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53. Similarities and Differences in Intracerebral Hemorrhage Risk Factors by Race/Ethnicity (P5.3-039)

Author

Kittner, Steven J., primary, Sekar, Padmini, additional, Sheth, Kevin N., additional, Comeau, Mary C., additional, Flaherty, Matthew L., additional, Testai, Fernando D., additional, Frankel, Michael R., additional, James, Michael L., additional, Sung, Gene, additional, Elkind, Mitchell S.V., additional, Worrall, Bradford B., additional, Kidwell, Chelsea S., additional, Gonzales, Nicole R., additional, Koch, Sebastian, additional, Hall, Christiana, additional, Birnbaum, Lee, additional, Mayson, Douglas, additional, Coull, Bruce M., additional, Malkoff, Marc, additional, Chong, Ji Y., additional, Coleman, Elisheva R., additional, Parikh, Gunjan, additional, Anderson, Christopher D., additional, McCauley, Jacob L., additional, Osborne, Jennifer, additional, Wethington, Misty, additional, Gilkerson, Lee A., additional, Behymer, Tyler P., additional, Moomaw, Charles J., additional, Rosand, Jonathan, additional, Langefeld, Carl D., additional, and Woo, Daniel, additional

Published
2019
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55. Paramedic utilization of Vision, Aphasia, Neglect (VAN) stroke severity scale in the prehospital setting predicts emergent large vessel occlusion stroke.

Author

Birnbaum, Lee, Wampler, David, Shadman, Arash, de Leonni Stanonik, Mateja, Patterson, Michele, Kidd, Emily, Tovar, Jeanette, Garza, Ashley, Blanchard, Bonnie, Slesnick, Lara, Blanchette, Adam, and Miramontes, David

Subjects
STROKE diagnosis, RESEARCH methodology evaluation, CHI-squared test, DESCRIPTIVE statistics, EMERGENCY medicine, LONGITUDINAL method
Abstract

background Numerous stroke severity scales have been published, but few have been studied with emergency medical services (EMS) in the prehospital setting. We studied the Vision, Aphasia, Neglect (VAN) stroke assessment scale in the prehospital setting for its simplicity to both teach and perform. This prospective prehospital cohort study was designed to validate the use and efficacy of VAN within our stroke systems of care, which includes multiple comprehensive stroke centers (CSCs) and EMS agencies. Methods The performances of VAN and the National Institutes of Health Stroke Scale (NIHSS) ≥6 for the presence of both emergent large vessel occlusion (ELVO) alone and ELVO or any intracranial hemorrhage (ICH) combined were reported with positive predictive value, sensitivity, negative predictive value, specificity, and overall accuracy. For subjects with intraparenchymal hemorrhage, volume was calculated based on the ABC/2 formula and the presence of intraventricular hemorrhage was recorded. results Both VAN and NIHSS ≥6 were significantly associated with ELVO alone and with ELVO or any ICH combined using χ² analysis. Overall, hospital NIHSS ≥6 performed better than prehospital VAN based on statistical measures. Of the 34 cases of intraparenchymal hemorrhage, mean±SD hemorrhage volumes were 2.5±4.0 mL for the five VAN- negative cases and 17.5±14.2 mL for the 29 VAN- positive cases. Conclusions Our VAN study adds to the published evidence that prehospital EMS scales can be effectively taught and implemented in stroke systems with multiple EMS agencies and CSCs. In addition to ELVO, prehospital scales such as VAN may also serve as an effective ICH bypass tool. [ABSTRACT FROM AUTHOR]

Published
2021
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56. Effect of Hyperosmolar Therapy on Outcome following Spontaneous Intracerebral Hemorrhage: ERICH Study

Author

Shah, Manan, Birnbaum, Lee, Rasmussen, Jennifer, Sekar, Padmini, Moomaw, Charles J., Osborne, Jennifer, Vashkevich, Anastasia, and Woo, Daniel

Subjects
Adult, Male, Saline Solution, Hypertonic, Chi-Square Distribution, Time Factors, Databases, Factual, Osmolar Concentration, Racial Groups, Hispanic or Latino, Middle Aged, Article, United States, White People, Black or African American, Disability Evaluation, Treatment Outcome, Risk Factors, Fluid Therapy, Humans, Female, Glasgow Coma Scale, Mannitol, Propensity Score, Aged, Cerebral Hemorrhage
Abstract

We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study.Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), log-transformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions. ERICH subjects with a pre-ICH modified Rankin Scale (mRS) score of 3 or lower were included. Treated cases were matched 1:1 to untreated cases by the closest propensity score (difference ≤.15), gender, and race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic). The McNemar and the Wilcoxon signed-rank tests were used to compare 3-month mRS outcomes between the 2 groups. Good outcome was defined as a 3-month mRS score of 3 or lower.As of December 31, 2013, the ERICH study enrolled 2279 cases, of which 304 hyperosmolar-treated cases were matched to 304 untreated cases. Treated cases had worse outcome at 3 months compared with untreated cases (McNemar, P = .0326), and the mean 3-month mRS score was lower in the untreated group (Wilcoxon, P = .0174). Post hoc analysis revealed more brain edema, herniation, and death at discharge for treated cases.Hyperosmolar therapy was not associated with better 3-month mRS outcomes for ICH cases in the ERICH study. This finding likely resulted from greater hyperosmolar therapy use in patients with edema and herniation rather than those agents leading to worse outcomes. Further studies should be performed to determine if hyperosmolar agents are effective in preventing poor outcomes.

