Mobile stroke units result in the shortest onset-to-treatment times in mostly urban settings. SUMMARY Future research should focus on further streamlining processes around mobile stroke units, especially improving dispatch algorithms and improve referral for endovascular therapy.

Актуальність. Інсульт є другою за частотою причиною смертності у світі пicля серцево-судинних захворювань. Концепція діашизу Монакова описує нейрофізіологічні зміни, що відбуваються на відстані від осередкового ураження головного мозку і відіграють значну роль у вираженості гострого неврологічного дефіциту в пацієнтів з інсультом. Проте на сьогодні опубліковано недостатньо перспективних клінічних досліджень, у яких проаналізовано характеристики перехресного понтинно-мозочкового діашизу в пацієнтів iз гострим інсультом. Мета дослідження: визначення особливостей клінічних проявів перехресного понтинно-мозочкового діашизу в пацієнтів iз гострим ішемічним інсультом. Матеріали та методи. Ми провели проспективне госпітальне когортне дослідження 124 пацієнтів iз гострим ішемічним інсультом, які надійшли до відділення цереброваскулярних захворювань Олександрівської клінічної лікарні м. Києва протягом перших 24 годин з моменту розвитку інсульту. Усі пацієнти пройшли комплексне клініко-неврологічне, лабораторне, ультразвукове та нейровізуалізаційне обстеження. Результати. Серед 124 обстежених хворих iз гострим ішемічним інсультом перехресний понтинно-мозочковий діашиз був діагностований у 5 осіб. Ми проаналізували патофізіологічні, анатомічні та клінічні особливості перехресного понтинно-мозочкового діашизу в пацієнтів iз гострим ішемічним інсультом. Висновки. Унілатеральні інфаркти верхнього і середнього відділів моста поєднувалися з вогнищем ішемії (діашиз) у контралатеральній півкулі мозочка, призводячи до перехресного понтинно-мозочкового діашизу, виникнення якого пов’язують з перериванням проходження імпульсів по відрізку корково-мосто-мозочкового шляху від вогнища інфаркту в мостi до перехрещення волокон, що йдуть поперечно від ядер моста до півкулі мозочка.

Background The optimal timing of anticoagulation following acute ischaemic stroke or TIA in patients with atrial fibrillation (AF) is a frequent challenge. Early initiation of anticoagulation can reduce the risk for recurrent ischaemic events, but may lead to an increased risk for intracerebral haemorrhage. Aim The Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA (PRODAST) study was initiated to investigate outcome events under antithrombotic therapy after ischaemic stroke or TIA in patients with AF. The main objective is to compare the three-month rates of major haemorrhagic events between early (≤ 7 days) versus late (> 7 days) administration of dabigatran or treatment with vitamin-K antagonists started at any time. Occurrences of ischaemic and major haemorrhagic events will be evaluated to determine the optimal time point for initiation or resumption of anticoagulation. Design and Methods PRODAST is a prospective, multicenter, observational, non-interventional post-authorization safety study. 10,000 patients with recent (≤ 1 week from index event) ischaemic stroke or TIA and non-valvular AF were recruited at 86 German sites starting in July 2015. The observational plan includes a baseline visit, documentation of data during hospitalization and a telephone-based, central follow-up at three months after the index event. The primary endpoint is the major bleeding rate within three months. Secondary endpoints include rates of recurrent ischaemic or haemorrhagic stroke, TIA, systemic embolism, myocardial infarction and death. Summary PRODAST will provide important real-world data on safety and efficacy of antithrombotic therapy after acute stroke and TIA in patients with AF.

