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Objective: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. Methods: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. Results: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. Conclusion: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death. [ABSTRACT FROM AUTHOR]

Background: Neurofibromatosis type 2 (NF2) is a multifaceted disease characterized primarily by benign CNS tumors, especially meningiomas and vestibular schwannomas. There have been several cases of brainstem ischemic stroke in young NF2 patients reported in the literature. To date, there is no unified theory about the connection between NF2 and pediatric stroke. Methods: We present a case of ischemia in the left cerebellar peduncle of a young patient with NF2, as well as a narrative review of the literature of previous cases. Results: Serial magnetic resonance images (MRIs) displayed an initial area of restricted diffusion in the left cerebellar peduncle with peripheral enhancement which did improve over several months, consistent with maturing infarct. Conclusions: Our case joins several others with similar presentations and findings. The primary theory for the cause of brainstem ischemia in juvenile NF2 is a microvascular cause due to deficiency of neurofibromin 2, a regulator of endothelial development. Multicenter studies with large NF2 cohorts are needed to better characterize this syndrome. [ABSTRACT FROM AUTHOR]

We report the case of a 51-year-old female with history of end stage renal disease on hemodialysis who presented with right hemiplegia and aphasia. On admission, head CT was negative for intracranial hemorrhage. MRI showed an area of acute infarct in the left parietal lobe. The patient received intravenous tissue plasminogen activator. Head CT 24 hours later showed areas of increased density in the left parietal and posterior temporal lobes. Contrast extravasation with superimposed intracranial hemorrhage could not be excluded. Therefore, antiplatelet therapy was held. A follow up CT scan demonstrated the same findings. Another head CT was obtained after hemodialysis showed resolution of the previously noted areas of increased density suggesting that contrast extravasation was the reason of increased density areas. [ABSTRACT FROM AUTHOR]

Optimization of time metrics in the management of acute stroke is a priority. Nurses with special training in stroke management may contribute to enhanced delivery of care. This study analyzes the effects of initiating a nurse-led stroke triage program at a regional stroke center on time metrics of acute stroke. In retrospective review, stroke metrics 25 months prior to the start of the triage program and 23 months after the start of the program were analyzed, including time from arrival to: emergency department assessment, neurologist assessment, head computed tomography (CT) scan, start of tissue plasminogen activator (tPA) administration, and puncture for mechanical thrombectomy. The study included 1,019 patients presenting with symptoms of acute stroke. Significant decrease was found between means for the time measures of arrival to emergency department (ED) physician assessment (pre-program: 6.2 minutes, post-program: 5.7 minutes, p= 0.0036), and CT start (pre-program: 21.3 minutes, post-program: 19.8 minutes, p= 0.0001). Time from arrival to ED physician assessment and CT start showed an increase in the proportion of cases meeting goal times: ED physician assessment increased from 82 percent to 84.4 percent of cases meeting the goal time (p= 0.3543), and CT start increased from 55.3 percent to 63.2 percent (p= 0.0481) of cases meeting the goal time. Significant increase was found between means for time from arrival to neurologist assessment (pre-program: 11.6 minutes, post-program: 17.1 minutes, p= 0.0015), and the proportion of cases meeting the goal time for arrival to neurologist assessment decreased (88.8 percent pre-program, 75.8 percent postprogram, p= <0.0001). No significant differences were found for times from arrival to tPA administration and mechanical thrombectomy, or between Modified Rankin Scores (mRS) at discharge. Certain time-sensitive metrics of acute stroke care were improved after implementation of the stroke nurse triage program, particularly those related to immediate patient assessment within the ED. Time metrics related to the direct administration of stroke therapies were unaffected, indicating the need for recognition of additional factors affecting timely stroke management. Incorporating specially trained stroke nurses in acute stroke management may be an important component in efforts to improve time metrics of acute stroke. [ABSTRACT FROM AUTHOR]

Painful post-traumatic trigeminal neuropathy (PTTN), or anesthesia dolorosa, is a condition on the same continuum as trigeminal neuralgia. Unlike trigeminal neuralgia, trigeminal neuropathy is a more significant state of neural pathology resulting in constant pain opposed to the episodic nature of trigeminal neuralgia. This typically occurs after facial trauma or as a complication from some treatments for trigeminal neuralgia. Useful diagnostic features that can help distinguish PTTN are an identified trauma to the nerve and other clinical features such as facial swelling. The presented case describes a classic presentation after third molar (wisdom tooth) removal and a review of pertinent literature. [ABSTRACT FROM AUTHOR]

Introduction: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota., Methods: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system., Results: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease., Conclusions: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death., (Copyright© South Dakota State Medical Association.)

Competing Interests: None

Background: Pompe's disease is a glycogen storage disease that manifests as progressive neuropathy, and myopathy. There are a few reports of vasculopathy in this disease, thought to be from small- and medium-vessel arteriopathy. We present a case of late-onset Pompe's disease with microhemorrhages and review of the pertinent literature., Methods: We describe a case of microhemorrhages in a patient with known late-onset Pompe's disease., Results: Our patient was noted to have numerous microhemorrhages concentrated in the posterior circulation distribution in what can best be described as central microhemorrhages, distinct from the pattern seen in amyloid angiopathy. Previous autopsy studies have found vacuoles in the vessel wall, resulting in small aneurysms as a part of the Pompe syndrome., Conclusions: There is an accumulating body of evidence that suggests cerebral vasculopathy as one of the primary manifestations of adult-onset Pompe's disease. This is manifested as dolichoectasia of basilar artery, aneurysms, and microhemorrhages that are central in distribution. The primary pathology is thought to be glycogen deposition in small- and medium-sized intracranial vessels. Controlling blood pressure aggressively and screening intracranial vascular imaging are recommended. Further definition of the syndrome is continuing from phenotypic and genotypic dimensions.