Published
2018

60. Abstract 75: Predictors of Poor Outcome After Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Author

Woo, Daniel, primary, Comeau, Mary, additional, Venema, Simone U, additional, Anderson, Christopher, additional, Flaherty, Matthew L, additional, Testai, Fernando D, additional, Kittner, Steven, additional, Frankel, Michael R, additional, James, Micahel L, additional, Sung, Gene, additional, Elkind, Mitchell S, additional, Worrall, Bradford B, additional, Kidwell, Chelsea S, additional, Gonzales, Nicole R, additional, Koch, Sebastian, additional, Hall, Christiana, additional, Birnbaum, Lee, additional, Mayson, Douglas, additional, Coull, Bruce M, additional, Malkoff, Marc, additional, Sheth, Kevin N, additional, Chong, Ji Y, additional, McCauley, Jacob L, additional, Osborne, Jennifer, additional, Wethington, Misty, additional, Gilkerson, Lee A, additional, Behymer, Tyler P, additional, Coleman, Elisheva R, additional, Sekar, Padmini, additional, Moomaw, Charles J, additional, Rosand, Jonathan, additional, and Langefeld, Carl D, additional

Published
2019
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62. Determinants of Poor Outcome after Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Author

Woo, Daniel, primary, Comeau, Mary E., additional, Uniken Venema, Simone M., additional, Anderson, Christopher D., additional, Flaherty, Matthew L., additional, Testai, Fernando D., additional, Kittner, Steven J, additional, Frankel, Michael R., additional, James, Michael L., additional, Sung, Gene, additional, Elkind, Mitchell S.V., additional, Worrall, Bradford B., additional, Kidwell, Chelsea S., additional, Gonzales, Nicole R., additional, Koch, Sebastian, additional, Hall, Christiana E., additional, Birnbaum, Lee, additional, Mayson, Douglas, additional, Coull, Bruce, additional, Malkoff, Marc D., additional, Sheth, Kevin N., additional, McCauley, Jacob L., additional, Osborne, Jennifer, additional, Wethington, Misty, additional, Gilkerson, Lee A., additional, Behymer, Tyler P., additional, Coleman, Elisheva R., additional, Sekar, Padmini, additional, Moomaw, Charles J., additional, Rosand, Jonathan, additional, and Langefeld, Carl D., additional

Published
2019
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74. Opportunities and challenges in secondary stroke prevention: a mixed methods study.

Author

White, Carole L., Cantu, Adelita, Motz, Deb, Patterson, Michele, Caron, Jean-Louis, and Birnbaum, Lee A.

Subjects
DISEASE relapse prevention, STROKE risk factors, STROKE prevention, ATTITUDE (Psychology), BLOOD pressure, CONTENT analysis, DRUGS, FOCUS groups, INTERVIEWING, RESEARCH methodology, MEDICAL personnel, PATIENT compliance, SELF-management (Psychology), THEMATIC analysis, SMARTPHONES, CROSS-sectional method, PATIENTS' attitudes, FAMILY attitudes, DESCRIPTIVE statistics
Abstract

Purpose: To describe control of risk factors after stroke from the perspectives of the stroke survivor, the family, and healthcare professionals. Materials and methods: A mixed methods design was used, undertaken in two phases: i) qualitative study using focus group methodology to explore secondary stroke prevention and ii) survey of stroke survivors about use of technology and self-management of blood pressure (BP). Results: From the eight focus groups (n = 33), three themes were identified: i) stroke is a wake-up call to do the right things; ii) challenges to doing the right things; and iii) role of technology in helping you to do the right things. Among survey respondents (n = 82), most participants reported mobile phone ownership (93%), mostly smartphones (66%), and >80% identified a greater role for technology in supporting management of risk factors. Participants who reported monitoring BP at home were significantly more likely to know their target BP than those not monitoring at home (83 vs. 42%; p < 0.001) and more adherent with medications (78 vs. 52%; p = 0.016). Conclusions: These findings highlight the ongoing challenges with achieving risk factor control after stroke and the potential to utilise health information technology to engage stroke survivors in self-management of their risk factors. Clinicians should be knowledgeable of the challenges that stroke survivors face in managing their risk factors after stroke and the role that they can play in providing tailored education. BP continues to be poorly controlled after stroke and there is opportunity for improvement. Stroke survivors and their families are receptive to using health information technology to support their risk factor control. Rehabilitation clinicians have an opportunity to incorporate different aspects of health information technology into their practice to support self-management of risk factors. [ABSTRACT FROM AUTHOR]