Актуальність. Спонтанне відновлення неврологічних функцій після інсульту пояснюється феноменом діашизу й пов’язане з реорганізацією в моторних та премоторних ділянках кори головного мозку. Однак на сьогодні опубліковано недостатньо проспективних когортних досліджень, у яких наведено та проаналізовано клініко­нейровізуалізаційні характеристики перехресно­мозочкового діашизу в пацієнтів iз гострим ішемічним інсультом. Мета дослідження: визначення особливостей клінічних проявів перехресно­мозочкового діашизу в пацієнтів iз гострим ішемічним інсультом та підвищення ефективності його діагностики шляхом зіставлення отриманих даних з результатами магнітно­резонансної томографії. Матеріали та методи. Ми провели проспективне госпітальне когортне дослідження пацієнтiв iз гострим ішемічним інсультом (n = 124), які були госпіталізовані у відділення цереброваскулярних захворювань Олександрівської клінічної лікарні м. Київа протягом перших 24 годин з моменту розвитку інсульту. Усі пацієнти пройшли комплексне клініко­неврологічне, лабораторне, ультразвукове і нейровізуалізаційне обстеження. Результати. Серед 124 хворих iз гострим ішемічним інсультом перехресно­мозочковий діашиз був діагностований у 5 (4,03 %) пацієнтів. Ми проаналізували патофізіологічні, анатомічні та клініко­нейровізуалізаційні особливості перехресно­мозочкового діашиза в пацієнтів iз гострим ішемічним інсультом. Висновки. Семіотика гострого інсульту визначається не тільки первинним інфарктом мозочку, а й діашизом, що обумовлює більш серйозний неврологічний дефіцит. Перехресно­мозочковий діашиз асоціюється не тільки з характерними симптомами ураження мозочку, але й парезом кінцівок, порушеннями чутливості та вищих функцій мозку.

Purpose of the ReviewStent retrievers and large-bore aspiration catheters have doubled substantial reperfusion rates compared to first-generation devices. This has been accompanied by a 3-fold reduction in procedural time to revascularization. To measure future thrombectomy improvements, new benchmarks for technical efficacy are needed. This review summarizes the recent literature concerning biomarkers of procedural success and harm and highlights future directions.Recent FindingsExpanded Treatment in Cerebral Ischemia (eTICI), which incorporates scores for greater levels of reperfusion, improves outcome prediction. Core laboratory–adjudicated studies show that outcomes following eTICI 2c (90%–99% reperfusion) are superior to eTICI 2b50 and nearly equivalent to eTICI 3. Moreover, eTICI 2c improves scale reliability. Studies also confirm the importance of rapid revascularization, whether measured as first pass effect or procedural duration under 30 minutes. Distal embolization is a complication that impedes the extent and speed of revascularization, but few studies have reported its per-pass occurrence. Distal embolization and emboli to new territory should be measured after each thrombectomy maneuver. Collaterals have been shown to be an important modifier of thrombectomy benefit. A drawback of the currently accepted collateral grading scale is that it does not discriminate among the broad spectrum of partial collateralization. Important questions that require investigation include reasons for failed revascularization, the utility of a global Treatment in Cerebral Ischemia scale, and the optimal grading system for vertebrobasilar occlusions.SummaryEmerging data support a lead technical efficacy endpoint that combines the extent and speed of reperfusion. Efforts are needed to better characterize angiographic measures of treatment harm and of collateralization.

Background and ObjectivesNew imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke.Methods and ResultsThis article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in patients with acute stroke based on thrombus characteristics.DiscussionThrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.

The paper deals with the basic pathogenic mechanisms of thrombosis development both arterial and venous in patients with COVID-19. These patients developed critical complications in cases of vascular risk factors that significantly enhances the risk of occurrence of such vascular events as acute ischemic stroke. The thrombophilia mechanism in a patient with COVID-19 disease turns on the direct activation of coagulation, so antiplatelet drugs cannot prevent the development of thrombosis while the vascular risk factors and prominent inflammatory reaction cause vascular events. The optimization of antiplatelet therapy in patients with COVID-19 disease with vascular risk factors is relevant. Triflusal is an antiplatelet drug with the best characteristics for the treatment of these patients., В статье освещены основные патогенетические механизмы развития тромбозов, как артериальных, так и венозных, у пациентов с COVID-19. Осложнения, которые развиваются у таких пациентов, имеют крайне важное значение в случаях наличия сосудистых факторов риска, что значимо повышает риски развития таких сосудистых событий, как острый ишемический инсульт. Механизм тромбофилии у больного COVID-19 включает прямую активацию факторов свертывания крови, поэтому антитромбоцитарные препараты не в состоянии предотвратить развитие тромбозов, тогда как сосудистые факторы риска и выраженная воспалительная реакция вызывают развитие сосудистых событий. Актуальной является оптимизация антитромботической терапии у пациентов с COVID-19 с сосудистыми факторами риска. Трифлузал — антитромбоцитарный препарат, имеющий наилучшие характеристики для таких пациентов., У статті висвітлені основні патогенетичні механізми розвитку тромбозів, як артеріальних, так і венозних, у пацієнтів з COVID-19. Ускладнення, що розвиваються у таких пациентів, мають вкрай важливе значення у випадку наявності судинних факторів ризику, що значуще підвищує ризик розвитку таких судинних подій, як гострий ішемічний інсульт. Механізм тромбофілії у хворих на COVID-19 включає пряму активацію факторів згортання крові, тому антитромбоцитарні препарати не в змозі запобігти розвитку тромбозів, тоді як судинні фактори ризику та виражена запальна реакція викликають розвиток судинних подій. Актуальною є оптимізація антитромботичної терапії у пацієнтів з COVID-19 із судинними факторами ризику. Трифлузал — антитромбоцитарний препарат, що має найкращі характеристики для таких пацієнтів.

