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Recombinant tissue-plasminogen activator (rt-PA) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sICH). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sICH after rt-PA therapy. A total of 1007 patients (mean age, 72 ± 12 years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, 11.6 ± 5.6) with AIS treated with rt-PA were enrolled in this study during a 42-month period beginning in November 2007. Univariate and multivariate regression analyses were performed to estimate the predictors of IHM. Eighty-three of the 1007 patients (8.2%) died during hospitalization (mean duration of hospitalization, 10 ± 1.8 days). Logistic regression estimated the following independent predictors for IHM: age ≥80 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0; P = .031), aphasia (OR, 2.0; 95% CI, 1.1-3.4; P = .017), altered consciousness (OR, 3.6; 95% CI, 2.0-6.2; P < .001), hypertension (OR, 4; 95% CI, 1.4-11.6; P = 0.012), sICH (OR, 5.9; 95% CI, 2.9-11.9; P < 0.001), and pneumonia during hospitalization (OR, 3.0; 95% CI, 1.8-5.0; P < .001). After rt-PA therapy, 58 patients (5.8%) sustained sICH, 16 (28%) of whom died. Increased age (P = .008), higher NIHSS score (P = .011), and atrial fibrillation (P = .025) were correlated with sICH. The findings from this study may help clinicians estimate the prognosis and risk of sICH in patients with AIS treated with rt-PA., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Transient ischemic attack (TIA) is associated with high short-term risk of stroke, especially in the early phase following the event. Data about the impact of the early hospitalization in a stroke unit on patients with TIA are sparse. This study compares the prognostic impact of the stroke unit concept with conventional care on patients with TIA., Methods: During a 30-month period (beginning April 2005), 878 patients (mean age, 70±12years; 44.3% female) with TIA admitted within 24h of symptom onset were prospectively evaluated. The adjusted logistic regression analyses were used to estimate the odds ratio for the stroke risk during hospitalization and the 90-day mortality., Results: Of 878 patients, 591 (67.3%) were treated in the stroke unit, and 287 (32.7%) underwent conventional care. Patients receiving stroke-unit care had significantly higher rates of cranial computed tomography (96.3% vs. 88.1%; P<.001) and brain-supplying artery ultrasound (97.1% vs. 91.3%; P<.001) investigations. The stroke risk during hospitalization was 1.7% in patients treated in stroke unit and 2.4% in patients received a conventional care. A relevant difference between the groups was not found (1.7% vs. 2.4%; P=.45). The 90-day mortality rate was 1.7% in the stroke unit group compared to 2.2% in the conventional care group (1.7% vs. 2.2%; P=.66). The adjusted logistic regression analyses revealed no difference in stroke rates (odds ratio, 0.68; 95% confidence interval, 0.24-1.9) and in the 90-day mortality (odds ratio, 0.63; 95% confidence interval, 0.2-1.96) between the stroke unit concept and conventional care., Conclusion: The prognostic impact of the stroke unit care for patients with transient ischemic attack appears to be similar to that of the conventional care. Further randomized studies are needed to investigate the impact of stroke-unit care on patients with transient ischemic attack., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Microvascular imaging (MVI), a new ultrasound technology, is used to analyze brain perfusion at the patient's bedside. This study aims to evaluate the diagnostic and prognostic value of MVI in patients with acute ischemic stroke (AIS)., Methods: Nineteen patients suffering from AIS (mean age, 70.9 ± 12.2 years; 47% female; mean NIHSS-score, 12 ± 8) were investigated within the first 12 hours after symptom onset. We used the iU22 (Philips) system (S5-1 probe; low-mechanical index; depth, 13 cm), and 2 bolus injections of an ultrasound contrast agent (2.4 mL SonoVue per injection). The area of maximal perfusion deficit (AMPD) was compared with infarction on follow-up cranial computed tomography (CT) and NIHSS score 24 hours after stroke onset., Results: Of 19 patients, 15 patients (79%) had sufficient insonation conditions. Of these patients, 12 had infarctions. The sensitivity and specificity of detecting infarctions with ultrasound perfusion imaging were 91% and 67%, respectively. A significant correlation existed between the AMPD and NIHSS score at 24 hours after symptom onset (P= .023), and with occlusion of the internal carotid artery (P= .005)., Conclusion: Performing bedside MVI in the early phase of AIS provides information on brain parenchyma perfusion and prognosis of AIS., (Copyright © 2012 by the American Society of Neuroimaging.)

