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PurposeThe CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance.MethodsA custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%.ResultsA total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8 vs 38.9% p

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2007.00192.x Byline: M. Fareed K. Suri (1), Mustapha A. Ezzeddine (1), Kamakshi Lakshminarayan (1), Afshin A. Divani (1), Adnan I. Qureshi (1) Keywords: Carotid stenosis; screening Abstract: ABSTRACT BACKGROUND Identification of significant asymptomatic carotid artery stenosis (ACAS) is important because of potential stroke-risk reduction offered by carotid endarterectomy. We present an external validation of two previously developed scoring schemes designed to identify patients with ACAS. METHODS We used the data from the Cardiovascular Health Study (CHS)-a cohort study of cardiovascular risk factors, for external validation. Carotid Doppler ultrasound was performed in study participants. Two grading schemes, which used age more than 65 years, current smoking, and history of coronary artery disease and hyperlipidemia as predictors for ACAS, were validated using this dataset. RESULTS A total of 5,449 persons (mean age 72 [+ or -] 5 years; 42% men; and 84% white) were screened. The overall prevalence of ACAS of [greater than or equal to]50% was 4.2%. The prevalence of ACAS in the highest risk category was 19% in both stratification schemes. The stratification remained effective in the white sub-population (P < .001), but was not significant in the African American population (P > .05). CONCLUSION Both schemes were effective in identifying persons with ACAS among general population aged 65 years or greater. A subset with a prevalence of ACAS of greater than 20% can be identified using these schemes making screening cost-effective among white population. Author Affiliation: (1)From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, Minnesota (MFKS, KL, AAD, AIQ); and Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (MAE, AIQ) Article History: Acceptance: Received June 10, 2007, and in revised form xxxx xx xxxx, 2007. Accepted for publication August 23, 2007. Article note: Correspondence: Address correspondence to M. Fareed K. Suri, MD, Department of Neurology MMC 295, 420 Delaware Ave, Minneapolis, MN 55455. E-mail: suri0027@umn.edu.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2007.00185.x Byline: Adnan I. Qureshi (1), Haitham M. Hussein (1), Nazli Janjua (1), Pansy Harris-Lane (1), Mustapha A. Ezzeddine (1) Keywords: Eptifibatide; clinical trial; reteplase; ischemic stroke; platelet inhibitors; computed tomographic scan Abstract: ABSTRACT BACKGROUND AND PURPOSE Early use of intravenous platelet glycoprotein IIB/IIIA antagonists after intra-arterial (IA) thrombolysis may reduce the risk of reocclusion and microvascular compromise. METHODS We performed a retrospective study to determine the in-hospital outcomes using serial neurological evaluations and imaging among patients treated with intravenous eptifibatide administered as a 135 microg/kg single-dose bolus, followed by 0.5 microg/kg/min infusions for 20 to 24 hours following treatment with IA reteplase. RESULTS Twenty patients were treated (mean age [+ or -] standard deviation, 68.4 [+ or -] 14.5 years; median National Institutes of Health Stroke Scale [NIHSS] score was 17). The dose of reteplase ranged from 0.5 to 4 units. Eleven patients demonstrated early neurological improvement, defined as a decline of [greater than or equal to]4 points on the 24 hours NIHSS score compared with initial NIHSS score; neurological deterioration, defined as an increase of [greater than or equal to]4 points on the 24 hours NIHSS score as compared with initial NIHSS score, was observed in one patient. Two asymptomatic intracerebral hemorrhages were observed while no symptomatic hemorrhages were observed on serial computed tomographic scans. CONCLUSIONS The use of intravenous eptifibatide within 24 hours in selected patients after IA thrombolysis is feasible and safe. Further studies are required to determine the benefit of early use of intravenous eptifibatide following thrombolysis. Author Affiliation: (1)Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, and Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ. Article History: Acceptance: Received September 15, 2006, and in revised form March 18, 2007; July 7, 2007. Accepted for publication July 11, 2007. Article note: Correspondence: Address correspondence to Adnan I. Qureshi, MD, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455. E-mail: aiqureshi@hotmail.com.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2007.00161.x Byline: Gustavo J. Rodriguez (1), Abu Nasar (1), M. Fareed K. Suri (1), Mustapha A. Ezzeddine (1), Adnan I. Qureshi (1) Keywords: Neuroimaging; neurological emergencies; acute stroke; seizure Abstract: ABSTRACT OBJECTIVE To report the current national utilization of neuroimaging in the emergency department for the two most common neurological emergencies; stroke and seizure. METHODS Patients were identified using primary International Classification of Diseases (ICD)-9-CM codes from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is designed to collect data on the utilization and provision of care in emergency departments of hospitals in the United States. We analyzed the use of neuroimaging in patients presenting to the emergency department with seizure or stroke. RESULTS About 60% of 1,190,219 patients with the diagnosis of stroke or seizure had neuroimaging performed emergently. Patients with any type of stroke were more likely to undergo neuroimaging compared to patients with seizure (78% vs. 37%, P < .05). When stroke subtypes were analyzed separately, neuroimaging was performed in the emergency department among 100% of patients with subarachnoid hemorrhage, 79% with ischemic stroke, and 69% with intracerebral hemorrhage. CONCLUSIONS In a nationally representative study, emergent neuroimaging appeared to be underutilized among patients with ischemic stroke and intracerebral hemorrhage. There is a need to increase the utilization of neuroimaging in the emergency department in anticipation of new acute stroke treatments. Author Affiliation: (1)From the Zeenat Qureshi Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN (GJR, MFKS, MAE, AIQ); and Department of Surgery, Columbia University Medical Center, New York, NY (AN) Article History: Acceptance: Received January 15, 2007, and in revised form January 15, 2007. Accepted for publication January 15, 2007. Article note: Correspondence: Address correspondence to Gustavo Jose Rodriguez, MD, Neurology Department, University of Minnesota, MMC 295, 420 Delaware SE, Minneapolis, MN 55455. E-mail: rodri218@umn.edu.

A comparison of accuracy between Multimodal magnetic resonance imaging (MRI) and Noncontrast computed tomography (CT) for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms is described. It is found that MRI is more accurate than CT for detection of chronic intracerebral hemorrhage.

Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score < 2 at discharge. Statistical analyses used univariate and multivariate logistic regression models. Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22%) of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03). After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7) of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.