Objective: The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Background: Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. Method: Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption—the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. Results: Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard–related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. Conclusion: Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.

BackgroundNon-interventional large-scale research on real-world patients who had a stroke requires the use of multiple data sources ensuring access to longitudinal data from large populations with clinically-detailed information. We sought to establish a framework for longitudinal research on patients hospitalised with stroke by linking information-rich, deidentified inpatient data from the Paul Coverdell National Acute Stroke Program (PCNASP) to commercial and Medicare Advantage longitudinal claims data.MethodsAll stroke admissions in PCNASP between 2008 and 2015 were evaluated for linkage to longitudinal claims from a commercial insurer using an algorithm based on six available common data fields (patient age, gender, admission date, discharge date, discharge diagnosis and state) and a hospital match. We evaluated the linkage quality (via the percentage of unique records in the linked dataset) and the representativeness of the linked population. We also described medical history, stroke severity and patterns of medication use among the PCNASP-claims linked cohort.ResultsThe linkage produced uniqueness equal to 99.1%. We identified 5644 linked and 98 896 unlinked patients who had an ischaemic stroke hospitalisation in claims data. Linked patients were younger than unlinked (69.7 vs 72.5 years), but otherwise similar by medical history, prestroke medication use or lab values. Stroke severity was mild and most patients were discharged home. Prestroke and discharge use of antihypertensive and statins in the PCNASP were greater than their use as measured by filled prescriptions in claims.ConclusionsHigh-quality linkage between the PCNASP and commercial claims data is feasible. This linkage identified differences between reported or recommended versus actual out-of-hospital medication utilisation, highlighting the importance of longitudinal data availability for research aimed to improve the care of patients who had a stroke.

Background and purpose Multiple embolic sources are sometimes observed simultaneously in patients with embolic stroke. The present study investigated the effects of coexisting aortic arch atheroma ≥ 4 mm thick and atrial fibrillation (AF) on short-term stroke recurrence and functional outcome. Methods Transesophageal echocardiography (TEE) was performed in consecutive embolic stroke patients, and 395 patients were classified into 4 groups according to the presence of aortic arch atheroma ≥ 4 mm thick and AF: AF - /ARCH - group, AF + /ARCH - group, AF - /ARCH + group, and AF + /ARCH + group. In accordance with these 4 groups, we evaluated stroke recurrence and all-cause death for 3 months after stroke onset, and also evaluated the 3-month functional outcome using the modified Rankin scale (mRS). Results Among the 128 AF patients, 39.1% also had aortic arch atheroma ≥ 4 mm thick. Of the 395 enrolled cases, the AF + /ARCH + group showed the highest frequencies of stroke recurrence and all-cause death during 3 months after onset. On multivariate analysis, stroke recurrence or all-cause death during 3 months after onset was relatively more frequent in the AF + /ARCH + group than in the AF + /ARCH - group (OR, 2.34; 95% CI, 0.82-6.69; p = 0.11), but that was not statistically significant, and poor functional outcome (mRS score 3-6) at 3 months was significantly more frequent in the AF + /ARCH + group than in the AF + /ARCH - group (OR, 2.59; 95% CI, 1.08-6.24; p = 0.0339). Conclusions Aortic arch atheroma concomitant with AF is not rare and appears associated with increased risks of stroke recurrence and poor functional outcome.