Introduction: According to the most recent definition of transient ischemic attack (TIA) and the recommendations of the American Heart Association, magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) is considered a mandatory tool in evaluating and treating patients with TIA. This study aims to determine the incidence of TIA-related acute infarction, identify the independent predictors of acute infarction, and investigate the correlation between acute infarction detected by DWI-MRI and stroke risk during hospitalization., Methods: Over a 36-month period (starting November 2007), all TIA patients (symptom duration of <24 h) who were admitted to hospital within 48 h of symptom onset and who underwent DWI-MRI were included in this population-based prospective study. The incidence of acute infarction, clinical predictors, and association with stroke recurrence during hospitalization were studied., Results: Of 1,910 patients (mean age, 66.7 ± 13 years; 46 % women), 1,862 met the inclusion criteria. A TIA-related acute infarction was detected in 206 patients (11.1 %). Several independent predictors were identified with logistic regression analysis: motor weakness [odds ratio (OR), 1.5], aphasia (OR, 1.6), National Institutes of Health Stroke Scale (NIHSS) score of ≥10 at admission (OR, 3.2), and hyperlipidemia (OR, 0.6). Of 24 patients (1.3 %) who suffered a stroke during hospitalization (mean, 6 ± 4 days), five had positive DWI. Stroke rate during hospitalization was nonsignificantly higher in patients with positive DWI than those with negative DWI (2.4 vs 1.1 %, respectively; P = 0.12)., Conclusion: The evidence of acute infarction by DWI-MRI in TIA patients was detected in 11.1 % of patients and associated with motor weakness, aphasia, and NIHSS score of ≥10 at admission.

Background and Purpose: The risk of a stroke after a transient ischemic attack (TIA) is high in the short time following a TIA. The German Stroke Society recommends an early hospitalization of patients with TIA preferably in a stroke unit (SU). This study aims to compare the impact of SU care with conventional care (CC) in patients with TIA., Methods: In a prospective study, during a 36-month phase (starting November 2007), patients with TIA who were admitted to the hospital within 48 h of symptom onset were enrolled. Stroke rate during hospitalization and the 90-day rates of stroke and mortality were studied. Logistic regression analyses were used to estimate the odds ratio (OR)., Results: Of 2,200 patients (mean age, 17.6 ± 12 years, 49% female), 1,347 (61%) treated in a SU and 853 (39%) received CC at general departments. Patients treated in SU were significantly younger than those received a CC (69.9 vs. 71.7 years; P = 0.001). TIA patients treated on SU received more ultrasound investigations of the neck arteries (98 vs. 96%; P = 0.003) and of the brain arteries (97 vs. 82%; P < 0.001) than those of CC. The primary outcomes (stroke during hospitalization, stroke after 90 days, and mortality after 90 days) did not show a difference between the SU and CC groups. In patients of male sex, the 90-day stroke rate was significantly lower in the SU group than the CC group (1.8 vs. 4.5%; P = 0.033). Using the adjusted logistic regression analysis, treatment in a SU revealed a reduction of 90-day stroke rate in patients of male sex (OR 0.38; 95% CI 0.15-0.95; P = 0.04)., Conclusion: The impact of evaluation and treatment of patients with TIA in SU and CC appears to differ only among patients of male sex. Further randomized trials are necessary.

Research on infarct detection by noncontrast cranial computed tomography (CCT) in patients with transient ischemic attack (TIA) is sparse. However, the aims of this study are to determine the frequency of new infarcts in patients with TIA, to evaluate the independent predictors of infarct detection, and to investigate the association between a new infarct and early short-term risk of stroke during hospitalization. We prospectively evaluated 1533 consecutive patients (mean age, 75.3 ± 11 years; 54% female; mean National Institutes of Health Stroke Scale [NIHSS] score, 1.7 ± 2.9) with TIA who were admitted to hospital within 48 h of symptom onset. A new infarct was detected by CCT in 47 (3.1%) of the 1533 patients. During hospitalization, 17 patients suffered a stroke. Multivariate logistic regression analysis revealed the following independent predictors for infarct detection: NIHSS score ≥10 (odds ratio [OR], 4.8), time to CCT assessment >6 h (OR 2.2), and diabetes (OR 2.3). The evidence of a new infarct was not associated with the risk of stroke after TIA. The frequency of a new infarct in patients with TIA using CCT is low. The use of the CCT tool to predict the stroke risk during hospitalization in patients with TIA is found to be inappropriate. The estimated clinical predictors are easy to use and may help clinicians in the TIA work up.

Background: Transient ischemic attack (TIA) is a marker of stroke, especially in the early phase following this event. The aims of this study are to determine the short-term risk of stroke and to evaluate the independent predictors of stroke in patients with TIA who are hospitalized within 48 hours after symptom onset., Methods: During a 36-month period (beginning in November 2007), 3554 patients (mean age: 70.5 ± 13 years; 49.9% female; mean NIHSS score: 1.4 ± 2.5) from 15 hospitals suffering from TIA were prospectively evaluated., Results: Of the 3554 patients, 43 (1.2%) suffered from stroke during hospitalization (6.5 ± 4.3 days). We identified the following independent predictors for stroke after TIA: male sex (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3-5; P=0.008), age ≥65 years (OR, 4.7; 95% CI, 1.4-15; P=0.01), hyperlipidemia (OR, 2.4; 95% CI, 1.2-4.8; P=0.015), and dysarthria (OR, 2; 95% CI, 1.1-5.0; P=0.038)., Conclusion: Patient characteristics (male sex, age, and hyperlipidemia) and TIA symptom (dysarthria) may be useful in defining stroke after TIA in patients who were hospitalized with TIA., (Copyright © 2011 Elsevier B.V. All rights reserved.)