Published
2019
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76. Abstract TP385: Evolution of an Organized System of Care Positively Impacts Regional Stroke Treatment

Author

Motz, Deb, primary, Patterson, Michele, additional, Moore, Tracy, additional, Barrett, Diana, additional, Buford, Martha, additional, Baker, Cheryl, additional, Blanchette, Adam, additional, Hunt, Kassandra, additional, Widemon, Sonja, additional, Epley, Eric, additional, Love, Preston, additional, Birnbaum, Lee, additional, Miramontes, David, additional, Wampler, David, additional, Mcalpine, Candace, additional, Prentiss, Cheryl, additional, and Huey, Dicky, additional

Published
2017
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77. Delayed appearance of basilar trunk small atypical aneurysms in nontraumatic, initially angiogram-negative subarachnoid hemorrhage: A report of three patients

Author

Johnson, William C, Webb, Matthew R, Espinosa, Jonathan W, Birnbaum, Lee A, Rodriguez, Pavel, and Mascitelli, Justin R

Abstract

Background Repeat angiography will identify vascular pathology in approximately 10% of cases following angiogram-negative subarachnoid hemorrhage (anSAH), but small atypical aneurysms of the basilar artery are very uncommon.Objective To report a case series of delayed appearance of nontraumatic basilar artery small atypical aneurysms.Methods IRB approval was obtained for this retrospective case series and patient consent was waived.Results Herein we report three cases of spontaneous anSAH, all of whom had a negative digital subtraction angiogram (DSA) on admission and all of whom had appearance of a small atypical aneurysms of the upper basilar trunk/apex on follow-up imaging (two during the initial admission and one in a delayed fashion). All three patients were ultimately treated with flow diversion (although one patient underwent attempted coiling that was abandoned due to inability to catheterize the aneurysm).Conclusion This report highlights the importance of a repeat DSA in cases of anSAH as well as the importance of scrutinizing the basilar trunk for these very small atypical aneurysms that may go unnoticed.

Published
2024
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83. Isolated intracranial fibromuscular dysplasia presents as stroke in a 19-year-old female

Author

Birnbaum, Lee A., Sherry, Richard, and Pereira, Edgard

Subjects
fibromuscular dysplasia, caudate nucleus, cerebral angiography, angiografia cerebral, acidente vascular cerebral, núcleo caudado, stroke, displasia fibromuscular
Abstract

Isolated intracranial fibromuscular dysplasia is rare and may present with cerebrovascular events. It should be considered as etiology of stroke in otherwise healthy young patients. Though diagnosis is often challenging, characteristic morphologies may be revealed on magnetic resonance and catheter angiography. Cephalocervical fibromuscular dysplasia typically involves the extracranial portion of the internal carotid artery (nearly 95%). This rare case demonstrates isolated intracranial fibromuscular dysplasia in a 19-year-old female with left caudate and genu of internal capsule stroke. Displasia fibromuscular intracraniana isolada é rara e pode se apresentar como acidente vascular cerebral (AVC). Ela deve ser considerada como etiologia do AVC em paciente jovem saudável. Embora o seu diagnóstico possa ser um desafio, características morfológicas específicas podem ser reveladas através da angiografia através de ressonância nuclear magnética e por de catéter. A displasia fibromuscular envolvendo a circulação cérvico-cefálica afeta tipicamente a artéria carótida interna extracraniana (95%). O presente caso relata uma rara ocorrência de displasia fibromuscular intracraniana em uma jovem de 19 anos com infarto do núcleo caudado e joelho da cápsula interna à esquerda.

Published
2005

93. Abstract WP335: Closing the Gap - Development of a Regional Stroke System

Author

Sharp, Johanna, primary, Hunter-Alonzo, Melissa, additional, Blanchette, Adam, additional, Birnbaum, Lee, additional, Epley, Eric, additional, Lacson, Eleanor, additional, Leonard, Anne, additional, Love, Preston, additional, Motz, Deb, additional, Patterson, Michele, additional, Pruitt, Justin, additional, Wright, Brandi, additional, and Huey, Dicky, additional

Published
2013
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99. Abstract W MP93.

Author

Rasmussen, Jennifer, Birnbaum, Lee, Langefeld, Carl D, Brown, W. M, Moomaw, Charles J, Nanez, Esther, Vashkevich, Anastasia, Rosand, Jonathan, Kidwell, Chelsea S, Osborne, Jennifer, and Woo, Daniel

Published
2014

100. Abstract NS15.

Author

White, Carole L, Brady, Tracy L, Saucedo, Laura L, Motz, Deb, Sharp, Johanna A, and Birnbaum, Lee A

Published
2014

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