Introduction: Stroke is one of the leading causes of death worldwide including Bangladesh. There are various modifiable and non-modifiable risk factors for stroke. Metabolic syndrome is an important factor amongst them. Objective: To determine the association of stroke with metabolic syndrome. Materials and Methods: This cross sectional study was carried out at Neurology Centre and Family Medical Ward of combined military hospital (CMH) Dhaka from July 2018 to December 2018. Total 100 admitted cases of acute stroke (both ischaemic and haemorrhagic) were enrolled. Diagnosis was confirmed by clinical examinations, relevant laboratory investigations and CT scan and/or MRI of brain. Verbal consent was obtained from patients or next of kin. Ethical issue was addressed. Data collection was done in a prescribed form by face to face interview, clinical findings and laboratory and imaging results. Statistical analysis was carried out by using SPSS v16.0. Chi square test was done to see the level of significance. Results: Hypertension (HTN) was found in 54.6% of haemorrhagic stroke and 45.5% of ischemic stroke. Diabetes Mellitus (DM) was present in 40% of ischaemic stroke and 32% of haemorrhagic stroke. Abdominal obesity was present in 13 haemorrhagic stroke and only 4 ischaemic stroke cases. Fasting hyperglycaemia was found in 20 haemorrhagic stroke and 30 ischaemic stroke cases. Hypertriglyceridaemia was found in 33 ischaemic stroke and 18 haemorrhagic stroke cases. Low high density lipoprotein cholesterol (HDL-C) was found in 30 ischaemic stroke and 15 haemorrhagic stroke patients. Total 53 patients fulfilled the criteria of metabolic syndrome and 21 of them had 4 elements like HTN, DM, high triglyceride (TG), low HDL-C. Metabolic syndrome was present in 39 out of 54 ischaemic stroke and 14 out of 46 haemorrhagic strokes. There was significant association between metabolic syndrome and stroke especially in the ischaemic stroke (p value

Objectives: To assess degree and severity of depression To describe the symptomatic profile of depression Analyse the relation between depression and demographic, predisposing and precipitating factors. Materials and Methods: A cross-sectional study was done on 160 subjects chosen by random sampling technique from the Department of General Medicine of Saveetha Medical College and Hospital using Montgomery-Asberg Depression Rating Scale. Results: 68% of the cases with acute stroke was assessed and found to have depression according to Montgomery-Asberg Depression Rating Scale. Conclusion: Post-Stroke Depression is expected in patients diagnosed with acute stroke.

Introduction Infection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis. Patients and methods We searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality. Results 4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450). Discussion and conclusion Preventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.

Gastrointestinal dysfunction is one of the complications after stroke. If it is not treated in time, it will affect the rehabilitation process after stroke and reduce the quality of life of patients. In this study, we conducted a systematic review and meta-analysis of the reports on the treatment of gastrointestinal dysfunction after stroke with traditional Chinese medicine (TCM) in recent years to provide evidence for clinical diagnosis and treatment.The clinical randomized controlled trials (RCTs) published in Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Medline, and Web of Science databases from January 2010 to August 2021 were searched. After screening the qualified literatures, literature quality evaluation was performed. The software Stata 16.0 was used to analyze and compare the outcome indicators of TCM and conventional western medicine treatment, and the utility of TCM in the treatment of gastrointestinal disorders after stroke was comprehensively evaluated.A total of 16 studies were finally selected including a total of 1,589. Meta-analysis showed that TCM treatment of gastrointestinal disorders after stroke was more effective than conventional western medicine treatment [odds ratio (OR) =3.94; 95% confidence interval (CI): 2.63 to 5.89; P=0.000]. It was also shown that TCM can reduce the recovery time of bowel sounds and is superior to conventional western medicine [standard mean difference (SMD) =-1.92; 95% CI: -2.51 to -1.34; P=0.000]; reduce defecation and flatulence recovery time (SMD =-2.51; 95% CI: -3.41 to -1.61; P=0.000); increase gastrin level (SMD =0.80; 95% CI: 0.35 to 1.25; P=0.001); increase motilin level (SMD =2.27; 95% CI: 1.55 to 3.00; P=0.000); increase serum albumin level (SMD =0.72; 95% CI: 0.54 to 0.90; P=0.000); increase transferrin levels (SMD =1.11; 95% CI: 0.86 to 1.36; P=0.000); and it can increase serum prealbumin levels (SMD =1.50; 95% CI: 0.78 to 2.22; P=0.000).The use of TCM in the treatment of gastrointestinal dysfunction after stroke can effectively reduce symptoms, shorten the recovery time of bowel sounds, the first defecation and flatulence time, promote gastric motility and gastrointestinal hormone secretion, and improve the nutritional status of patients.

The incidence of stroke is increasing year by year, which seriously affects the quality of life of patients in the later period. At present, there is no clear evidence-based medical support for very early mobilization (VEM). Therefore, this study aims to systematically evaluate the effect of VEM intervention on patients with acute stroke in order to further understand the application value of VEM.The Cochrane Library, PubMed, Embase, Web of Science, CNKI, and other databases were searched for randomized controlled trials (RCTs) on the VEM of patients with acute stroke. The articles were screened according to the inclusion and exclusion criteria. Data was extracted and the quality of the studies was evaluated. Revman 5.3 software was used to analyze the impact of VEM on adverse events after stroke, the disability rate, bed-related complications, length of hospital stay, and ability of daily living.After screening, 8 studies reported on the efficacy of VEM intervention for stroke patients. After analysis, VEM had no significant relationship with adverse events [relative risk (RR): 1.18; 95% confidence interval (95% CI): 0.94-1.47], disability rates (RR: 1.05; 95% CI: 0.95-1.15), and bed-related complications (RR: 0.84; 95% CI: 0.66-1.06). VEM was related to length of hospital stay [mean difference (MD): -1.72; 95% CI: -2.63 to -0.81] and ability of daily living (MD: 4.97; 95% CI: 0.15-9.79).VEM can shorten the hospital stay and improve the activities of daily living of patients. Additionally, it will not increase the adverse events, bed-related complications, and disability rates of acute stroke patients, suggesting that VEM is safe and effective.

Background: Acute low back pain is one of the most common reasons for adults to see a physician. However, vertebral osteomyelitis (VO) is a rare condition, which mostly affects the lumbar spine. Lumbar spine MRI imaging is the diagnostic method of choice. If left untreated can lead to vertebral destruction or spinal abscess formation. Case: An 86-year-old man presented with a stroke to our facility, while undergoing therapy complained of excruciating low back pain that prevented him from undergoing therapy specially standing and walking. His vital signs were normal, and he was afebrile. Plain X-ray of the lower spine showed osteoarthritic changes. Patient was initially started on non-steroidal anti-inflammatory (NSAID) with no change in the severity of his low back pain. Lumbar vertebral spine magnetic resonance imaging (MRI) showed lumbar vertebral osteomyelitis. Initiation of IV antibiotics dramatically decreased the pain severity. Conclusion: Low back pain is common in the elderly population and responds effectively to NSAID. Persistence of low back pain in the presence of pathognomonic changes in the lumbar spine MRI indicate the presence of VO. Prompt treatment with empirical antibiotics is warranted.

INTRODUCTION Stroke is a leading cause of death and disability, with the administration of recombinant transcriptase-plasminogen activator (rtPA) improving outcomes in a time-dependent manner. Only 52.3% of eligible stroke patients at our institution received rtPA within 60 minutes of arrival. We aimed to improve the percentage of acute stroke patients receiving rtPA within 60 minutes of arrival at the emergency department (ED). METHODS This study presents results from the first year of a clinical practice improvement project that implemented quality improvement interventions. The primary outcome measure was percentage of acute ischaemic stroke patients receiving rtPA within 60 minutes of arrival at the ED. Secondary outcome measures included components of total door-to-needle (DTN) time and factors for delay to thrombolysis. Interventions were establishment of standardised acute stroke activation guidelines, screening question at ED registration, prehospital notification of stroke activation, public education, scripting for thrombolysis consent and easy access to equipment. RESULTS The percentage of patients thrombolysed within 60 minutes increased to 60.6% (p = 0.27), and DTN time decreased from 59 minutes to 54.5 minutes (p = 0.15). This was attributable to reduced door-to-physician time, door-to-imaging time and decision time, although the results were not significant. There was no significant increase in symptomatic intracranial haemorrhage or mortality secondary to stroke. Length of stay was significantly reduced by 1.5 days (p < 0.048). CONCLUSION The interventions resulted in an increasing but non-significant trend of acute stroke patients receiving thrombolysis within 60 minutes. Outcomes will be monitored for a longer duration to demonstrate trends and sustainability.

Background and Purpose: Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. Methods: In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. Results: From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (p < 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (p < 0.001). Conclusions: Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

En las ultimas décadas, el papel de la enfermería en el triaje y cribado de pacientes en los servicios de urgencias y emergencias, tanto en el entorno prehospitalario como sobre todo en los hospitales, es esencial e indiscutible. Con el objetivo de analizar el triaje realizado por enfermería para detectar los pacientes con ictus agudo, y llegado el caso mejorarlo, se ha realizado un estudio retrospectivo de las presentaciones cardinales del ictus, la escala del Instituto Nacional de la Salud de Estados Unidos, y la escala modificada de Rankin, aplicadas en el set del triaje por enfermería en el Hospital Universitario de Salamanca, durante el período comprendido entre los años 2016 y 2019, ambos inclusive. El total de historias clínicas analizadas ha sido de 1572. El análisis está centrado en la fiabilidad, evaluado por enfermería, de la presentación cardinal del ictus agudo, y de las dos escalas, frente a los algoritmos tradicionales rápidos de detección del ictus, en particular el método FAST, y la escala de Cincinnati. Nuestro estudio demuestra que son varias las presentaciones clínicas que escapan a las escalas rápidas, por lo que es esencial ampliar los métodos de triaje del ictus agudo realizados por enfermería, con el fin de evitar retardos en la detección y el tratamiento definitivo (enfermedad tiempo-dependiente). Así pues, la identificación ampliada de las presentaciónes cardinales, junto con el uso de escalas más detalladas aplicadas por enfermería entrenada, se muestran como herramientas muy útiles de detección del ictus agudo. In recent decades, the role of nursing in triage and screening of patients in emergency services, both in prehospital environment and especially in hospitals, is essential and indisputable. In order to analyze the triage carried out by nursing to detect patients with acute stroke, and if necessary improve it, a retrospective study was carried out of the cardinal presentations of stroke, the scale of the National Institute of Health of the United States, and the modified Rankin scale, applied in the nursing triage set at the Salamanca University Hospital, during the period between 2016 and 2019, both inclusive. The total number of clinical records analyzed was 1572. The analysis is focused on the reliability, evaluated by nursing, of the cardinal presentations of acute stroke, and of the two scales, compared to the traditional rapid algorithms for stroke detection, in particular the FAST method, and the Cincinnati scale. Our study shows that there are several clinical presentations that escape the rapid scales, so it is essential to expand the triage methods of acute stroke carried out by nursing, in order to avoid delays in detection and definitive treatment (time-dependent disease). Thus, the expanded identification of cardinal presentations, together with the use of more detailed scales applied by trained nurses, appear to be very useful tools for the detection of acute stroke.

The article discusses the use of mannitol in patients with acute stroke (AS). The features of treating edema, swelling of the brain and known complications with the use of mannitol in this category of patients are described. The experience of treatment of 416 acute stroke patients, most of which used mannitol (402 of 416 persons, 96.63 %), was presented. It has been found that electrolyte disturbances have often been observed in patients receiving mannitol infusion. In general, one or other type of electrolyte disturbances was detected in 73.9 % of cases (258 of 349 patients, who were treated for more than 7 days). The imbalance in the exchange of sodium and potassium was most common. As a result of review and analyzing own experience, a compromise solution to the problem of mannitol use in acute stroke patients is proposed.

Актуальність. Розлади водно-електролітного балансу, що виникають у хворих із гострим інсультом (ГІ), є однією з причин ускладнень його перебігу. У той же час розлади обміну фосфатів, особливо гіпофосфатемія (ГФЕ), часто залишаються поза увагою дослідників. Мета: вивчити особливості перебігу й результати лікування ГФЕ у хворих із гострим інсультом на тлі цукрового діабету (ЦД). Матеріали та методи. Проведено дослідження порушень обміну фосфатів у 346 хворих на ГІ, яких розподілили на групи: перша (основна) — хворі з ГІ на тлі ЦД (n = 104); друга (група порівняння) — хворі з ГІ без ЦД (n = 206); третя група — контрольна (n = 36). ГФЕ коригували введенням препарату D-фруктозо-1,6-дифосфату натрію (Езафосфіна) в дозі 1200–1500 мг/добу. Результати. Загалом різні види електролітних порушень спостерігали у 256 з 346 (73,98 %) пацієнтів із ГІ. ГФЕ (рівень фосфату менше від 0,8 ммоль/л) була виявлена у 19 хворих на ГІ із супутнім ЦД (21,83 %) та 3 хворих на ГІ без ЦД (4,68 %). Нормалізація показників рівня фосфатів сприяла покращенню стану пацієнтів та зменшенню кількості балів за шкалою NIHSS (з 12,8 до 7,0 у першій групі проти 12,9 до 10,1 у групі контролю, p < 0,05). Висновки. Порушення обміну фосфатів у хворих на ГІ на фоні супутнього ЦД виникають вірогідно частіше, ніж у хворих без ЦД (21,83 % проти 4,68 %, p < 0,01). Корекцію ГФЕ тяжкого ступеня доцільно проводити внутрішньовенним введенням препарату D-фруктозо-1,6-дифосфату натрію, що сприяє вірогідному зменшенню неврологічного дефіциту.

Background In some acute care trials, immediate informed consent is not possible, but deferred consent is often considered problematic. We investigated the opinions of patients, proxies, and physicians about deferred consent in an acute stroke trial to gain insight into its acceptability and effects. Methods Paper-based surveys were sent to patients who were randomly assigned in the Ultra-early Tranexamic Acid After Subarachnoid Hemorrhage (ULTRA) trial between 2015 and 2018 in two tertiary referral centers and to physicians of centers who agreed or declined to participate. The primary outcome measure was the proportion of respondents who agreed with deferral of consent in the ULTRA trial. Secondary outcomes included respondents’ preferred consent procedure for the ULTRA trial, the effect of deferred consent on trust in physicians and scientific research, and the willingness to participate in future research. Results Eighty-nine of 135 (66%) patients or proxies and 20 of 30 (67%) physicians completed the survey. Of these, 82 of 89 (92%) patients or proxies and 14 of 20 (70%) physicians agreed with deferral of consent in the ULTRA trial. When asked for their preferred consent procedure for the ULTRA trial, 31 of 89 (35%) patients or proxies indicated deferred consent, 15 of 89 (17%) preferred immediate informed consent, and 32 of 89 (36%) had no preference. None of the patients’ or proxies’ trust in physicians or scientific research had decreased because of the deferred consent procedure. Willingness to participate in future studies remained the same or increased in 84 of 89 (94%) patients or proxies. Conclusions A large majority of the surveyed patients and proxies and a somewhat smaller majority of the surveyed physicians agreed with deferred consent in the ULTRA trial. Deferred consent may enable acute care trials in an acceptable manner without decreasing trust in medicine. Future research should investigate factors facilitating the responsible use of deferred consent, such as in-depth interviews, to study the minority of participants who agreed with deferred consent but still preferred immediate informed consent.

Актуальность. Острый инсульт (ОИ) остается одной из главных проблем со здоровьем для женщин во всем мире. Среди факторов риска ОИ у женщин выделяют возраст, расу, курение, пониженную физическую активность, сахарный диабет (СД) и другие нарушения углеводного обмена. Цель: проанализировать особенности возникновения нарушений углеводного обмена у женщин, больных ОИ, и усовершенствовать схему диагностики этих нарушений. Материалы и методы. Про­анализировано 416 историй болезни пациентов, перенесших ОИ, путем изучения паспортных и анамнестических данных, объективного обследования, лабораторных и инструментальных методов исследования. По результатам этого анализа была создана схема выявления СД и других форм нарушений углеводного обмена у больных ОИ. На втором этапе были обследованы 346 пациентов, распределенных на три группы: 1-я — основная группа — больные с ОИ на фоне СД; 2-я — больные с состояниями предиабета (гипергликемия натощак, постпрандиальная гипергликемия, транзиторная (стрессовая) гипергликемия); 3-я — больные без СД. Больные представленных групп не отличались между собой по основным антропометрическим и клинико-инструментальным характеристикам. Результаты. Различные формы нарушений углеводного обмена у пациентов с ОИ встречались у 227 больных из 346, вошедших в группы исследования (65,6 % случаев). У женщин нарушения углеводного обмена выявлялись несколько чаще — 118 больных из 171 (69,01 %), однако эта разница с мужчинами (109 пациентов, 62,28 %) не достигла уровня статистической достоверности (p > 0,05). У 29 (6,97 %) больных диагноз СД, несмотря на наличие клинической картины и изменений гликемии натощак, не был установлен, а гипергликемия у этих пациентов трактовалась как транзиторная и не была своевременно откорректирована. Выводы. Рутинное определение гликемии натощак недостаточно для выявления СД и других нарушений углеводного обмена у женщин на фоне ОИ. Уровень гликозилированного гемоглобина не дает полной картины о наличии заболевания, но полезен для оценки степени компенсации СД. Проведение орального глюкозотолерантного теста позволяет повысить качество диагностики и оптимизировать тактику лечения ОИ. Благодаря проведению этого теста было выявлено 16 новых случаев СД (среди которых было 8 женщин) и 28 больных (15 женщин) с другими нарушениями углеводного обмена.

Фибрилляция предсердий остается основной причиной развития острого нарушения мозгового кровообращения (ОНМК), которое является одной из основных причин смерти и тяжелой продолжительной нетрудоспособности. Продолжается поиск препаратов, способных предупредить повреждение тканей головного мозга и улучшить восстановление после ОНМК. Целью работы было определение изменения функционального состояния эндотелия сосудов, уровня С-реактивного протеина и когнитивных функций у пациентов с фибрилляцией предсердий и острым нарушением мозгового кровообращения под влиянием лечения цитиколином. По результатам исследования у всех пациентов с фибрилляцией предсердий и острым нарушением мозгового кровообращения определены нарушение эндотелиальной функции и когнитивные расстройства, а у 74 % больных установлено повышение уровня С-реактивного протеина. Назначение цитиколина в дозе 1000 мг в сутки способствовало достоверному улучшению функционального состояния эндотелия сосудов и снижению уровня С-реактивного протеина, что особенно важно в условиях острого нарушения мозгового кровообращения, поскольку может помочь в ограничении повреджения тканей на фоне ОНМК и улучшить прогноз у данной категории больных.

In contrast to the traditional definition of the disorder, many individuals with aphasia exhibit non-linguistic cognitive impairments, including executive control deficits. Classic lesion studies cite frontal lobe damage in executive dysfunction, but more recent lesion symptom-mapping studies in chronic aphasia present mixed results. In this study, we compared executive control abilities of acute stroke survivors with and without aphasia and investigated lesion correlates of linguistic and non-linguistic cognitive tasks. Twenty-nine participants with acute left hemisphere stroke resulting in aphasia (n = 14) or no aphasia (n = 15) completed clinical MRI and testing, including three NIH Toolbox Cognition Batteries (Pattern Comparison Processing Speed, Flanker Inhibitory Control and Attention, and Dimensional Change Card Sort Tests) and the Boston Naming Test. We compared performance between groups using Wilcoxon rank sum tests. We used Least Absolute Shrinkage and Selection Operator Regression to identify neural markers (percent regional damage, hypoperfusion within vascular territories, and total lesion volume) of executive control deficits and anomia. Group performance was comparable on the Pattern Comparison Processing Speed Test, but people with aphasia had poorer standard scores, lower accuracy, and slower response times on the Dimensional Change Card Sort Test than people without aphasia. Damage to extrasylvian regions (dorsolateral prefrontal cortex, intraparietal sulcus) was related to executive control deficits, whereas language network damage (to inferior frontal and superior and posterior middle temporal gyri) was linked to naming impairments. These results suggest people with aphasia can exhibit comorbid executive control impairments linked to damage outside classic language network areas. Supplementary Information The online version contains supplementary material available at 10.1007/s11682-021-00580-y.